How Metabolic Surgery Can Help Control Diabetes?

How Metabolic Procedures Can Help Control Diabetes, Blood Pressure, and Other Chronic Diseases?

Metabolic surgery is a proven and credible option for individuals struggling with obesity and its associated health complications. By modifying the stomach and intestines through minimally invasive laparoscopic or robotic techniques, this procedure promotes significant weight loss while effectively addressing chronic conditions such as uncontrolled diabetes (despite being on medical treatment), hypertension, sleep apnea, and high cholesterol.

Compared to traditional methods, patients undergoing minimally invasive metabolic surgery, benefit from reduced discomfort, shorter hospital stays, and faster recovery times. Importantly, metabolic surgery is, at times, considered even safer than common procedures like gallbladder removal or hip replacement.

Beyond weight management, this transformative treatment enhances overall well-being, extends life expectancy, and significantly reduces the risk of future health issues.

How Metabolic Surgery is Different from Bariatric Surgery?

Metabolic surgery offers a promising approach to effectively managing uncontrolled type 2 diabetes, leading to significant improvement of the disease. While currently synonymous with weight-loss surgery, metabolic surgery tends to focus on more targeted interventions that affect the body’s metabolism whereas bariatric surgery, mainly focused on weight loss, alters the digestive system through procedures like gastric bypass or sleeve gastrectomy. These interventions primarily aim to reduce food intake or limit nutrient absorption, resulting in weight loss.

Types of Metabolic Surgery for Diabetes

Metabolic surgery has demonstrated remarkable efficacy in managing diabetes. A vast majority of patients experience significant improvements within days of the procedure, characterized by lower blood sugar levels and reduced reliance on diabetes medications.

Notably, an impressive 78% of patients achieve diabetes remission, and better glycemic control, at times eliminating the need for medication.

There are several metabolic surgical approaches, of which commonly used are as follows:

Sleeve Gastrectomy with Duodenojejunal Bypass (SDJB): Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel metabolic surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect.

Sleeve Gastrectomy with Proximal Jejunal Bypass (SG-PJB): This is a surgical weight-loss procedure that modifies the digestive system to improve metabolic health. By reducing stomach size and bypassing a portion of the small intestine, it alters the body’s processing of food and nutrients, leading to significant weight loss and improved control of conditions like type 2 diabetes.

Ileal interposition: It is a metabolic surgery that modifies the stomach, duodenum, and small intestine. It’s used to treat type 2 diabetes, especially for achieving diabetes remission, even in patients without obesity. The procedure works by altering the digestive process, which impacts hormone levels and blood sugar control.

By altering the digestive system, metabolic surgery not only reduces food intake and calorie absorption but also directly impacts blood sugar control. Additional benefits include lesser food consumption, increased satiety, and improved weight management.

Mechanism of Action: Facilitating Better Glycaemic Control

Metabolic surgery benefits blood sugar control in two significant ways.

First, weight loss, an intended outcome of the surgery, improves the body’s ability to use insulin, particularly in muscles and fat.

Second, the surgery itself directly impacts how the body handles food. It changes gut hormones and improves liver function, often leading to better blood sugar levels even before significant weight loss.

Benefits of Metabolic Surgery for People with Diabetes

Metabolic surgery is emerging as an effective alternative for the management of severe obesity and type 2 diabetes. By altering the digestive system, it significantly improves blood sugar control, blood pressure, and cholesterol levels.

It’s essential to monitor patients with existing diabetes-related issues as good glycemic control helps in moderating micro- and macro-vascular complications associated with the eye, nerve, or foot. Additionally, while promising cost-saving potential exists, especially for patients with severe diabetes complications, more studies are required to confirm these economic advantages.

Overall, metabolic surgery offers substantial hope for people with type 2 diabetes, but ongoing research is crucial to fully realize its potential and address potential challenges.

Comparative Effectiveness: Surgery vs. Medical Management

The management of type 2 diabetes has evolved significantly. Traditionally, lifestyle modifications such as diet, exercise, and weight management have been, and still are, cornerstones of treatment. These approaches remain crucial in preventing and managing the condition. However, the complexity of diabetes often necessitates additional interventions.

Medical advancements have introduced a range of medications that effectively control blood sugar levels. These drugs, when used in conjunction with lifestyle changes, can significantly improve diabetes management for many individuals. In some cases, despite optimal medical therapy, diabetes may persist or worsen. Metabolic surgery has emerged as a powerful tool in addressing these challenges. This surgical approach not only induces substantial weight loss but also has a profound impact on metabolic processes, often leading to remission of type 2 diabetes. Metabolic surgery can also be performed on people with normal weight, though, uncontrolled diabetics. In this subset of the population, patients don’t lose weight but get other metabolic benefits from surgery.

It’s important to emphasize that metabolic surgery is not a standalone solution. It complements other treatment modalities. The most effective approach to diabetes management often involves a personalized combination of lifestyle changes, medication, and, in select cases, surgical intervention.

