Diabetes vs. Insulin Resistance

Diabetes vs. Insulin Resistance: The Key Differences Explained

In today’s healthcare landscape, few conditions command as much attention as diabetes and insulin resistance.

These metabolic disorders are not just buzzwords; they disrupt blood sugar regulation and pose significant health risks if unmanaged, affecting millions worldwide. But while these terms are often mentioned together, they are not the same.

Understanding their differences is crucial for effective management and prevention.

What is Insulin Resistance?

Insulin resistance occurs when the body’s cells become less responsive to insulin, a hormone produced by the pancreas that plays a crucial role in regulating blood sugar levels. If your cells become too resistant to insulin, it leads to elevated blood glucose levels (hyperglycemia), which, over time, leads to prediabetes and Type 2 diabetes.

Common causes of insulin resistance include obesity, a sedentary lifestyle, and genetic predisposition. Excess fat, particularly around the abdomen, can contribute significantly to the development of this condition. This is because it releases inflammatory substances that interfere with insulin’s action.

By understanding the complexities of insulin resistance, individuals can take proactive steps to improve their health and prevent its consequences.

What is Diabetes?

Diabetes is a chronic condition, characterized by high blood sugar levels due to the body’s inability to produce or utilize insulin effectively. There are two main types of diabetes:

Type 1 Diabetes – Type 1 diabetes occurs when the pancreas produces little or no insulin, often due to an autoimmune reaction. This type is typically diagnosed in children and young adults.
Type 2 Diabetes – Type 2 diabetes is more common and develops when the body becomes resistant to insulin or when the pancreas fails to produce sufficient insulin.

The symptoms of diabetes can include excessive thirst, frequent urination, fatigue, and blurred vision. If not managed timely and properly, diabetes can lead to serious long-term complications, including cardiovascular diseases, kidney damage, and nerve issues.

Key Differences Between Diabetes and Insulin Resistance

Insulin resistance and diabetes are closely related. However, not everyone who is insulin resistant has diabetes, and not all people with diabetes are insulin resistant.

Both conditions are tied to your body’s ability to make or use insulin, a hormone that allows glucose to enter the body’s cells from the bloodstream to be used for energy. Listed below are the characteristics of both conditions to help you differentiate between insulin resistance and diabetes:

FEATURE	INSULIN RESISTANCE	DIABETES
*Definition*	In this condition, the cells become less responsive to insulin.	It is a chronic condition that develops when the body is not able to produce enough insulin, thereby causing a spike in blood sugar levels.
*Causes*	The risk factors involve obesity, a sedentary lifestyle, and genetics.	Type 1 diabetes is characterized as an autoimmune disorder, while type 2 diabetes is caused by obesity or insulin resistance.
*Symptoms*	The condition is often asymptomatic; however one can experience fatigue.	The condition may cause thirst, frequent urination, fatigue, and blurred vision.
*Diagnosis*	Blood tests (e.g., fasting insulin, glucose tolerance test)	Blood sugar tests (e.g., HbA1c, fasting glucose)
*Management*	The condition can be managed by modifying lifestyle and through medications (e.g., metformin)	People with diabetes need to manage their blood sugar levels with diet, exercise, and sometimes insulin therapy.

Understanding these differences can help individuals identify their condition and seek appropriate medical guidance.

Impact on Health

The impact of diabetes and insulin resistance on health can be profound.

Insulin resistance is often a precursor to Type 2 diabetes, making its management crucial in preventing the condition. Both diabetes and insulin resistance increase the risk of several serious health complications. Individuals with diabetes may experience cardiovascular disease, nerve damage (neuropathy), kidney damage (nephropathy), and vision issues (retinopathy). Insulin resistance can also lead to similar complications if it progresses to diabetes.

Early detection and management of both conditions are vital to reducing these risks. Regular health check-ups, monitoring blood sugar levels, and lifestyle modifications can significantly impact overall health and quality of life.

How to Manage Insulin Resistance and Diabetes

Managing insulin resistance and diabetes involves a combination of lifestyle changes and, in some cases, medication. Here are actionable tips for individuals:

Dietary Changes: Focus on low-glycemic foods that help stabilize blood sugar levels. Incorporate whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables.
Regular Physical Activity: Engage in at least 150 minutes of moderate aerobic exercise per week. Physical activity improves insulin sensitivity and aids in weight management.
Monitoring: Regular check-ups with healthcare professionals and monitoring blood sugar levels are essential for effective management.
Medications: For insulin resistance, medications like metformin may be prescribed. For diabetes management, insulin therapy or other oral medications may be necessary depending on the type and severity.

