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Can metabolic surgery help control diabetes in patients?

According to a doctor, metabolic/bariatric surgery includes operations like gastric bypass, sleeve gastrectomy and sleeve-plus procedures

metabolic surgery, metabolic surgery for diabetes, weight loss surgery, diabetes patients, surgery for weight loss, bariatric surgery, health, type 2 diabetes, indian express newsPatients who undergo metabolic surgery need to be under regular follow-up of an endocrinologist/diabetologist. (Photo: Getty/Thinkstock)

Diabetes is a life-altering disorder that requires a person to make lifestyle tweaks and dietary modifications. According to Dr Aparna Govil Bhasker, bariatric and laparoscopic surgeon, Saifee, Apollo Spectra, Namaha and Currae Hospitals, Mumbai, metabolic surgery (weight loss surgery) is one of the most effective ways to lose weight and manage type 2 diabetes. The doctor said the goals of diabetes treatment ultimately include control of blood sugars, blood pressure and cholesterol levels, delaying the appearance of complications of diabetes such as eye issues (retinopathy), kidney problems (nephropathy), peripheral neuropathy, heart disease etc., and to reduce mortality and better the quality of life.

“In recent years, weight loss has been established as an integral part of treatment for people with type 2 diabetes with obesity. Sustained weight loss is linked to sustained blood sugar control in the long term,” said Dr Aparna.

She added that losing up to 10 per cent of total body weight has many beneficial effects. For patients with diabetes, however, weight loss can be a challenge. Some anti-diabetic medications like insulin, sulfonylureas etc., can also lead to weight gain.

The role of metabolic surgery

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“The American Diabetes Association (ADA) has accepted and included [metabolic surgery] in the treatment algorithm of diabetes for the last 10 years,” the doctor said. She added that it can lead to sustained weight loss in patients with diabetes and obesity, and has a “significant impact” on type 2 diabetes.

“More than 90 per cent of patients experience improvement in blood sugar control along with the reduction in the need for diabetes medications. It also delays the onset of long-term complications of type 2 diabetes such as retinopathy, nephropathy, peripheral neuropathy and heart disease,” she said.

What is metabolic surgery?

According to the doctor, metabolic/bariatric surgery includes operations like gastric bypass, sleeve gastrectomy and sleeve-plus procedures.

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· Sleeve gastrectomy is a surgical operation, in which the stomach is divided vertically to create a narrow tubular stomach.

· Gastric bypass is where a pouch of the stomach is created and the small intestine is re-routed and joined to this pouch. Remaining stomach and first part of the small intestine is bypassed.

· Sleeve-plus procedures are when a sleeve gastrectomy is performed and different lengths of small intestines are bypassed and joined to the sleeved stomach.

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“Metabolic surgery leads to improvement in diabetes through weight dependent and weight independent mechanisms,” Dr Aparna explained, adding that weight independent mechanisms include the “incretin effect due to bypassing of the small intestine, increased levels of gastro-intestinal hormones like GLP1, GIP and PYY, decrease in the level of hunger hormone ‘ghrelin’, decreased insulin resistance, bile acid interactions, change in gut microbiota, and many others”.

The goals of diabetes treatment ultimately include control of blood sugars, blood pressure and cholesterol levels. (Photo: Getty/Thinkstock)

Who is eligible for metabolic surgery for diabetes?

“As per the guidelines of obesity and metabolic surgery society of India (OSSI):

* Bariatric/metabolic surgery should be considered for patients with a BMI ≥ 35 kg/m2, with/without presence of any obesity related comorbidity.
* For patients with a BMI ≥ 30 kg/m2, in presence of two or more obesity-related comorbidities.
* As a non-primary treatment option for patients with a BMI ≥ 27.5 kg/m2, with uncontrolled type 2 diabetes despite optimum medical management.

“Any bariatric/metabolic surgery for a patient with BMI < 27.5 kg/m2 should be strictly performed under experimental study protocol with prior ethics committee approval and informed consent. It should be considered as a treatment option for patients with central obesity with a waist circumference ≥ 80 cm in females and ≥ 90 cm in males along with type two diabetes and other obesity-related comorbidities,” the expert stated.

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She concluded by saying that metabolic/bariatric surgery is as safe as any other surgery, and that it is considered to be less risky than cardiac bypass surgery or surgery for esophageal cancer etc.

“Patients who undergo metabolic surgery need to be under regular follow-up of an endocrinologist/diabetologist and also the operating team. They must be regular with their medications and supplementation in order to avoid nutritional issues.”

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First published on: 29-11-2022 at 21:40 IST
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