Diabetes is unique, as care is not episodic but chronic. Metabolism is simple terms refers to the burning capacity of one’s body. Many factors contribute to poor metabolism. These can be classified as non-modifiable and modifiable factors. The non-modifiable factors include genetics, ethnicity, drug usage in childhood, dietary and physical habits of childhood, childhood stress etc. The modifiable factors include current physical lifestyle, dietary pattern, stress and altered sleep cycle. Hence any attempt at improving the metabolism would include identification and appropriate correction of the underlying abnormality. The metabolism is also related to one’s body composition (less lean muscle and more body fat) irrespective of the overall weight. This explains why many thin patients also suffer from poor diabetic status. Phenotypically, Indians have higher body fat and poor lean muscle mass leading to increased chances of development of insulin resistance, the major pathognomic factor for the development of type 2 diabetes and metabolic syndrome.
Any treatment of metabolic syndrome would include a holistic approach where the aim would not be just prescription of drugs, but appropriately modifying all the modifiable factors described above. Education is needed that would assist patient to concentrate beyond simplistic blood glucose control in the management of their diabetes. This education will have to cover the changes to the body or lifestyle that come with age or environmental factors. These changes need to be understood in terms of how they affect the patient’s control and what support he or she requires across a range of disciplines.
The management team will have to include a multidisciplinary team of physicians, dieticians, life style counsellors, psychologists, diabetologists and bariatric surgeons. With a close follow-up and appropriate modification of these factors we can achieve improvements in insulin resistance. The medical, nutritional, psychological and surgical care is need to the successful management of diabetes as are the strictly clinical facets of the condition. And most importantly, individual patient needs must be at the core of every aspect of prevention and care if one is to achieve successful outcomes. By this diabetic remission is possible without the actual need of drugs. But this requires a committed patient and a committed team.
Interestingly, with bariatric (also called Obesity surgery) which was initially intended to treat Obesity permanently, it was noticed that for most patients with diabetes, this was completely cured over a follow up of 10-15 yrs. Further research and scientific data both from our Institute and other pioneer institutes in the world have shown that, this was related to certain hormonal changes which bring diabetes under remission on a permanent basis. Hence this hormonal concept was further studied and the results have shown promising results in control of diabetes even in patients using large doses of insulin and also inadequate control in-spite of various medication usage. Hence this is ideally suited for those patients who want to get rid of their insulin shots and also not able to achieve diabetes remission in-spite of maximum medical therapy.
Especially with India becoming the diabetic capital and more and more usage of insulin this diabetic surgery is possibly the only solution in this subgroup of patients. A recent Level I evidence (STAMPEDE trail) that compared Bariatric surgery and medical therapy has clearly shown that surgery for diabetes provides most effective diabetic control in the short and long term compared to medical therapy.
GEM Obesity & Diabetes Surgery Centre holds pride to have performed the largest numbers of such surgeries in Asia and the only centre experienced to perform all kinds of such operations including novel procedures like Laparoscopic Duodenojejunal bypass, Laparoscopic ileal Interposition etc.
Hence with the right understanding of the causative factors and appropriate holistic management, with or without the need for a metabolic surgery, diabetes can be brought under remission, both in the short and the long term
Together, let’s CONQUER DIABETES!!!