These strategies can significantly improve health outcomes for individuals with insulin resistance and diabetes.

Prevention Strategies

Preventing insulin resistance and diabetes involves proactive lifestyle changes. Here are some effective strategies:

Maintain a Healthy Weight: Achieving and maintaining a healthy weight can significantly reduce the risk of developing insulin resistance and diabetes.
Eat a Balanced Diet: A diet rich in fibre, whole grains, and healthy fats can support overall health and stabilize blood sugar levels.
Engage in Regular Physical Activity: Regular exercise helps improve insulin sensitivity and supports weight management.
Stress Management: Techniques such as mindfulness, meditation, and yoga can help manage stress, which is beneficial for overall health.

Taking proactive steps towards a healthier lifestyle can play a crucial role in preventing these conditions.

Why Choose Diabetes Surgery in Delhi?

Delhi has emerged as an ideal destination for diabetes care, offering various specialized options for managing diabetes and insulin resistance. Here are some reasons to consider diabetes surgery in Delhi:

Top Hospitals and Clinics: The city boasts several leading hospitals and clinics dedicated to diabetes management, equipped with advanced technology and treatment options.
Expertise of Healthcare Professionals: Healthcare providers in Delhi have extensive experience in managing diabetes and insulin resistance, ensuring that patients receive the best possible care.
Comprehensive Treatment Options: From lifestyle interventions to surgical options, patients have access to a wide range of treatments tailored to their individual needs.

Choosing to undergo diabetes surgery in Delhi can lead to improved health outcomes and a better quality of life.

Choosing the Right Diabetes Surgeon in Delhi

Selecting the right diabetes surgeon is crucial for effective treatment. Here are some tips to help you find the best specialist:

Qualifications and Experience: Look for a surgeon with specific qualifications in diabetes management and a proven track record of successful outcomes.
Patient Reviews: Read patient testimonials and success stories to gauge the surgeon’s reputation and approach to care.
Approach to Treatment: Ensure the surgeon’s treatment philosophy aligns with your expectations and health goals. A collaborative approach to care can enhance the patient experience.

Finding the right surgeon can make a significant difference in your diabetes management journey.

Meet Prof. (Dr.) Atul N.C Peters: Expert in Diabetes Surgery in Delhi

Prof. (Dr.) Atul N.C. Peters is one of the leading bariatric surgeons. Having spent more than two decades in this field, he established the Department of Bariatric, Minimal Access, and Robotic Surgery at Max Smart Super Speciality Hospital, Saket, Delhi, India as a Center of Excellence (CoE).?

Metabolic surgery has proven to be a powerful intervention not only to manage type 2 diabetes but even to ‘cure’ the disease. The most recent studies amply show how, for 80% of the patients, complete remission of the disease is achieved after surgery. For the remaining 20%, metabolic surgery greatly improves their condition, reducing medication intake and the use of injectable insulin.?

It is noteworthy that metabolic surgery must only be conducted in specialized centers by experienced, specifically trained surgeons to ensure maximum benefits and fewer complications associated with the surgical procedure.?

Dr. Peters is a recognized figure around the world in the?medical field for his professionalism, commitment to care, and dedication toward his patients. He is acknowledged as a “Surgeon of Excellence” by the Surgical Review Corporation. He is established as a prominent leader in this specialty for performing successful metabolic surgery for diabetes in India.?

Conclusion

Diabetes and insulin resistance are connected yet distinct. By understanding the difference, you equip yourself—and others—with the knowledge to make informed choices, take proactive steps, and potentially prevent severe complications.

Consulting healthcare professionals for personalized advice can further empower individuals to take control of their health.

In this battle for better health, awareness is your most powerful weapon. So, stay informed, stay vigilant, and take control—because your health is worth it.

Frequently Asked Questions (FAQ)

Can insulin resistance lead to diabetes?
Yes, insulin resistance is a significant risk factor for developing Type 2 diabetes. If left unmanaged, it can lead to higher blood sugar levels and eventually diabetes.

