- Mr. Ajit Joshi
- Age: 59 years
- Weight: 101 Kg
- BMI: 36 Kg/m2
- Type 2 diabetes mellitus since 20 years. FBS- 220, PPBS- 285, HbA1c- 8.6
- On 130 units of insulin and two oral hypoglycemic agents per day
- Other problems- High blood pressure and high cholesterol
- Referred by a top consulting diabetologist from Chennai for bariatric surgery as a last resort to blood sugar control.
- Underwent Laparoscopic Roux-en y gastric bypass at CODS one year back.
- Current status- Weight: 72 Kg, FBS- 120, PPBS- 135, HbA1c- 6.8, Currently takes 1 oral drug.
- Mrs. Saila Khan
- Age: 52 years
- Weight: 104 Kg
- BMI: 46.2 Kg/m2
- Type 2 diabetes mellitus since 18 years. FBS- 156, PPBS- 220, HbA1c- 9.2, One 230 units of insulin and one oral drug per day
- Referred by an endocrinologist for bariatric surgery, as the dose of insulin could not be increased further.
- Underwent Laparoscopic Roux-en y gastric bypass at CODS 9 months back.
- Current status- Weight: 82 kg, FBS- 125, PPBS- 124, HbA1c- 5.6. Takes one oral drug.
Type 2 diabetes mellitus also known as adult onset diabetes or non insulin dependent diabetes is a condition in which either the pancreas do not produce sufficient insulin or the body tissues are not able to use the insulin well (insulin resistance). As shown in the above case scenarios type 2 diabetes is closely linked with obesity. The greater the increase in waist line higher is the chance of turning into a diabetic.
Most common symptoms of type 2 diabetes are increased thirst, frequent urination, sudden change in weight, fatigue, non-healing wounds, lack of energy etc. It is a complex, progressive, chronic and costly disease that eventually has deleterious effects on the eyes, nerves, kidneys and the heart.
Over the years there has been a steady influx of newer drugs for the management of type 2 diabetes. Today the diabetologists have a battery of drugs and various types of insulin to offer to their patients. Yet, sadly only about 7 to 8% of the patients achieve good control of diabetes. This also connotes that almost 90% of the diabetics do not achieve control and will eventually develop micro and macrovascular complications which ultimately translates into blindness, chronic kidney disease, lower limb amputations and heart attacks. Imagine the implications of this on the patient and their family. Diabetes drains physically, mentally, emotionally and financially.
Why does this happen? Why do 90% of the patients fail to achieve good control?
The biggest challenge in the treatment of type 2 diabetes is weight management. Most patients find it difficult to keep the weight off. Most physicians struggle with their patients with regards to lifestyle interventions. Most of the doctors will tell you that compliance for regular exercise and diet modification dips gradually as time passes by. Insulin intake also does not help the matter much and sadly leads to a fair degree of weight gain.
Going back to the above case scenarios, Mr. Ajit Joshi and Mrs. Sehla Khan, struggled with their weight for years and eventually ended up with more than 100 units of insulin alongwith a battery of other medicines on a daily basis. Their diabetologists struggled hard to get the sugars under control and finally hit the wall. Bariatric surgery was offered to them as a last resort. The results are for all to see. Both patients lost 20 to 30 kilos and were off insulin within a year. Today they are not only lighter on their feet but are extremely happy as they can avoid the multiple pills and jabs for control of blood sugar.
Bariatric/metabolic surgery not only leads to durable weight loss but also gives hope for a life without type 2 diabetes. In more than 85% of obese diabetics, bariatric surgery leads to remission of diabetes.Studies have proven that it improves life expectancy and also decreases the overall morbidity associated with long term complications of diabetes and thus proves to be the more cost effective option in the long-term.
The American Diabetes Association (ADA) and the International Diabetes Federation (IDF) haveofficially recognized it as an effective treatment option for the obese type 2 diabetics.
The IDF also mentions that surgery should be introduced as an early option in the course of treatment of an uncontrolled obese diabetic when existing medical therapies fail to achieve acceptable targets and not necessarily as the last resort.
Bariatric/metabolic surgery for type 2 diabetes comes as a light at the end of the tunnel. It offers an opportunity to limit the progression of this devastating disease in selected patients and gives them a second chance at life.