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Diabetes: Does Surgery have any role in treatment of Diabetes? What is Metabolic Surgery?

Diabetes currently affects more than 150 million people worldwide and that number is expected to quickly increase. Over 90% of people with the disease have TypeII form, which is associated with obesity and overweight, lack of physical activity, family history, and older age. Unlike Type I diabetes in which the pancreas fails to produce sufficient insulin, the pancreas in patients with Type 2 diabetes produces enough insulin, but for unknown reasons, the body is unable to use the insulin. Diabetes can lead to blindness, heart, and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Current therapies, which include diet, exercise, oral antidiabetic drugs, and insulin, do not always cure the disease.

TRADITIONAL THERAPY FOR DIABETES

The goal of treatment is to improve the symptoms of diabetes through normalizing blood glucose levels. The ongoing goals are to prevent long-term complications like eye and kidney disease, damage of nerves, and blood vessels. The strict control of blood glucose reduces the risk of death, stroke, heart failure, and other complications. Glycosylated hemoglobin (HbA1C) is a test that determines the risk of long-term complications. It measures how much glucose has been sticking to red blood cells and other cells. The first-line treatment for type II diabetes is weight loss, diet, and exercise. Appropriate meal planning includes choosing healthy foods and eating the right amount of food. Exercise is important for effective treatment of diabetes. Regular exercising helps burning excess calories, managing weight thus improves control of the glucose amount in the blood.  When diet and exercise are not sufficient to maintain normal blood glucose levels, medications may be needed. They work through triggering the pancreas to make more insulin, helping insulin work better, decreasing the absorption of carbohydrates from the gut, or decreasing glucose production in the liver. Poor blood glucose control despite lifestyle changes and taking medications means insulin should be injected.

ROLE OF SURGERY

Despite continuing advances in diabetes pharmacotherapy, fewer than half of adults with type 2 diabetes mellitus (T2D) attain therapeutic goals designed to reduce long-term risks of complications, especially for glycemic control, and lifestyle interventions are disappointing in the long term. Metabolic surgery, on the other hand, has been shown to improve glucose homeostasis more effectively than any known pharmaceutical or behavioral approach.

For the patients having diabetes for less than 5 years, there is a high likelihood of achieving normal blood sugar levels without any medications. If the person is obese and not yet requiring Insulin his chances of complete stoppage of medication and still achieving normal sugar levels are very high. If they are having very poorly controlled diabetes, are on a high dose of insulin, and are having diabetes for a very long time, surgery helps in achieving normal sugar levels with decreased requirements of Insulin and medications. Such patients may still need medications but they can achieve good glycemic control leading to the prevention of diabetes-related complications

While Metabolic surgery( Surgery for Diabetes) certainly has some risk, the long-term risk of continued diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery, though, should be evaluated in the context of the duration and severity of their diabetes as well as their other obesity-related health problems.

THE EARLIER THE SURGERY, THE BETTER THE OUTCOME

A key finding of many studies is that the shorter the history of diabetes, the greater the likelihood of complete remission. Glucose toxicity, particularly in poorly controlled diabetes, accelerates B-cell failure. B-cells are located in the pancreas and produce and secrete insulin. Weight loss can improve B-cell responsiveness to glucose. If the bariatric surgical procedure is performed before irreversible B-cell failure has occurred, durable weight loss will be accompanied by a high likelihood of long-term remission.

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