How do I know if I have insulin resistance?
Common indicators of insulin resistance include difficulty losing weight, fatigue, and high blood sugar levels. Diagnostic tests, such as fasting insulin and glucose tolerance tests, can confirm the condition.

What are the best lifestyle changes to prevent diabetes?
Maintaining a healthy weight, eating a balanced diet rich in fiber, engaging in regular physical activity, and managing stress are key lifestyle changes that can help prevent diabetes.

Are there specific tests for diagnosing insulin resistance?
Yes, tests such as fasting insulin levels, glucose tolerance tests, and HbA1c and HOMA-IR levels can help diagnose insulin resistance and assess blood sugar control.

References

• American Diabetes Association: diabetes.org

• Centers for Disease Control and Prevention (CDC): cdc.gov/diabetes

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): niddk.nih.gov

• World Health Organization (WHO) – Diabetes: who.int/health-topics/diabetes

• Mayo Clinic – Insulin Resistance: mayoclinic.org/diseases-conditions/insulin-resistance/symptoms-causes/syc-20447387

Examining the Pros and Cons of Bariatric Surgery

Experience a Journey Towards a Healthier You!

Weight loss surgery, also known as bariatric surgery, can be a transformative step towards a healthier and happier you. This procedure acts as a powerful ally in your weight loss journey, helping you achieve significant, lasting weight loss. As a result, the risk of developing serious health conditions like heart disease, diabetes, and even some cancers can be significantly reduced. Bariatric surgery allows you to unlock a future filled with increased energy, improved mobility, and a renewed sense of well-being.

Moreover, here’s the good news: weight loss surgery has become much safer over time. Thanks to newer techniques, better training for surgeons, and quality control programs, the mortality risk associated with this surgery has gone way down, from around 1.5% to a much lower 0.3%. So, while it remains a major procedure, it can be a powerful tool to help people with obesity live longer, healthier lives.

Consider the Option that Best Meets Your Requirements

There are different procedures available for Bariatric surgery, and surgeons can choose the best option based on each patient’s, individual needs.

Roux-en-Y Gastric Bypass: This two-pronged surgical approach tackles weight loss by both curbing appetite and reducing nutrient absorption. Staples are used to create a smaller stomach to limit the amount of food intake, and certain section of the small intestine is bypassed to limit the nutrients and calories absorbed.

Sleeve Gastrectomy: The method encompasses the stapling and removal of a portion of the stomach to reduce the size of the stomach to that of a small banana. It also influences weight loss by altering gut hormones that regulate appetite, taste, and blood sugar levels, contributing to feelings of fullness after consuming a smaller volume of food.?

Mini Gastric Bypass: In this surgery, the surgeon creates a long, sleeve-shaped pouch from the stomach. This pouch is then connected directly to the small intestine, forming a loop.

Banded Gastric Bypass: By adding a band to a gastric bypass surgery, surgeons can precisely control the pouch and stoma sizes in this banded gastric bypass procedure. This standardization and adjustability can potentially improve weight loss outcomes in the long run.

Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a two-part weight loss surgery. The first part involves reducing the stomach’s size through a procedure called sleeve gastrectomy. The second part reroutes the digestive system. This reduces the body’s ability to absorb fats and calories, leading to weight loss.

Is Weight Loss Surgery Right for Me?

Weight loss surgery isn’t for everyone. The question comes round to:

Am I qualifying for bariatric surgery?

Bariatric surgery is for patients with:

BMI > 32.5 kg/m2 with obesity related co-morbidities

BMI > 37.5 kg/m2 without co-morbidities

BMI > 30 kg/m2 with life-threatening obesity-related disorders like uncontrolled diabetes, cardiovascular disease/cardiomyopathy, and severe obstructive sleep apnoea

Bariatric Surgery to be considered only between the ages of 18 – 65 years

Bariatric surgery may be considered in patients more than 65 years in the presence of severe obesity-related co-morbidities/disability

Bariatric Surgery may be considered in patients < 18 years in special situations after paediatrician/endocrinology certification, or after attainment of puberty or completion of skeletal maturity

Obesity treatment encompasses a lot more than stated. A good lifestyle works wonders with a follow-up routine. Moreover, regularly consulting the multidisciplinary team to monitor progress is fundamental to addressing the underlying potential complications.

