| Metabolic Surgery � cure for type II diabetics:
In the recent Metabolic Surgery Consensus Summit organized by Bangalore Endoscopic Surgery Training Institute & Research Centre and Karnataka Institute of Diabetology, Bangalore. Professionals involved in the field of bariatric, metabolic surgery, diabetes, and medical research from all over India along with visiting international faculty met in Bangalore on 12 Feb 2012 embraced Metabolic Surgery as a treatment option for type 2 diabetes Mellitus
RESULTS
The gathering comprised of 38% Bariatric and Metabolic Surgeons, 18% Endocrinologist / Diabetologist / Physicians and 28% General Surgeons. The table describes the questions posed to the delegates at the consensus meet, the answer options and the answers in percentage obtained by the vote.
| What percent of your patients are not compliant with medical treatment? |
<25- 37% |
25-50- 18%, |
50-75-11% |
don’t deal with such patients-32%, |
| In your practice, what percent of patients come with complications in spite of best medical management? |
< 25- 32% |
25-50-54% |
50-75-11% |
>75- 3% |
| At what BMI would you suggest metabolic surgery? |
BMI not criteria- 78% |
> 25- 15% |
>30-12% |
>35- 17%, |
| The minimal duration of Diabetes after which Metabolic Surgery could be recommended is- |
Duration is not a criteria- 67% |
3 yrs- 52% |
5yrs- 5% |
10 yrs- 3% |
| Which are the patients for whom metabolic surgery should be recommended? |
Not responding to both insulin & OHA- 63% |
Treatment is not a criteria- 37%
|
|
|
| Metabolic Surgery can be recommended for type II diabetic patients whose diabetes is not controlled with maximal Insulin and OAD treatment |
92%- Yes |
6%-Undecided |
|
|
| Metabolic Surgery should be recommended for type II diabetic patients whose diabetes is not controlled with maximal Insulin and OAD treatment |
89%- yes |
8%-no |
3%- can’t decide |
|
| Metabolic Surgery can be recommended for a type II diabetic with family history of cardiovascular disease |
85%-yes |
11%-no |
3%- can’t decide |
|
| Metabolic Surgery should be recommended for type II diabetic patients with Hyperlipidemia and severe diabetes |
90%-yes |
5%-no, |
5%- can’t decide |
|
| Metabolic Surgery should be recommended for type II diabetic patients with Hypertension and severe diabetes |
93%-yes |
2%- no |
5%- can’t decide |
|
| Criteria to take up a patient for metabolic surgery? |
High HbA1C-19% |
High FBS -3% |
High PPBS-2% |
76%-all 3 present |
| What HbA1C should be considered as remission of Type II Diabetes? |
56% - <6 |
25%- 6- 6.5 |
14%-6.5-7 |
5%- Cant Decide |
| Do you think C- Peptide levels are important in treatment of diabetes |
83%-yes |
10%-no |
8% -don’t know |
|
| It is essential to estimate GAD antibodies before recommending Metabolic Surgery- |
79%- yes |
9% no |
12% -don’t know |
|
| Would you recommend metabolic surgery early before end organ damage? |
94%-yes |
2%-after |
5%-can’t decide |
|
| Metabolic surgery- Does it reverse the micro vascular disease (retinopathy, nephropathy, and neuropathy)? |
81%- yes |
3%- no |
15%- can’t decide |
|
RECOMMENDATIONS OF THE EXPERT PANEL.
- To provide metabolic surgery as an option to eligible patients early rather than as a last resort.
- To include metabolic surgery as an integral part of the treatment algorithm for T2DM in all patients with B.M.I > 27.5 and HbA1c > 7.5% despite fully optimized conventional therapy, especially if weight is increasing, or other weight responsive co-morbidities not achieving targets on conventional therapies. For example, blood pressure, dyslipidaemia and obstructive sleep apnea.[According to the expert panel a lower B.M.I cut off may be a reasonable guideline at the present stage.]
- To consider metabolic surgery as a experimental option in non obese( irrespective of B.M. I )patients with uncontrolled T2DM and collect data for future recommendations for the non obese and move towards a trend of deciding the need for metabolic surgery irrespective of the patient’s B.M.I
- To conduct further studies and randomized trials to evaluate and identify the best procedure for both obese and non-obese patients in India.
- Further research to elucidate mechanisms of metabolic surgery to facilitate the design of novel pharmacotherapeutics and dedicated antidiabetes GI manipulations.
- To conduct training programs among health professionals and surgeons to increase the manpower to combat the disease.
- To make Metabolic surgery an accessible, affordable option to all patients.
- To increase public awareness regarding Metabolic syndrome, Obesity, T2DM and Metabolic Surgery.
|