In a recent research called the STAMPEDE trial– from Cleveland Clinic, USA,a comparison was done between diabetic patients managed on medicines versus bariatric surgery. The patients’ chosen were obese diabetics including the mildly obese. One group of patients was treated by drugs and diet under the intensive supervision of an expert team of physicians. The other group was treated by bariatric surgery. These patients were followed up for at least 3 years. It was seen that the post surgical patients lost more weight and were either off medicines or better controlled whereas the patients treated on diet and drugs did not match up at all with these targets. It was concluded that bariatric surgery worked better than medicines in the treatment of obese diabetics. They also observed that a particular bariatric procedure – gastric bypass was more beneficial than the other procedure called the sleeve gastrectomy. It was further seen that bariatric surgery worked very well even for the diabetics with mild obesity.
This research has thrown light upon how diabetes occurs. It is now known that there are chemicals in the body that are called incretins and antiincretins the balance of which dictates whether insulin will work satisfactorily or not. The gut and the fat cells are responsible for the release of these chemicals and hence addressing them leads to resolution of diabetes. It is worthwhile to remember that the blood sugar of the patient comes to normal immediately after the surgery much before any weight loss has occurred. This is evidence that the gut brings about the normalization of diabetes independent of weight loss by producing the incretins. More research is however underway to evaluate these incretins and study their effects. Future research in diabetes is exciting and holds promise for millions of diabetics in the world.
This is also great news for the seven crores diabetics in India. With the awareness spreading regarding bariatric surgery, many diabetics may now be able to resolve the disease once and for all instead of living in fear of complications. Diabetes kills patients through various complications such as heart attacks, strokes, hypertension, kidney failure, etc. In addition, the diabetic patients are under potential risk of blindness, infections and loss of leg. These translate into increased cost and morbidity. Preventing these complications by bariatric surgery will improve the quality of life, be cost effective and at times life saving.
Diabetes has always been considered an incurable disease that can be treated only by medicines. However research has eroded this notion and had mode this disease better understood and conquerable. The resolution of diabetes by bariatric surgery has therefore been hailed as the most important medical discovery of the last decade.
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