Weighing the Pros and Cons of Bariatric Surgery

Weight-loss surgery is an effective and more reliable alternative to lose 60-80% of your excess weight within a year of surgery. Significant weight loss after bariatric surgery positively impacts cardiac metabolism, workload, performance, and structure.?

Bariatric Surgery improved the quality of life for 95% of patients with an 89% reduction in 5-year mortality.

Migraines 57% resolved

Depression 55% resolved

Pseudotumor cerebri 96% resolved

Obstructive sleep apnea 74-98% resolved

Dyslipidemia hypercholesterolemia 63% resolved

Asthma 82% improved or resolved

Cardiovascular disease 82% risk reduction

Hypertension 52-92% resolved

Non-alcoholic fatty liver disease 90% improved steatosis; 37% resolution of inflammation; 20% resolution of fibrosis

GERD 72-98% resolved

Metabolic syndrome 80% resolved

Type II diabetes mellitus 83% resolved

Stress urinary incontinence 44-88% resolved

Polycystic ovarian syndrome 79% resolution of hirsuitism; 100% resolution of menstrual dysfunction

Degenerative joint disease 41-76% resolved

Venous stasis disease 95% resolved

Understanding the risks associated is of equal importance. By and large, every surgery involves risks.

Risks of Bariatric & Metabolic Surgery

The more extensive the bypass operation, the greater the risk for complications and nutritional deficiencies. Patients with extensive bypasses of the normal digestive process require not only close monitoring but also may require the use of special foods and medications. Five to ten percent of patients who undergo weight-loss operations may require surgical/medical interventions to correct complications.

Rare complications of gastric bypass surgery include leak through staples or sutures, ulcers in the stomach or small intestine, and blood clots in the lungs or legs (it is hence important for all our patients to strictly adhere to the compression stockings and LMWH therapy as advised postoperatively), stretching of the pouch or oesophagus, persistent vomiting, and abdominal pain, inflammation of the gallbladder, and failure to lose weight.

Many a patient undergoing bariatric surgery develop gallstones. Gallstones are clumps of cholesterol and other matter that form in the gallbladder. A person’s risk of developing gallstones increases during rapid or substantial weight loss.

A few studies have reported up to 30 percent of patients who have weight-loss surgery may develop nutritional deficiencies such as anaemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if vitamin and mineral intakes are maintained – a close follow-up with our dietician is thus emphasized.

Women of childbearing age should avoid pregnancy for 12-15 months until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus. Though some bariatric procedures can be reversed, patients should carefully consider all of the risks and benefits before electing to have this surgery.

Patients with uncontrolled diabetes, retinopathy, neuropathy, and nephropathy are advised a very close monitoring of their blood sugar and other medications with regular follow-up. Patients who have been advised C-PAP/Bi-PAP must strictly adhere to the usage, or else it could even prove fatal.

In short bariatric/metabolic surgery is not a magic pill but could work like magic if used and practised judiciously under supervision.

Post-Surgery Care and Management

Post-bariatric surgery, there are a few things to keep in mind to make it a success. Here’s what your post-bariatric surgery care must involve.

Your surgeon and healthcare team will be there to watch over you, answer questions, and help avoid any problems. They’ll also track your weight loss to see how you’re doing.

Having good people around you is important. Friends, family, or even a support group can be a big help after surgery. They can offer encouragement and understand what you’re going through.

Food after surgery is a step-by-step process. Right after, for 15 days it’ll be non-aerated, sugar-free liquids like fat-free milk, buttermilk, soy milk, almond milk, strained soups, coconut water, etc. It’s like giving your stomach a little rest for a few weeks to heal up. Then, things will slowly move to soft foods for the next 15 days that are easy to chew and digest. Make sure to get plenty of protein during this time, like lean meats or dairy products. After a month the diet becomes normal, focusing on protein-based foods.

Don’t forget to move your body! So, getting some exercise is a great way to manage the long-term effects of bariatric surgery, feel better overall, and keep the extra kgs away for good.

Your Weight Shouldn’t Be the Barrier to the New ‘You’!

Bariatric surgery, or weight loss surgery isn’t just about the numbers on the scale. It can be a major win for your overall well-being!

Studies show that people who have weight loss surgery not only manage health problems better but also feel a lot better about themselves. They have more energy, and they feel more confident in their own skin.

