Friday, September 30, 2016

A New Ray of Hope for Obesity Related Diabetic Patients Across India

India’s population is the third most obese in the world and obesity is the number one cause of type-II diabetes in India. 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 a ethnic and genetic predisposition for developing diabetes at a younger age and at lower body mass index than the Caucasian population.

90 percent 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 the 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 see any impact on the weight and or control on their diabetes have a ray of hope to look forward too. 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, data from study titled COSMID was presented that demonstrates ‘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 (Comparison of Surgery vs. Medicine for Indian Diabetes) Trial is the first randomized 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 patient’ 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 kgs and was on insulin. Being a teacher, she had challenges in travelling and working for 8 hours. Frequent hypoglycemia and giddiness was about to make her lose her job. She already had started neuropathy and kidney disease. After Gastric Bypass she is completely off all treatment for diabetes, she now feels much more energetic and has normal kidney function. She says, “In this era of advanced medicine, I was extremely worried about my kids and was feeling helpless because of my increasing diabetic complications. Gastric Bypass has saved not just me but my family”

Bariatric Surgery recognized as a permanent weight loss solution for people with high BMI or Body Mass Index or those categorized as obese. Over the years, globally it has been seen 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 a path breaking and the first of its kind, evidence which may change the guidelines for treatment for patients with type-II diabetes which cannot be controlled by medication.

By Dr Shashank Shah, well known Bariatric Surgeon 
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