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Diabetes has become a silent epidemic among Indians. The country has the second-largest adult population suffering from the disease. As per the Indian Council of Medical Research (ICMR), there has been a 150 percent spike in diabetes cases over the past three decades. The apex medical research body also highlighted the increasing prevalence of type 2 diabetes among the younger age group of 25-34 years.
Since the disease has no cure in sight, it can only be managed well with necessary dietary changes and physical exercise. However, for the last few years, endocrinologists are also considering surgical correction of diabetes, popularly called diabetes surgery, especially for people who are not able to manage their diabetes well.
Wockhardt Hospital, Mumbai Central recently launched a Diabetes Surgery Clinic to provide better therapeutic care to diabetes patients in the country. Talking about the efficacy of diabetes surgery, Dr. Ramen Goel, Consultant Bariatric and Metabolic Surgeon, at Wockhardt Hospital, says that it offers diabetes patients freedom from painful daily needle pricks, insulin injections, and lifelong medications.
"Diabetes surgery is an effective treatment option for diabetes - almost all patients will either go into remission or will become well-controlled diabetics," says the expert.
In an exclusive interaction with the Healthsite, Dr Goel sheds more light on Diabetes Surgery. Given below are excerpts from the conversation:
Diabetes is called 'Rajrog' or a lifetime disease for a reason. One of the most dreaded illness, diabetes limits person's ability to lead a normal life, with dietary restrictions and requirement of time bound medicine consumption, regular blood sugar testing, etc.
Surgical correction of diabetes is now almost two decades old, and it is an accepted treatment option. This usually results in discontinuation of diabetes medicines within a week of surgery. Done through a keyhole/laparoscopic route in 30-40 minutes, majority of the diabetes patients can look forward to a healthy and carefree life gaining freedom from daily needle pricks for blood testing and/or insulin injections.
It is now believed that diabetes is the disease of intestines and pancreas get secondary affected. In diabetes surgery, re-routing of stomach and/or intestine is done which changes the gut hormones production. Enhanced production of these gut hormones like GLP-1 brings down the blood sugar levels.
Diabetic Surgery is generally recommended for people between 18-70 years age. A suitable candidate is one whose blood sugars are not well controlled (HbA1c of over 7 per cent) with medicines and has BMI of 27.5 or more.
There are two types of diabetes, Type 1 diabetes is the less common one (in ~10 per cent population). It usually happens in children and thus is also termed as Juvenile Diabetes. Because the problem is with the pancreas, the children need insulin right from the beginning. However, the common variety (in 80-90 per cent patients) is type 2 diabetes which is usually seen in adults. The primary problem is that the insulin produced by the pancreas is not effective/working, this is called insulin resistance. Thus, the muscle cells are not able to absorb the sugar from blood and hence blood sugars keep rising.
After diabetes surgery there is enhanced secretion of GLP-1 hormone from the intestine which reduces insulin resistance and thus body's own insulin becomes effective, and most persons will not require insulin or even tablets for sugar control.
Unlike tablet/insulin injections, which need to be taken daily for the whole life, diabetes surgery is a onetime intervention and diabetes can be reversed, depending on factors like duration of diabetes, pancreatic function, etc. which a diabetes surgeon will assess before offering surgery. It is established that the surgical response is better in those who get surgery done early as pancreatic function is still good. However even long-standing diabetics benefit from this surgery as well.
Diabetes surgery does not cure diabetes, but it is as good as a cure. Diabetes surgery is not only about blood sugar control but more so about avoiding diabetes related complications like heart attacks, brain strokes, kidney failures, blindness or nerve damages. It is now known that this surgery reduces such complications by 33 per cent 65 per cent.
During the conversation, Dr Goel shared with us the results of a successful diabetes surgery that he had performed this year.
A diabetes patient, Mukesh Panchal (name changed) approached Dr Goel at Wockhardt Hospital for diabetes surgery in Feb 2022. The 52-year man was suffering from diabetes for over 25 years and was receiving three insulin injections daily for 12 years besides consuming many tablets. Still his after-food blood sugar was 258 before he approached Dr Goel.
Within a week's time after undergoing diabetes surgery, all his diabetes medicines stopped, and he continues to have normal blood sugar levels even after 6 months, Dr Goel stated.
Type 1 Diabetes is believed to be an autoimmune disease in which the pancreas produces little or no insulin, the hormone that control blood sugar levels in the body.
In its guidelines ICMR noted that lifestyle management (LSM) is crucial in managing type 1 diabetes. It highlighted the need to maintain optimal blood pressure, weight, and lipid levels, and to provide adequate nutrition to children for prevention and management of diabetes.
People with type 1 diabetes may require insulin throughout life. The ICMR wants such patients to be careful while using it, citing some possible side effects related to insulin us, such Hypoglycemia, weight gain, and infection.
An optimal insulin dose, according to the health body, is one which will "achieve good glycemic control without frequent hypoglycemic episodes"
Further, the ICMR emphasized the importance of blood glucose in patients with type 1 diabetes for glycemic control.
If you want to reverse Type-2 diabetes, reduce carbohydrate intake to about 50-55 per cent of your total calorie intake and increase your protein intake to 20 per cent, say experts at Indian Council of Medical Research (ICMR) and India Diabetes (INDIAB).
An ongoing study by ICMR and INDIAB has highlighted high carbohydrate consumption as a major driving factor for the rapidly increasing diabetes burden in India. The study report has been published in the journal Diabetes Care.
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