Of course, everyone’s reasons for wanting weight loss surgery are different. The important thing is to talk to your surgeon about all your options and concerns. They can help you decide if weight loss surgery is right for you and provide support before and after surgery.

References:

https://asmbs.org/patients/is-metabolic-and-bariatric-surgery-right-for-you/

Bariatric (Weight Loss) Surgery: Types & Requirements (clevelandclinic.org)

Medanta | Beyond Weight Loss: Understanding Bariatric Surgery and Its Life-changing Benefits

Bariatric surgery – Mayo Clinic

Bariatric Surgery: What You Need To Know – Forbes Health

Best Weight Loss Surgery in Delhi NCR, Weight Loss Treatment in india (atulpeters.com)

risks-and-complications-of-bariatric-surgery.ashx (clevelandclinic.org)

Effect of exercise training before and after bariatric surgery: A systematic review and meta?analysis – PMC (nih.gov)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538485/

https://www.niddk.nih.gov/health-information/digestive-diseases/dumping-syndrome

https://www.ncbi.nlm.nih.gov/books/NBK594253/

Understanding the Causes of Obesity in Children and Adolescents

Causes of Obesity in Children & Adolescents: Unraveling the Complex Factors

Recognizing the Growing Epidemic

According to the World Health Organization (WHO), children and adolescents from all walks of life, are increasingly facing the health threat of excess body fat, leading to overweight and obesity.

However, managing weight isn’t a quick fix; it’s a journey that requires lifelong support. The WHO emphasizes the importance of sustainable lifestyle changes that promote long-term well-being, not crash diets or rapid weight loss.

We used to think weight was simply about ‘calories in’ versus ‘calories out’, but science reveals a more complex picture. Genetics, environment, stress levels, emotional well-being, sleep patterns, underlying medical conditions, and even medications can all influence how our bodies store and manage fat.

Recognizing this complexity is crucial.

By addressing these multifaceted factors – behaviour, environment, and genetics – we can create a more effective and holistic approach to childhood weight management, paving the way for a healthier future for all.

Genetic Factors Contributing to Obesity

While we inherit a blueprint (genes) that influences weight, obesity isn’t just about our DNA. It’s a complex mix of factors. Genes can make some people more likely to gain weight, but hormones, metabolism, and even our culture and habits can all play a role in fat storage.

Even early in life, certain factors can increase a child’s chances of becoming obese. A mother’s weight before pregnancy, how much weight she gains while being pregnant, and even gestational diabetes (pregnancy-related high blood sugar) can all play a role. These factors can sometimes lead to a higher birth weight for the baby, which can independently be a risk factor for obesity, later in life. Additionally, a family history of weight issues, diabetes, high blood pressure, or certain hormonal problems can also increase a child’s risk of being overweight.

The good news? …Even with a genetic nudge, healthy choices like diet and exercise can make a big difference.

Dietary Habits and Nutrition

Childhood obesity may be linked to certain dietary habits. One major contributor is the overconsumption of calorie-dense foods that are low in essential nutrients. This includes things like processed snacks, fast food, and sugary drinks. These types of foods are often heavily marketed to children, making them even more appealing. While the research is ongoing on the exact impact of other dietary factors like snacking frequency, meal skipping, or one’s eating speed, it’s clear that an overall healthy diet plays a crucial role in weight management for young people.

Shedding extra kilos through calorie restriction (dieting) may be an effective strategy in the short term, but it’s important to consider how our bodies respond over time. While dieting offers a jumpstart, our bodies adapt to changes in calorie intake. This adaptation can sometimes involve a slowdown in metabolism, making it trickier to maintain weight loss in the long run.

Physical Activity Vs Sedentary Lifestyle

Children tend to become less active as they grow older, with a dip seen around age 6 and another around 13. This is especially more true for girls than boys. Children who are overweight or obese tend to move less throughout the day compared to their thinner peers. There’s also a general trend of children spending more time sitting as they get older.

Catching those Zzzs is important for more than just feeling well-rested! Studies have established a direct link between sleep habits and weight gain in children. Children or adolescents who don’t get enough quality sleep, whether it’s due to shorter sleep duration, restless sleep, or going to bed too late, seem to be at a higher risk for obesity. This might be because insufficient sleep is associated with being less active, having unhealthy eating habits, and even developing insulin resistance.

