Diabetes Metabolic and Bariatric Surgery - medECUBE
Diabetes Metabolic and Bariatric Surgery

Diabetes Metabolic and Bariatric Surgery

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high sugar) resulting from defects in insulin secretion, insulin action, or both.

There are largely 2 types of Diabetes:

  • Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults.
  • Type 2 Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion.

The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

Therapeutic options

Interventions designed to impact an individual’s physical activity levels and food intake are critical parts of type 2 diabetes management. All patients should receive standardised general diabetes education (individual or group, preferably using an approved curriculum), with a specific focus on dietary interventions and the importance of increasing physical activity. While encouraging therapeutic lifestyle change is important at diagnosis, periodic counselling should also be integrated into the treatment programme.

Weight reduction, achieved through dietary means alone or with adjunctive medical or surgical intervention, improves glycaemic control and other cardiovascular risk factors. Modest weight loss (5–10%) contributes meaningfully to achieving improved glucose control. Accordingly, establishing a goal of weight reduction, or at least weight maintenance, is recommended.

Dietary advice must be personalised. Patients should be encouraged to eat healthy foods that are consistent with the prevailing population-wide dietary recommendations and with an individual’s preferences and culture. Foods high in fibre (such as vegetables, fruits, wholegrains and legumes), low-fat dairy products and fresh fish should be emphasised. High-energy foods, including those rich in saturated fats, and sweet desserts and snacks should be eaten less frequently and in lower amounts.

Key Points in Medical Management

  • Glycaemic targets and glucose- lowering therapies must be individualised.
  • Diet, exercise and education remain the foundation of any type 2 Diabetes programme.
  • Unless there are prevalent contraindications, metformin is the optimal first-line drug.
  • After metformin, there are limited data to guide us. Combination therapy with an additional 1-2 oral or injectable agents is reasonable, aiming to minimise side effects where possible.
  • Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control.
  • All treatment decisions, where possible, should be made in conjunction with the patient, focusing on his/her preferences, needs and values.
  • Comprehensive cardiovascular risk reduction must be a major focus of the therapy.

Metabolic and Bariatric Surgery and Type 2 Diabetes

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:

Improves type 2 diabetes in nearly 90 % 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 % of individuals by:

  • reducing blood sugar levels to normal levels
  • eliminating the need for diabetes medications

Types of Metabolic and Bariatric Surgeries

  1. Roux-en-y Gastric Bypass:

Roux-en-y Gastric Bypass is a surgery that alters the GI tract to cause food to bypass most of the stomach and the upper portion of the small intestine. The operation results in significant weight-loss and causes remission of Type 2 DM in 80% of patients and improvement of the disease in an additional 15 % of patients.Improvement or remission of diabetes with gastric bypass occurs early after surgery and before there is significant weight-loss. The weight-loss independent mechanisms of diabetes improvement after gastric bypass are partially explained by changes in hormones produced by the gut after the surgery.

 

  1. Sleeve Gastrectomy

Sleeve Gastrectomy (Vertical gastrectomy) is an operation that removes a large portion of the stomach and, in doing so, causes weight-loss. The remaining stomach is narrow and provides a much smaller reservoir for food.
Sleeve gastrectomy also appears to have some weight-loss independent effects on glucose metabolism and also causes some changes in gut hormones that favour improvement in diabetes. Diabetes remission rates after sleeve gastrectomy are also very high (more than 60%) and, in some studies, similar to results seen after gastric bypass.

 

  1. Adjustable Gastric Band

The Adjustable Gastric Band is a weight-loss procedure that involves the placement of a band around the upper portion of the stomach.
Remission of diabetes occurs in approximately 45-60 percent of patients. The remission or improvement of diabetes, however, is secondary to the weight-loss produced by the procedure, and there does not appear to be any other mechanism for diabetes improvement in band patients. In other words, patients who have diabetes and who are unsuccessful in losing weight with the AGB will unlikely see any improvement in the diabetes.

 

FAQs on Bariatric Surgery

How many days will I take to resume to work post bariatric surgery?

After surgery, most patients return to work in one or two weeks. You will have low energy for a while after surgery and may need to have some half days, or work every other day for your first week back. Your surgeon will give you clear instructions. Most jobs want you back in the workplace as soon as possible, even if you can’t perform ALL duties right away. Your safety and the safety of others are extremely important – low energy can be dangerous in some jobs.

When can I start exercising again after surgery?

Right away! You will take gentle, short walks even while you are in the hospital. The key is to start slow. Listen to your body and your surgeon. If you lift weights or do sports, stay “low impact” for the first month (avoid competition, think participation). Build slowly over several weeks. If you swim, your wounds need to be healed over before you get back in the water.

Does type 2 diabetes make surgery riskier?

It can. Be sure to follow any instructions from your surgeon about managing your diabetes around the time of surgery. Almost everyone with Type 2 Diabetes sees big improvement or even complete remission after surgery. Some studies have even reported improvement of Type 1 Diabetes after bariatric procedures.

 

Cost

Gastric Sleeve – $ 6000-8000Gastric Bypass – $ 7500-8500

Inguinal Hernia Laproscopic surgery – $ 2500-3000

Ventral hernia Laproscopic surgery – $ 3500-4500

Lap Gall bladder stone surgery – $ 2200-3000

Stapler Hamorroihds /piles surgery – $ 2000-2500

 

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