Patient Success Stories and Testimonials

Mr. Jagmeet Kohli, who previously weighed 124.9 kg and had a BMI of 41.3, faced serious health issues including diabetes (with an HbA1c of 10.9) and hypertension. Despite trying to lose weight through diet, he saw little success.

In 2013, he opted for bariatric surgery, and within six months, he shed 37.5 kg. This significant weight loss led to a dramatic improvement in his HbA1c, reducing it to 5.3, and his hypertension was effectively managed. Today, Mr. Kohli is delighted with his results, which have enabled him to excel in both his business and family life. As a testament to his remarkable transformation, he recently walked the runway for the prestigious clothing brand ZARA—a truly impressive achievement!

Choosing the Right Surgeon and the Center

The success of your surgery depends on the expertise of your chosen surgeon and his team. A top-tier metabolic surgery center offers a comprehensive approach, from pre-operative evaluation to post-operative care.

Key factors to consider when selecting a metabolic surgeon and clinic:

Comprehensive Care: Look for a center that provides a full range of services, including expert surgical care, nutritional guidance, and ongoing support.
Experienced Team: A dedicated team of specialists, including a metabolic surgeon, bariatric nurse, bariatric dietitian, and program coordinators and program manager, is essential for optimal outcomes.
Accreditation and Qualifications: Check the accreditation of the clinic and surgeon also look for his qualifications and experience in performing metabolic surgery.
Proven Success: Research the surgeon’s success rates and patient testimonials to gauge their expertise because patient satisfaction is of paramount importance.

By carefully evaluating these factors, you can increase your chances of achieving successful and long-lasting weight loss through metabolic surgery.

Future Directions in Metabolic Surgery

Metabolic surgery is a proven treatment for severe obesity when diet and exercise have been unsuccessful. By modifying the digestive system, it helps patients lose significant weight and improve overall health. The success of this surgery depends not only on the surgical procedure but also on a comprehensive care plan involving a team of healthcare professionals.

To optimize outcomes, future research should focus on comparing different surgical techniques, understanding the role of multidisciplinary care, exploring the benefits of advanced technology, and addressing health disparities among patients.

Ultimately, metabolic surgery offers hope to many individuals struggling with obesity, and ongoing research will continue to improve its effectiveness and accessibility.

Conclusion: Embracing Hope and Health

While the immediate benefits of metabolic surgery are impressive, understanding the long-term effects is crucial. Researchers must focus on tracking weight loss, metabolic improvements, and potential complications over extended periods to provide comprehensive guidance for patients and healthcare providers.

Beyond clinical outcomes, it’s essential to consider the broader impact on patients’ lives. Factors such as overall quality of life, mental health, and satisfaction are equally important. A holistic approach will provide a more complete picture of metabolic surgery’s true value.

References

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/

Metabolic Surgery For Diabetes

Metabolic Surgery for Diabetes: A Promising Approach to Better Glycemic Control

Overview of Diabetes and Its Challenges

Diabetes is a chronic condition and its treatment involves lifelong diet and lifestyle modifications and pharmacotherapy (oral hypoglycemic drugs and insulin) that intensifies with the increase in the duration of the disease. Even then meeting adequate glycemic control is difficult and the patient may sooner or later end up with heart, kidney, and eye complications. Metabolic surgery for diabetes is emerging as a promising option for better control and potential resolution of the condition.

Understanding Metabolic Surgery for Diabetes

Metabolic surgeries are emerging as a lifesaver for diabetes patients. Metabolic surgeries help in the control or resolution of diabetes. Patients report improvement in blood glucose levels and a reduction in the number of medications and doses of insulin within months after the metabolic surgery for diabetes. Laparoscopic sleeve gastrectomy surgery was originally developed as a weight reduction procedure for obesity. In Laparoscopic sleeve gastrectomy surgery, 70-80% of the stomach is removed leaving a narrow tube.

Laparoscopic Sleeve Gastrectomy for Diabetes

Laparoscopic sleeve gastrectomy surgery not only facilitates weight loss but also improves glycemic control among young, newly diagnosed patients. Sleeve gastrectomy surgery is now considered also as a metabolic treatment for diabetes in obese Diabetics as along with the restrictive element it also brings about certain metabolic and hormonal changes that cause weight loss and improvement in diabetes.

Mini Gastric Bypass Surgery

Mini gastric bypass surgery is another surgery for diabetes. In mini gastric bypass surgery, a gastric pouch is created which is joined to the intestines, similar to gastric bypass but mini gastric bypass surgery has fewer complications, and at the same time, its impact on obesity and associated co-morbidities is similar.

Alternative Options for Non-Obese Diabetics

For normal-weight persons with diabetes, we have other diabetes treatment options, such as Dudeno Jeunal bypass and Ileal transposition surgeries, though these people should initially be treated with medications.

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.