Screen time could also play a role. Too much screen time can disrupt sleep patterns and potentially mess with hormones that control hunger and fullness. Think of it as a domino effect: less sleep can lead to cravings for unhealthy foods and less energy for exercise, which can contribute to weight gain.

Psychosocial and Economical Factors

Weight stigma, the societal devaluation of people who are overweight or obese, can be a major psychosocial factor contributing to obesity. Negative stereotypes paint them as lazy and lacking willpower, creating a discouraging environment. This stigma manifests as bullying and social rejection, especially for children, impacting their mental health and self-esteem. The stress and negativity can even lead to disordered eating behaviours, making weight management even harder. Feeling ashamed and less motivated to participate in social activities due to weight stigma can further hinder progress. This cycle of negativity and discouragement creates a significant barrier to healthy lifestyle changes for those struggling with weight.

Building on the complex challenges of weight management, obesity also carries a significant cost burden. Not only does it strain healthcare systems financially, but it also has a profound impact on individual and societal well-being. The long-term nature of obesity means managing weight requires sustained commitment and lifestyle changes. This burden, coupled with psychosocial factors like weight stigma, can create a discouraging cycle that makes weight management even more difficult.

Environmental and Socioeconomic Influences

Our surroundings strongly influence how we live and our health. Modern life has become less active. Cars replaced walking, technology replaced exercise, and quick meals replaced healthy cooking. This makes it easy to fall into unhealthy habits like eating poorly and not getting enough exercise. As a result, we consume more calories than we burn, leading to weight gain.

The obesity spike in recent times is largely due to the surrounding environment that promotes weight gain.
This can happen at the family level (habits modelled by parents), community level (access to parks, healthy food options, and safe walking areas), or even national policies (government food subsidies or marketing practices). These influences can take advantage of our biological, psychological, social, and economic vulnerabilities.

Prevention Strategies and Early Intervention

Helping children and adolescents with obesity requires a multi-faceted approach. The goal is to reduce excess body fat, improve health problems related to weight, and prevent the development of chronic diseases in the future.

Treatment typically integrates a combination of different components. This may include learning healthy eating habits with the help of a nutritionist, incorporating regular physical activity into the child’s routine, and providing psychological support to address any emotional challenges associated with weight. In some cases, medication might be prescribed to assist with weight management.

Metabolic and bariatric surgery offers the best long-term results for weight loss in severely obese adolescents.
Studies show significant weight reduction (25-40%) even years after procedures like Roux-en-Y gastric bypass or sleeve gastrectomy.

The benefits go beyond weight loss!

Individuals often see improvement in health problems linked to obesity, like cardiometabolic risk factors, musculoskeletal pain, and functional mobility.

References:

showPdf (thelancet.com)

What is obesity? (bomss.org)

Obesity – American Society for Metabolic and Bariatric Surgery (asmbs.org)

https://www.atulpeters.com/blog/obesity-children-adolescents/

Bariatric and Metabolic Surgery Centre: Essential Components

Key Components of a Leading Bariatric and Metabolic Surgery Centre

Rising Incidence of Morbid Obesity

As the incidence of Morbid Obesity is rising day by day, more and more hospitals have started bariatric surgery programs. However, managing a morbidly obese patient is challenging in the way that obesity brings a lot more other diseases with it. Obstructive sleep apnea, Diabetes Mellitus type 2, Hypertension, and Hypothyroidism are a few of them.

Therefore it’s mandatory to set up a comprehensive management program for treating these patients in the best bariatric and metabolic surgery centre.

The decision to recommend bariatric surgery requires a multidisciplinary approach to evaluate the indications for surgery and to define co-morbidities properly.

Key Components of a Bariatric and Metabolic Surgery Centre

The surgeons at the best bariatric hospital must demonstrate the necessary training skills, experience, and leadership. The essential components of a bariatric surgical center include a Director, critical support, appropriate equipment and instruments, 24-hour qualified call coverage, continuous care, long-term follow-up care, and most importantly regular support groups. There must be facilities for data collection and maintaining a database. By collecting and sorting data, a well-maintained database would demonstrate past performance and help in directing future trends. Periodic evaluation and comparison will allow centers to develop improvement plans.

