Diabesity

The most common form of diabetes which accounts for 95 percent of all cases is T2DM

In this form of diabetes, the body either does not produce enough insulin, or there is insulin resistance because of which cells are not able to use insulin properly. Insulin is necessary for the body to be able to use glucose or blood sugar for energy. As a result, glucose accumulates excessively in blood which over the period leads to various complications like heart disease, blindness, nerve damage and kidney damage.

Type 2 Diabetes is the form of the disease which is either associated with obesity to start with or get worsened with weight gain and the name Diabesity has been used to describe this association.

How Type 2 Diabetes is normally treated?

Current therapy for T2DM includes lifestyle intervention including losing excess weight, eating a healthful diet and engaging in regular exercise are the first-line treatments for type 2 diabetes.All these treatments offer nothing as far as resolution is concerned and disease keeps progressing. This Disease often worsens with time, requiring either higher doses or increased number of medication to maintain blood sugar control.

Most of the complications related to diabetes is related to the micro vascular changes which diabetes induces in essential organ, micro vascular changes is directly proportional to number of years patient is suffering from diabetes. Most of these patients run the risks of long term complications like:

• Diabetic Retinopathy – the leading cause of blindness in adults.
• Diabetic Nephropathy – the leading cause of kidney failure in adults.
• Diabetic Neuropathy – leading cause of non-traumatic amputations of the lower extremities in adults.
• Cardiovascular disease – 8/10 patients with type 2 diabetes die of cardiovascular disease.
• Stroke – 2 to 4 times more likely to have a stroke.
• Diabetic Foot- which may lead to loss of limb.

Does Bariatric Surgery “Cure” Diabetes?

More than 30 scientific studies say yes!

Cure for Diabetes always aims to put it in remission, defined as normal blood sugar levels and no need for diabetes medication. This means bringing glucose to normal levels and arresting the progression of the diabetic complications, thus giving the body a chance to repair the damage.

One recent study in the Journal of the American Medical Association (JAMA) found that 73 percent of people with diabetes who underwent Bariatric procedure combined with conventional therapy achieved remission. By contrast, just 13 percent of those people who received only conventional therapy went into remission. A landmark 2004 study in JAMA of more than 22,000 people who underwent bariatric surgery showed the following:

• Diabetes was completely resolved or improved in 86% of patients.
• High blood lipids improved in 70% or more of patients.
• High blood pressure was resolved or improved in 78% of patients.

What’s more, a study in the Annals of Surgery showed that 83 percent of 240 people who underwent gastric bypass were “cured” of their diabetes.

A study in the New England Journal of Medicine found that long-term mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes.

The bottom line is that Bariatric surgery can play a big role in treating Type 2 diabetes.

How Does Bariatric Surgery “Cure” Type2 Diabetes?

There are lots of hypothesis about the mechanism by which Bariatric surgery induces remission in type 2 Diabetes Mellitus

The most common is the idea that shunting food directly to the lower intestine stimulates a substance called glucagon-like peptide 1 (GLP-1), which can increase insulin production.

Another theory suggests that hormones that prompt hunger such as peptide Y (PPY) may be dulled by rearranging the anatomy of the gut, so if they crave less sugar, people may be able to manage their blood sugar levels better.

Another question that remains is when, should the surgery be performed — when diabetes is first diagnosed or down the road, when complications have already begun to arise? It always better for surgery to be performed early in disease as the diabetic remissions rate are better , the life threatening complication has not sets into the various system of body.

Do all obese patients with Type 2 diabetes can undergo surgery?

Absolutely not, major international medical society and health regulatory authority has outlined various parameters based on which patient are selected for surgery. Consensus among most of regulatory authorities are any patient with BMI more than 40 irrespective of any co morbidities or patient with 30-40 with co morbidities like diabetes, hypertension, hypercholesterolemia are indicated for Bariatric surgery.

Diabetes Management and Safe Fasting in Ramadan