Obesity and Diabetes: The Role of Bariatric Surgery in the Treatment of “Diabesity”
We are currently in the midst of two closely linked epidemics – Obesity & Diabetes. Diabetes type 2 or adult onset Diabetes accounts for 90% of cases of diabetes and is poised to become the next pandemic. 90% people with Diabetes type 2 are overweight or obese.
The international Diabetes federation has reported that the number of diabetic cases will increase from the present 246 million to 380 million by 2025. World Health Organization foresees that more than 80% of the new cases will be seen the impact of his pandemic as the Diabetes capital of world. Rapid urbanisation with faulty food and lifestyle associated with more abdominal fat in Asian population causes diabetes to occur earlier and at a lower body weight than in the west. This pandemic is poised to flood the world Health Care system unless something is done to control it.
Diabetes is an inexorably progressive disease leading to deterioration in multiple organs and body systems. It is the most common cause of coronary artery disease and heart attacks, stroke and paralysis, adult blindness, limb amputation and kidney failure.
Research and development in drugs for Diabetes have been taking place at a steady rate. The current therapies like insulin, drugs, diet & behaviour modification give a reasonable control but rarely give complete cure. Further these therapies do not prevent the micro vascular damage and complications associated with diabetes. At present diabetes remain incurable by medicines.
Improvement or cure of Diabetes after weight loss surgery showed a new ray of hope. Who would have thought it but conventional gastrointestinal surgery for morbid obesity showed dramatic improvement in type 2 diabetes resulting in normal blood glucose, HbA1C level and insulin levels with discontinuation of all anti diabetic medication. Not only that but the cure remained sustained for more than 10 yrs. This degree of control is far better than only reported therapies so far.
Besides with complete and sustained glycemic controls the progress of micro vascular damages like retinopathy, neuropathy, and nephropathy halts altering the course of disease completely. In type 1 diabetes associated with obesity there is marked decrease in insulin requirement after surgery. Apart from mechanical factors like limitations of calorie intake, delayed transit time from stomach to small intestine due to small gastric outlet and carbohydrate intake restriction, hormonal theory is scientifically more acceptable. Food bypasses the normally active antrum, duodenum, proximal jejunum and undigested food enters in the mid jejunum which results in to secretion of Glycogen like peptides and peptide YY levels which improve glucose metabolism.
The significant and sustained weight loss after surgery further help in controlling the disease for long time. Meta analysis involving 136 studies for a total of 22094 patients have shown that type 2 Diabetes was completely cured in 78.6% and improved in 86% of patients after bariatric surgery. More than 90% of patient who undergo surgery experience a complete and sustained cure of type 2 Diabetes especially when done early. A present Bariatric surgery is indicated in person with BMI more than 32 with diabetes for Indian population.
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