Role of the Bariatric and Metabolic Committee

There must be a bariatric and metabolic committee which is headed by the program director and includes the coordinator, clinical reviewer, and hospital administration staff. All the surgeons included in the committee must focus on quality improvement which includes a reduction in variation, standardization of practice, establishing selection guidelines, and quality improvements. This can result in decreasing rates of complications, re-admissions, length of stays, surgical site infections, etc. The committee also establishes pathways of care for pre-operative and post-operative management. All relevant staff must be educated in patient safety and complication recognition. The goal of the pathways is to prevent failure to rescue situations which means early recognition and treatment of the post-surgical complications.

Responsibilities of the Bariatric Surgical Care Coordinator

The Bariatric Surgical Care coordinator assists and reports to the director of the committee. The coordinator assists in center development, managing the accreditation process, maintaining relevant policies and procedures, patient education, outcomes and data collection, quality improvement efforts, and education of relevant institution staff. The coordinator supports the development of written protocols and education of nurses to recognize the critical vital signs required to minimize delays in the diagnosis of serious adverse events.

Data Management and Accreditation

The clinical reviewer enters data into relevant platforms. The reviewer should not be contributing to patient care to avoid bias.

The hospital must be accredited by relevant authorities to ensure that the care for metabolic and bariatric surgery patients is provided in a safe environment. In this respect, Apollo Hospitals New Delhi has been accredited by the JCI.

Certifications and Training

The director or the chief surgeon must have obtained a verification certificate to operate on morbidly obese patients by relevant governing bodies. These certificates are purely based on the volume of surgeries and quality of care and dedication to the practice. Similarly, there must be 24-hour call coverage for the patients attended by qualified persons.

The bariatric surgical nurse must obtain specialized training such as the Certified Bariatric Nurse certification.

Essential Support Services

There must be dedicated physicians, dieticians, psychologists and psychiatrists, social workers, and physical therapists.

Registered dieticians are absolutely essential for the success of any bariatric surgical center.

They do all the nutritional counseling and follow-up.

Psychologist and psychological evaluation is a must before any bariatric and metabolic procedure. These patients are often suffering from depression, anxiety, and other stress-related disorders. Psychological education, evaluation, and preparation are useful in achieving overall patient stability and emotional well-being.

Facilities and Equipment

Morbidly obese patients must feel welcome upon entering an institution. There must be appropriate furniture to accommodate them in the waiting room as well as the examination room. The plus size hospital clothes, beds wheelchairs, and floor-mounted toilets are a must. There must be dedicated beds or floors for bariatric surgical patients. Similarly, operating room tables and equipment are accordingly sized to the needs of such patients.

Critical Care and Anesthesia

The critical care support providers must be trained in identifying early signs of potential complications. The anesthesia team must be trained to give anesthesia to such patients taking care of DVT prevention and obstructive sleep apnea to name a few.

Various specialty consultants are also asked to give preoperative clearances to the patient in view of the existing co-morbid conditions.

Support Groups and Electronic Media

A pediatric and adolescent medical advisor is also a part of the team at the center. He/she operates on adolescent patients.

Support groups are designed for the patients who are in the recovery phase. These are primarily organized to take care of the medical, nutritional, psychological, and social issues experienced by the patients.

The development of electronic information media such as dedicated websites is an essential part of addressing various issues and reaching people in remote places.

Future Trends and Institutional Commitment

As more and more people are undergoing bariatric surgical procedures these days, the demand for safe treatment facilities will grow. According to Dr. Atul NC Peters, Senior Consultant and Head of Apollo Institute of Metabolic and Bariatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India, the most important element in the best bariatric surgery center is leadership from the surgeon and integrated medical staff. They require dedication, strong fundamental infrastructure, and total institutional commitment.

How Does Bariatric Surgery Reverse Diabetes?

How Bariatric Surgery Can Reverse Diabetes and Improve Overall Health

Obesity is the root cause of diverse diseases such as Asthma, sleep apnea, cardiovascular problems, Type 2 Diabetes Mellitus, joint pains and most important some forms of cancers.

Obesity increases insulin resistance in the body leading to Type 2 Diabetes Mellitus, and also results in Metabolic Syndrome.

There are various ways to deal with these problems which include changes in lifestyle and modification in the eating habits and use of certain drugs. But almost all of the studies conducted have come to the conclusion that these therapies are not effective in providing sustained weight loss. Bariatric surgery has been the most effective treatment option till date which results in effective and sustained weight loss along with resolution of the other problems associated with obesity.

