THIRUVANANTHAPURAM: It is an astonishing fact that the number of Diabetes Mellitus (DM) patients is increasing day by day. Asians have higher incidence of diabetes due to genetic reasons. India ranks number one in percentage of diabetic population followed by UAE, owing to life style changes and food habits. It affects all organs in the body like eye, brain, heart, kidney and limb vessels. Chronic renal problems and myocardial infarctions are increased with diabetes. Also, 45 per cent of patients undergoing dyalisis is because they are diabetic. These contribute to early death.
HbA1c is the test which gives accurate value of diabetic control. HbA1c more than six is not ideal. Studies have shown that bringing down the HbA1c level even by one unit reduces death rate by 21 per cent, eye and kidney disease by 37 per cent and heart attack by 14 per cent, which is why it is very important to keep blood sugar levels at normal.
Intestinal Hormone (GLP1) levels can regulate the insulin production in pancreas which is why, increasing GLP1 levels in the gut, can help in controlling diabetes. GLP1 is produced by terminal portion of the small intestine. By key-hole surgery, the stomach size is reduced which decreases intake of food.
Also last portion of small intestine is brought towards the stomach which helps in bringing partially digested food into the small intestine rapidly. This will result in increasing GLP1 levels and there by increasing insulin levels. Weight reduction and associated fat loss will also increase insulin activity. Key-hole surgeries like Sleeve Gastrectomy and Ileal Interposition are thus found to increase insulin performance and give long standing (permanent) resolution of diabetes.
These procedures are helpful in patients with Type2 diabetes, in whom pancreas is capable of producing increased levels of insulin. This surgery gives better results for those with ideal weight and diabetes of short duration (few years); than in those who have already damaged their end organs. It is highly appreciable for a diabetic patient to know that cure is possible. In type 1 diabetes, where pancreas is not functioning, these surgeries are not helpful. One needs to undergo some blood tests before deciding on the feasibility of surgery. These include C-peptide (fasting and after food), S Insulin, liver and kidney tests etc. Antibody tests like GAD 65 & IA2 are indicated in lean diabetic patients and in those on insulin for many years. More than 90% of the diabetic patients treated by this surgery are fully cured of diabetes. Rest 10 % could bring down their medication dosage. The International Diabetic Federation has already approved bariatric surgeries in obese diabetics. All these procedures are done by laparoscopic methods and hence, patients will be highly comfortable and can resume normal activity in a few days time.
Dr R Padmakumar
Senior Consultant Surgeon, Sunrise Hospital, Kochi