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Bariatric surgery may help cure diabetes:-

In these days of take-one-get-one-free, a surgical procedure for curbing obesity too comes with a freebie. Get under the scalpel to get rid of excess fat and your diabetes will be gone, forever.

Independent experts say that they are not surprised by the finding, as being overweight or obese leads to diabetes and so when obesity is treated — surgically or otherwise — diabetes can also disappear, at least briefly. Normally, the beneficial effect lasts up to two years for those who undergo weight-loss surgery, commonly known as bariatric surgery.

The researchers — who did the study at Pune’s Ruby Hall Clinic — however, assert that there is an element of surprise in their findings. They found that the anti-diabetic mechanisms kicked in much before substantial weight loss had occurred. This means that the remission of diabetes did not happen just because the patients had their obesity problem under control, but something else. “It seems certain gastro-intestinal hormones are at play here,” says Shashank S. Shah, a bariatric surgeon at Ruby Hall Clinic, a co-author of the study.

The researchers — led by David E. Cummings, professor at the University of Washington School of Medicine, Seattle — also found that not just the obese, but thinner diabetics too can benefit from such surgery. The study was published in the latest issue of the journal Surgery for Obesity and Related Diseases.

India currently has more than 42 million known cases of diabetes. The numbers will, it is feared, shoot up to 59 million by 2025, according to the World Diabetes Foundation, a Denmark-based organisation.

The researchers used one of the most popular forms of bariatric surgery called gastro bypass surgery. The procedure makes the stomach smaller and allows food to bypass part of the small intestine. But as of now, only extremely obese people — who have a body mass index (BMI) of 40 kg/m2 (or a BMI of 35 with metabolic complications like diabetes) — are advised bariatric surgery.

The researchers chose 15 people — both men and women — in their forties who have been extremely diabetic for three to 13 years. Nearly 80 per cent of them were on insulin before the surgery was performed, while the rest were on oral medicines.

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Cummings says they chose people of Indian descent because of their higher risk of developing Type 2 diabetes at lower BMI levels than those of other ethnic communities such as Caucasians. According to the World Health Organisation, the BMI of overweight adult Indians is 23-25 kg/m2, while for the obese it could be more than 25 kg/m2. In the case of other populations, the latter value is more than 30 kg/m2. This is because for any given BMI, the body fat percentage is 3 to 5 per cent higher in Indians than in others. The subjects selected for the study had BMI values in the range of 22 to 35 kg/m2.

“Our patients had very high diabetes at the outset (with very high levels of blood sugar despite the use of anti-diabetes medicines). In spite of this, all of them experienced complete diabetes remission,” says Cummings. Moreover, the effect was very fast: 80 per cent of the patients had no evidence of diabetes by the first month following the surgery while the rest showed complete remission by three months, he adds. The duration of follow-up lasted another six months.

According to Cummings, the results were several notches better than reported elsewhere. On an average, bariatric surgeries conducted in the past reported diabetes remission in only 84 per cent of cases.

Another interesting finding that emerged from the study is that lean patients had better diabetes remission than those who were fatter.

Kesavadev Jothydev, who runs a specialist diabetes clinic in Thiruvananthapuram, Kerala, says that the results are not surprising. But bariatric surgery is a major process and entails several short and long-term risks. “When part of the gut is removed (or bypassed), absorption of some vitamins and minerals are permanently impaired. This requires lifelong supplementation,” he says.

Bariatric surgery may sound like an attractive option, but only to those who are lazy and do not want to shed the extra kilos through dieting and exercise. Jothydev fears that it may in the long run be misused if wrong messages are conveyed. “Currently, in India, bariatric surgery is permitted only for those with a BMI of more than 32.5 kg/m2,” says Anoop Misra, head of the department of diabetes and metabolic diseases, Fortis Hospitals, New Delhi. “Depending on weight loss, this procedure leads to a marked benefit in all diseases associated with obesity”.

Cummings, however, discounts the risks involved in bariatric surgery. “The operative risks of bariatric surgery have been decreasing steadily over the past several years, largely owing to progressively better and less invasive laparoscopic techniques,” he told KnowHow.

The researchers are now planning to conduct a larger study involving nearly 100 patients in four countries — India, Brazil, Chile and the US. “We would also try to ascertain the exact mechanism involved in diabetes remission,” says Shah.

However, one word of caution from the researchers: the process is recommend to only those who have exhausted other options of medication and lifestyle modification. “Bariatric surgery remains an aggressive intervention and it should be reserved for cases in which medical and behavioural strategies to control diabetes have proven ineffective,” warns Cummings.


Source
: The Telegraph (Kolkata, India)

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