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Consultancy Corner: Gastric bypass surgery can help reduce diabete
The above titled article by Prof.Walter Pories published in the year 1995 changed the perspective of what Type 2 diabetes was believed to be. His retrospective study of 600 + patients who underwent gastric bypass for the treatment of obesity, who also had diabetes, more than 80% of them had their diabetes disappeared. He initially didn’t know how and why. It was just a WoW!
By
migrator
migrator
Chennai
Was this due to weight loss was the first thought?
No, because the improvement of diabetes was much earlier compared to weight loss. In fact, the improvement in sugar levels were noted as early as few days after surgery.
Was this diabetic improvement related to reduced caloric intake in the immediate post-operative period?
Nope, because many of these patients had their sugars continue to remain within normal limits even after return to near normal dietary pattern.
What else could be the reasons?
This prompted further research in the field of diabetes by the medical and the surgical community, the results of which were shockingly interesting.
When diabetes was believed to be dysfunctional insulin production and function(insulin is produced by the beta cell of pancreas), the entire concept of diabetes incidence was now understood to be arising from the GUT(intestines) related to hormones produced in the gut that regulate insulin production and action.
This was popularly called the GUT HYPOTHESIS of Type 2 diabetes. These hormones/peptides produced in the gut are called incretins which signals the presence of glucose in the intestines to the pancreas to produce insulin.Â
It was understood that the action of these incretins was diminished in patients with type 2 diabetes, which was restored by alteration of intestinal anatomy as done in procedures like gastric bypass.
More newer understanding of the GUT is related to the micro-organisms present in the intestines. These normal microbial floras which are helpful in maintaining the gut immunity, also seem to play a role in the pathophysiology of type 2 diabetes.Â
Not just diabetes, a different spectrum of flora has been noted amongst patients who are normal weight and obese and those with diabetes and no diabetes. Surgery also plays a role in the improvement of obesity and diabetes by alteration of this flora, by bypassing portions of the intestinal tract.
These improvements have not been for obesity and diabetes alone, but also for other related diseases like hypertension, dyslipidemia, non-alcoholic fatty liver disease, polycystic ovarian disease, obstructive sleep apnea etc.Â
Hence the term bariatric/obesity surgery has now been popularly referred to as metabolic surgery.Understanding the benefits of this , the government of India has recognised bariatric surgery under the Central Government Health Insurance scheme(CGHS).
The state of Tamil Nadu has included bariatric surgery under the Comprehensive Chief Ministers Insurance scheme for the benefit of the poor. With this other state should follow suit in accepting bariatric surgery as a lifesaving procedure.
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