Jahnavi Sarma
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Written By: Jahnavi Sarma | Published : October 31, 2020 7:12 PM IST
Gastric surgery, like gastric bypass surgery, helps control the weight of obese people. It also improves their glucose levels. Studies in the New England Journal of Medicine compared patients who were treated with medical interventions and surgery to those treated with just medications. In a study, patients who underwent surgical procedure exhibited better glucose control than patients who were just on medication. An endoscopic procedure developed by experts at Vanderbilt University significantly improved blood glucose levels in patients with type 2 diabetes. The minimally invasive endoscopic procedure resurfaces the uppermost part of the intestines, an area that some experts believe may become dysfunctional in diabetes patients.
According to researchers there is little doubt at this point that manipulation of the gut can improve glucose metabolism. But the big question here is why? Though the answer is not yet known, there are several theories that are floating around in scientific communities. One theory is that there's something in the first part of the intestine, right beyond the stomach, that becomes abnormal, probably as a reaction to food that's not good for you. The gut changes and starts to produce something that is bad for glucose metabolism. To counter this, experts recommend duodenal mucosal resurfacing, in which the damaged surface of the duodonem, that first part of the intestine, is sloughed off, allowing a healthy layer to regrow.
In the study, experts treated 39 patients with poorly controlled type 2 diabetes. The aim of the study was to learn the best way to do the procedure and also to demonstrate its safety. In the procedure, under sedation, an endoscope is passed into the duodenum, and saline is injected under the mucosal layer to separate it from the muscle. The tissue is then destroyed, sloughing off in a few days. Patients reported little discomfort after the procedure and there were no serious adverse events. Following the procedure, the patients had to be on a liquid diet for two weeks, and slowly worked their way up to solid food. They were told to go on a low-calorie diet, but there were no specific medication recommendations given.
Patients who had a >9 cm ablation and who remained on their diabetes medications had an average improvement in their HbA1c of 1.4 per cent at 6 months and saw a modest weight reduction of about five pounds. At 3 years, levels of HBA1c were 6 per cent or less in 38 per cent of patients in the gastric-bypass group compared with 5 per cent of the patients in the medical-therapy group. Also, the use of glucose-lowering medications, including insulin, was lower in the surgical group than in the medical-therapy group. Currently bariatric surgery is reserved for the obese, but because this is much less invasive and more minimal procedure, it could potentially be used in a broader group of people. You could argue that it could be useful for those who have really bad glucose control even on one or two medications, regardless of their weight.
(With inputs from Agencies)
