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Metabolic Surgery

Did You Know these facts about Diabetes?

  • Someone in the world dies from complications associated with diabetes every 10 seconds.
  • Diabetes is one of the top ten leading causes of deaths.
  • One out of ten health care Rupee is attributed to diabetes.
  • Diabetics have health expenditures that are 2.3 times higher than non-diabetics.
  • Approximately 90 percent of Type 2 Diabetes Mellitus , the most common form of diabetes, is attributable to excessive body fat.
  • If current trends continue, Type 2 Diabetes Mellitus or pre diabetic conditions will strike as many as half of adult Indian Population very soon.
  • India is soon going to lead the world in the prevalence of Type 2 Diabetes Mellitus.
  • Metabolic and bariatric surgery is the most effective treatment for Type 2 Diabetes Mellitus among individuals who are affected by obesity and may result in remission or improvement in nearly all cases.

Type 2 Diabetes Mellitus

Type 2 diabetes is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for Type 2 Diabetes Mellitus and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. Type 2 Diabetes Mellitus leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from Type 2 Diabetes Mellitus is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years.

Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adherence to the prescribed diabetes treatment regimen may help to keep blood sugar levels from being excessively high although medications and lifestyle changes cause remission of the disease. In fact, Type 2 Diabetes Mellitus often worsens with time, requiring even greater numbers of medication or a higher dosage to keep blood sugar under control. For this reason, Type 2 Diabetes Mellitus has been considered a chronic and progressive disease.

Metabolic Surgery and Type 2 Diabetes

Metabolic surgery is laparoscopic Gastro Intestinal surgery like a bariatric surgery with the primary aim to treat Type 2 Diabetes. With years of experience and long term results of bariatric surgery, it has now been proved that changes done in the G I system by laparoscopic surgery improves the sugar control. Such surgeries lead to a changes in the hormones secreted from our intestine, leading to increase in secretion of insulin from the pancreas. It also helps to preserve the pancreatic reserve leading to long term benefits with diabetes. Metabolic surgery help to maintain steady level of bood sugar over a longer period of time leading to prevention of diabetes related complications. Looking at these advantages scope of such surgeries are advised even to patients who have poorly controlled Type 2 Diabetes even if these patients are mildly obese ( BMI from 27.5 to 32.5).

Nearly all individuals who have bariatric surgery show improvement in their diabetic state. Bariatric surgeries performed in more than 135,000 patients were found to affect type 2 diabetes in the following ways:

Surgery improves type 2 diabetes in nearly 90 percent of patients by:

  • lowering blood sugar
  • reducing the dosage and type of medication required
  • improving diabetes-related health problems
Surgery causes type 2 diabetes to go into remission in 78 percent of individuals by:
  • reducing blood sugar levels to normal levels
  • eliminating the need for diabetes medications
Health Improvements
  • Cause the improvement or remission of T2DM to last for year

Benefits vs Risks

Type 2 Diabetes is a leading cause of death in the U.S. and is a major contributor to morbidity and mortality from heart disease, stroke and kidney failure. Each year millions of individuals die from the effects of T2DM. With the advancements in bariatric surgery, many of these individuals could be saved and experience an improved quality of health and life.

While bariatric surgery 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.


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.

Consensus from Diabetes Organizations Worldwide: Metabolic Surgery Recognized as a Standard Treatment Option for Type 2 Diabetes

The new Guidelines emerged from the Second Diabetes Surgery Summit (DSS-II), an international consensus conference held September 28-30, 2015, in London, and jointly organized with the American Diabetes Association (ADA), International Diabetes Federation (IDF), Diabetes UK (DUK), Chinese Diabetes Society (CDS), and Diabetes India (DI). The goal of the Summit was to develop global guidelines to inform clinicians and policy makers about the benefits and limitations of metabolic surgery for type 2 diabetes.

In the report, metabolic surgery is defined as the use of gastrointestinal operations, originally designed to induce weight loss ("bariatric surgery"), with the primary intent to treat type 2 diabetes and obesity. These procedures remove parts of the stomach or reroute the small intestine. Many people who undergo metabolic surgery experience major improvements in glycemia, as well as a reduction in cardiovascular risk factors, making it a highly effective treatment for type 2 diabetes and a highly effective means of diabetes prevention.

"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," wrote the Guideline authors in the commentary. Metabolic surgery, on the other hand, has been shown to "improve glucose homeostasis more effectively than any known pharmaceutical or behavioral approach," they wrote. Despite such evidence, to date, metabolic surgery had not been included in clinical guidelines for diabetes care as a recommended intervention.

According to the new Guidelines, metabolic surgery should be recommended to treat type 2 diabetes in patients with Class III obesity (BMI greater than or equal to 40 kg/m2), as well as in those with Class II obesity (BMI between 35 and 39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and medical therapy. It should also be considered for patients with type 2 diabetes who have a BMI between 30 and 34.9 kg/m2 if hyperglycemia is inadequately controlled, the authors agreed. The Consensus Statement also recognizes that BMI thresholds in Asian patients, who develop type 2 diabetes at lower BMI than other populations, should be lowered 2.5 kg/m2 for each of these categories.