02 May Metabolic Surgery: Newer Paradigm in the treatment of Type 2 Diabetes
Metabolic Surgery: Newer Paradigm in the treatment of Type 2 Diabetes
“Metabolic Surgery” is the term used to describe surgical procedures specifically aimed at treating Type 2 Diabetes with or without causing a weight loss. According to IDF ( International Diabetic Federation) guidelines for Asians, most of metabolic surgeons will accept patients with Type 2 Diabetes and BMI (Body Mass Index) of 27.5Kg/m2 or greater for metabolic surgery.
Traditional 1st line treatment includes losing excess weight, eating a healthful diet, engaging in regular exercise; medications which help the pancreas produce more insulin or help the body to use the insulin that was produced efficiently. If these drugs don’t work, a person needs to take insulin.
Often these traditional treatments for diabetes do not work and patients run the risks of long term complications. Even with good medical control of diabetes, some patients still develop cardiovascular complications, diabetic foot, neuropathy and nephropathy, retinopathy and other complications.
According to the recent guidelines given by world Diabetes Associations (American Diabetic Association, International Diabetes Federation, Diabetes U.K.) Metabolic Surgery is recommended as the first line of treatment for Type 2 Diabetes in patients with BMI of > 37.5Kg/m2
After Metabolic surgery, remission is observed in the days to weeks before any substantial weight loss has occurred. Metabolic surgery cures Type 2 diabetes by causing calorie restriction, hormonal changes such as reduced Ghrelin, increased GLP1 and peptide YY. These hormones stimulate beta cells in pancreas to stimulate increased secretion of insulin, provided enough beta cell mass is still present in pancreas. Persistent increased GLP-1 secretion increases beta cell mass in the long term. These gastro intestinal hormonal changes cause control of diabetes within few days of the surgery.
Dr Amit Garg, Director CODSILS and Head of Bariatric and Metabolic Surgery department, Fortis Hospital, Mohali is one of the few surgeons in the region who has expertise in metabolic / diabetes surgery. Dr Amit Garg ( also known as best bariatric and metabolic surgeon in Punjab, India) designed a proper evaluation program. Before recommending any patient for metabolic surgery, evaluation of pancreatic Beta cell function is done to access Insulin secretion, Insulin Sensitivity and Insulin resistance. A type of metabolic procedure is chosen according to patients pancreatic beta cell function.