Do diabetics have an option other than making lifestyle changes and spending a lifetime on progressively increasing doses of insulin? The answer,according to two studies published in the New England Journal of Medicine (NEJM) on Wednesday,could lie in bariatric surgery commonly known as weight-loss surgery.
The studies show that the outcome for type 2 diabetes patients is better with gastric banding/ bypass surgeries than with medical management.
Doctors here are upbeat about the findings and cite data from their own studies to say that remission rates are high for type 2 diabetes,especially diseases which are less than 10 years old,so much so that there is a line of thinking now to preclude body mass index (BMI) as one of the eligibility criteria of bariatric surgery to replace it by uncontrolled diabetes.
Currently,the surgery is recommended for obese people with a BMI of at least 40,and for people with BMI 35 and coexisting medical conditions.
In the study by Dr Geltrude Mingrones team,diabetic patients on medical therapy were compared with those undergoing gastric bypass or biliopancreatic diversion. After two years no patients in the medical group had achieved remission whereas 75 per cent in the gastric bypass group and 95 per cent in the biliopancreatic diversion group had.
The team of Dr Philip R Schauer compared medical therapy with gastric bypass or sleeve gastrectomy. At the end of one year,12 per cent patients in the medical therapy group had achieved pre-set levels of glycaemic control against 42 per cent in the gastric bypass group and 37 per cent in the sleeve gastrectomy group.
The explanation for the phenomenon may lie in the incretin theory. Incretin is a hormone that facilitates insulin action. Food in stomach,duodenum and jejunum seems to trigger the release of a substance known as anti-incretin that competes with insulin for binding to incretin,thus lowering the ambient incretin levels.
Gastric bypass/banding shuts off those areas from the food so that insulin action is restored.
Studies by surgeons in India have had similar results. Dr Pradeep Chowbey,director of Max Minimal Access Metabolic and Bariatric Surgery,says his five-year study on diabetic patients with BMI of 27.5-32.5 seems to be throwing up astounding figures of 82 per cent remission rate. Our results along with those of NEJM are promising enough to recommend bariatric surgery as a treatment option to even non-obese patients, he says.
Dr Praveen Bhatia,chairman of Institute of Minimal Access Metabolic and Bariatric Surgery at Sir Ganga Ram Hospital,says,The best part is early surgery can prevent the diabetes collateral damages like retinopathy and nephropathy to a very large extent.