A RAY OF HOPE FOR OBESITY – RELATED DIABETIC PATIENTS
The author, who is a bariatric surgeon at Hinduja Healthcare Surgical at Khar in Mumbai, writes about the growing incidence of type-II diabetes in India and how it is being tackled by the medical community
Dr. Shashank Shah
India’s population is the third most obese in the world and obesity is the number one cause of type-II diabetes in the country. There are more than 300 million people suffering from obesity in India and type-II diabetes affects more than 63 million people in the country today.
Over 80% of adult diabetics in India are clinically overweight. One of the reasons for this is that Asian Indians have an ethnic and genetic predisposition for developing diabetes at a younger age and at lower body mass index than the Caucasian population.
About 90% of patients with diabetes have type-2 diabetes and almost 90% have some grade of obesity.
This joint syndrome is called diabesity. Such individuals need to lose weight and control diabetes, if they want to save themselves from life-threatening repercussions of both these diseases.
So far medical treatment, which is medication and lifestyle modification, has seen to have major limitations; hence we see high mortality and hospital admissions due to these diseases on the rise in the recent past.
For patients who have undergone traditional lifestyle modification including exercise, diet control and medication and still not seen any impact on their weight and/or control on their diabetes, there is a ray of hope to look forward to. There is a growing body of evidence for surgery as an effective treatment for obesity and related diabetes.
Recently, at the American Diabetes Association’s 76th scientific session at New Orleans in the US, data from a study titled Cosmid (Comparison of Surgery vs Medicine for Indian Diabetes) was presented, demonstrating ‘bariatric surgery is a better treatment option than medical therapy and lifestyle management alone for obese Asian Indian patients with inadequately controlled type 2 diabetes’.
The Cosmid trial is the first randomised controlled study that specifically addresses the Asian Indian population, which develops type-2 diabetes at an earlier age and a lower BMI than Caucasians.
One of the patients who underwent gastric bypass surgery in this trial was a 42-year-old lady suffering from diabetes for the past 7 years. She weighed 82 kg and was on insulin. Being a teacher, she had challenges in travelling and working for eight hours. Frequent hypoglycemia and giddiness was about to make her lose her job.
After Gastric Bypass she is completely off all treatment for diabetes and now feels much more energetic and has normal kidney function. “In this era of advanced medicine, I was extremely worried about my kids and was feeling helpless because of my increasing diabetic complications,” she says. “Gastric bypass has saved not just me but my family.”
Bariatric surgery has been recognised as a permanent weight loss solution for people with high BMI (Body Mass Index) or those categorised as obese. Over the years, it has been seen globally that bariatric surgery was used only on severely obese patients. However, this treatment, specifically for Indian patients who have weight-related diabetes, could be used effectively to manage their health and control diabetes.
Cosmid was the first-ever study worldwide where gastric bypass was used purely for treatment of diabetes.
The two-year study, following 80 subjects, found gastric bypass to be superior to medical management alone in treating patients with type-2 diabetes. This is path-breaking and first-of-its-kind evidence, which may change the guidelines for treatment for patients with type-II diabetes that cannot be controlled by medication.