There are various bariatric and metabolic surgical procedures available which can be done by Laparoscopic Techniques as well as with Robotic assistance. They include Sleeve gastrectomy, Roux-en-Y gastric bypass, Mini Gastric Bypass, Ileal Interposition, Duodeno-Jejunal Bypass, and so on.

Mechanism of resolution of Diabetes Mellitus:

The intestine is now considered as a metabolic organ and this new insight can be utilized for the treatment of Diabetes. Bariatric and metabolic surgery leads to changes in the anatomy of the gastrointestinal tract resulting in the treatment of obesity and diabetes mellitus.

Reason Behind How Bariatric Surgery Reverse Diabetes?

The quick lowering of blood sugar after bariatric surgery is due to hormonal changes after re-routing of the small intestine and not purely do the restriction of the calorie intake. It has been proposed and proved that after bariatric surgery there is an augmented release of certain hormones like GLP-1 and PYY from the small intestine that leads to improvement in the high blood sugar levels. These hormones not only decrease the cellular resistance to insulin, they also increase the efficiency of insulin. There is also decreased production of glucose from the liver due to their effects.

After surgery, long-term follow-up for the best results is a must. It’s a complete lifestyle change. One must follow instructions carefully for optimum results.There are absolute guidelines decided by the international diabetes federation for the selection of patients who can be benefitted from surgery.

These surgeries must be done at the best bariatric and metabolic surgical centers doing these surgeries routinely and under expert care and experienced hands. Although hospital stay remains from 2 to 3 days, a strict and regular follow-up is a must.

Diabetes Mellitus Type 2 – The Permanent solution

Addressing the Growing Emergency of Diabetes Mellitus Type 2: The Role of Metabolic Surgery

With the increase in obesity during the last few years all over the world, type 2 diabetes mellitus has emerged as one of the largest emergencies related to obesity.

There are various treatment options for type 2 diabetes starting from lifestyle and dietary modifications to various drug schedules including insulin therapy.

The Rise of Metabolic Surgery

These days, metabolic surgery has emerged and is accepted as a new step in the therapeutic regimen for T2DM when lifestyle modifications and drugs don’t give the required sugar control.

Metabolic surgery involves food re-routing through modifications of the gastrointestinal tract by laparoscopic or Robotic approach, it is safe and effective for the treatment of diabetes mellitus type 2. Metabolic surgery is being considered as the only permanent solution for diabetes these days.

Not only Diabetes, this surgery has also been seen to reduce other cardiovascular risk factors (cholesterol and blood pressure) when compared with medical treatment.

The Importance of Cardiovascular Health

According to WHO high blood pressure and tobacco use are the greatest cause of premature deaths; therefore, it becomes more important to focus on preventing cardiovascular complications related to high blood glucose and cholesterol.

Evidence from Global Studies

Several studies done all over the world have demonstrated that metabolic surgical procedures improve blood glucose levels independently of weight loss and also have a positive impact on blood cholesterol and blood pressure, with a very good long-term effect on cardiovascular morbidity and mortality.

Gastrointestinal surgery for the specific intention to treat T2DM was first recommended at the 2007 Diabetes Surgery Summit.

Guidelines for Metabolic Surgery and Their Implications

After going through various studies, the American Diabetes Association has recommended and formed certain guidelines on metabolic surgery for adult patients with type 2 diabetes.

They have expanded the indications for metabolic surgery to include patients with inadequately controlled type 2 diabetes who have a BMI as low as 30 kg/m2 (27.5 kg/m2 in Asians).

With the present guidelines, metabolic surgery is considered a permanent solution for type 2 diabetes and metabolic disease.

Surgery Options for Non-Obese Patients

Not only in the obese, the need for control of diabetes in non-obese patients led to the development of Ileal Interposition surgery or Duodenojejunal bypass surgery. These can be performed in thin type 2 diabetics with BMI as low as 27.5 kg/m2 as well as those who had undergone supervised treatment schedules but still have poorly controlled disease.

However, these surgeries must be performed in specialized centers and in expert hands where these procedures are being performed regularly with long follow-up schedules.

Looking for diabetes surgery in India? Consult Prof. (Dr.) Atul N.C Peters at Smart Cliniqs for the metabolic treatment of diabetes in India.