Diabetes Surgery

Diabetes Surgery

What is diabesity?
Obesity and type-2 diabetes are  global health problems there is a strong co-relations between them . The relative  risk of diabetes with increase  BMI is greater than those with normal BMI range . Generally 50% indivisuals are obese who diagnosed with type 2 diabetes.Prevalence of diabetes increases disproportionately  as obesity increases in  a population and now India is known as “Diabetes capital” of  the world and introduction of term ‘‘diabesity”was  coined to understand its a single disease.
What is Metabolic syndrome?
 Defined as  a combination of Increased Fasting Blood Sugar,Blood Pressure,cholesterol and Trigleceride with abdominal Obesity  that result in increased risk of Type2 Diabetes mellitus and Cardiovascular diseases.

What is diabetes surgery or metabolic surgery and it's type?

Surgeries which improves or cure diabetes and maintain blood sugar level within acceptable

normal range and it can also correct lipid level in blood.

There are two types surgery

  • One is pure for treatment of Type-2 Diabetes without obesity like Ileal Interposition ,Ileal Interposition with Sleeve Gastrectomy and Ileal Interposition with Sleeve Gastrectomy and Duodenal switch
  • Second is Bariatric surgeries Like Sleeve Gastrectomy,Gastric bypass,Minigastric bypass,BPD with DS and Gastric banding also known as diabetic surgery or metabolic surgery because surgery will  improves or cure of diabetes,hypertension and lipid abnormalities .


 
Mechanism of diabetes surgery
* By Change in gut harmone level and weight- loss  insulin sensitivity and production increases thus control blood sugar level.                 

Criteria for  Baritric Surgery in type 2 diabetes(with Obesity)
*BMI >32.5 kg/mt2
*BMI >27.5 kg/mt2 and < 32.5 kg/mt2 with insulin requirements >80 IU /day
*Age<60years
*Diabetes diagnosed < 5 years but results are also goods even <10 years old Type-2 Diabetes
*Failure to loss weight by diet and exercise

Impacts of Bariatric Surgery over Type-2 Diabete
Different bariatric procedure  can improves or cure diabetes  and previously diabete considerd as a progressive non-curable disease but now curable by baritric surgery or metabolic surgery and different procedure gives variable results as  remission of Type2 diabetes mellitus by BPD with DS is 95%,by RNYgastric bypass is 85-90%,by Sleeve gastrectomy is 80% and by Gastric banding is 60%. In some cases our patients  disharge with normal blood sugar level and without antidiabetic tabelets or insulin injection.
Overall cure of type2diabetes is 85%,improvement  of type2 diabetes is 90 % and health and life quality improvements after surgery and requirement of drugs reduces or no need of drug are seen.

Criteria for diabetes Surgery( without Obesity)

 

  • Type 2 Diabetes more than 1 year duration
  • BMI 21-55 kg/mt2
  • Poor Glycemic control(HbA1c >8%) despite maximal use of Oral Hypoglycemic Agents and Insulin or good control but requiring progressively higher drug doses.
  • Gives Informed consent for the surgery
  • Postmeal C-peptide >1.0ng/ml
  • Age 25-75 years
  • Stable weight for more than 3 months

Impact of Diabetes Surgery over Type -2 diabetes

  • Approximately 90% cure or improvements are seen and no need for oral hypoglycemic and Insulin

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