Gastric bypass surgery is the cure for people who have type 2 diabetes. For type 2 diabetes the best medicine is weight loss. Both women and men are equally represented. The world is round and so are a growing number of its inhabitants. Consider these staggering statistics. With more than 1.2 billion people in the world now officially classified as overweight, according to the World Health Organization (WHO), this is probably the most sedentary generation of people in the history of the world. India alone accounts for more than 25 million people from morbid obesity.
Dr Shashank Shah, bariatric surgeon at Ruby Hall Clinic says, "Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission or significant improvement of type 2 diabetes and other life-threatening diseases in most patients. Hence, there is a need to change the society's name from Obesity Surgery Society of India (OSSI) to Metabolic and Obesity Surgery Society of India (MOSSI). People generally don't think of surgery as a treatment for diabetes or high blood pressure, but it is, and we expect metabolic surgery to play an ever increasing role in managing these diseases. American Society and International Federation For Surgery of Obesity has already taken this step and changed the name. Its now India's turn to change its name."
Shah made this statement at the Metasurg 2008 conference held in Mumbai which was the first ever metabolic surgery conference in Asia Pacific Region. Besides, the President of American Society of Metabolic and Bariatric Surgeons (ASMBS), Dr Kelvin Higa, honorary secretary of International Federation for the Surgery of Obesity ( IFSO) , Dr Nicola Scopinaro, honorary president of IFSO and many other leading bariatric surgeons and presidents from different parts of the world like America, Europe, Australia, Austria, Belgium, Malaysian apart from India were present for this conference. There were 300 surgeons from across the world attending this mega conference from countries like USA, Pakistan, Bangladesh, Malaysia, Australia, Belgium, Brazil, Tanzania, UAE and Saudi Arabia apart from India.
Metabolism is the process by which the body converts food to energy at the cellular level. The most common metabolic disease is type 2 diabetes, which occurs when the body does not adequately metabolize or regulate blood sugars due to lack of insulin or the body's inability to respond to the insulin is produced. According to the latest figures there are 35.5 million people with type 2 diabetes and the problem is on the rise only. New research indicates that metabolic surgery may improve insulin resistance and secretion by mechanisms independent of weight loss - most likely involving changes in gastrointestinal hormones. Many patients with type 2 diabetes experience complete remission within days of metabolic surgery, long before significant weight comes off. This has led to new thinking that metabolic surgery may be also appropriate for diabetic individuals who are of normal weight or only slightly overweight.
Diabetes is emerging as a global public health problem. India tops the list in the prevalence of diabetes in the whole world with a burden of 35.5 million people with diabetes. The prevalence staggers around 12-15% in the urban areas and 6-8% in the rural areas. One third of persons with diabetes in the urban areas and 50% of the people in the rural areas are yet to be detected because of the asymptomatic nature of the disorder. In general, people do not go for diabetes test consciously and they are detected whenever they go for treatment for other illness. Diabetes mellitus type 2 affects more than 150 million people worldwide. Although the incidence of complications of type 2 diabetes can be reduced with tight control of hyperglycemia, current therapies do not achieve a cure.
Gastric bypass and biliopancreatic diversion seem to achieve control of diabetes as a primary and independent effect, not secondary to the treatment of overweight. Although controlled trials are needed to verify the effectiveness on non-obese individuals, gastric bypass surgery has the potential to change the current concepts of the pathophysiology of Type 2 diabetes and, possibly, the management of this disease. Patients with type 2 diabetes have a six fold increased risk of a first-time myocardial infarction compared with non-diabetic patients. Additionally, diabetic patients have twice the risk of myocardial infarction. As cardiovascular mortality is the leading single cause of death in India. and because patients with type 2 diabetes have a three- to eightfold increased risk of death, new treatment strategies need to be considered for this disease and its prevention.
Shah did a study on 150 patients who were operated to review the effect of morbid obesity surgery on type 2 diabetes mellitus, and to analyze data that might explain the mechanisms of action of these surgeries and that could answer the question of whether surgery for morbid obesity can represent a cure for type 2 diabetes in nonobese patients as well. Series with long-term follow-up show that gastric bypass and biliopancreatic diversion achieve durable normal levels of plasma glucose, plasma insulin, and glycosylated hemoglobin in 80 per cent to 100 per cent of severely obese diabetic patients, usually within days after surgery. Available data shows a significant change in the pattern of secretion of gastrointestinal hormones. Case reports have also documented remission of type 2 diabetes in non-morbidly obese individuals undergoing biliopancreatic diversion for other indications.
Shah describes the effects of Laparoscopic gastric bypass surgery on the development of type 2 diabetes. All patients had severe obesity (BMI 35.0 kg/m2). One year after surgery, 64 per cent patients had remission of diabetes. The prevalence of diabetes decreased from 10 to 5.6 per cent. An additional 26 per cent of patients with diabetes had an improvement in their control of diabetes.
While gastric bypass surgery may be hopeful for the severely obese, it must be tested prospectively in obese individuals before it can be recommended as a treatment for Type 2 diabetes. More importantly, new strategies are needed to prevent the progression of impaired fasting glucose and impaired glucose tolerance to Type 2 diabetes. Laparoscopic gastric bypass surgery may be the first to offer promise.