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.
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