View of Dr Banshi Saboo, Diabetologist, President Indian Obesity Society
We are now at a same platform, to discuss about obesity is an area where bariatric surgeons come into the picture. Now I call on the metabolic surgeons, because they are the ones who cure the diabetes, or they can keep patients for a long period of time on remission from it. But that does not mean that all the patients need this, because in India, there are different types of situations.
We don’t have all patients who are obese and suffering from type-2 diabetes, and we have patients who are lean and normal of weight and BMI too. At present I am interested in patients, where the issue of weight gain is a problem, and the diabetes is not getting under control, though he has undergone multiple therapies, or who have developed diabetes because of huge BMI, I generally refer such patient to my colleagues to see if can help in getting them cured. But the debatable issue will always be there that, can we cure all type-2 diabetes patients, who may not fit into the ideal situation of being obese, or a type-2 diabetes or overweight that will always remain a debate. So I will keep fighting for that situation, where these patients are controlled better with administering medication.
Bariatric surgery should be part of complete management for the type-2 diabetic patients. I fully agree with Dr Mahendra Narvaria, we are not debating or competing with each other, our field is being a diabetologist, and I would like my patient to have best control of diabetes, whatever the best medication and procedure which is available in the market.
For instance we put the patient on an insulin pump; it is because now we know there is an implantable insulin pump which is available. This is the time when we should refer the patient to metabolic surgeons, a few may not get full remission, but their dependence on medication goes now down considerably. We all should work together, for the better care of our patients.
Post bariatric surgery the medication requirement will be very low, so we can put them on very small doses of medicine. We have medical management post-surgery. After the surgery a patient requires the assistance of a good nutritionist, metabolic surgeons have good nutritionists, but they send them to us and we guide them.
View of Dr Mahendra Narvaria, Bariatric Surgeon
We have seen a number of patients, who were not responding to the therapies given to them by the diabetologist, their diabetes has been controlled after the surgery. If we can give 10 years of a diabetes free life then, this is the biggest achievement of science today. So we want to offer this surgery to those who are morbidly obese, have a BMI more than 32.5 with diabetes, we can cure the diabetes. We are complimenting each other, one diabetologist can’t treat the whole world, so by doing the bariatric surgery, the diabetes practice will go down.
Presently we have gastric bypass, sleeve gastrostomy is routinely being done. After the surgeries patient can have a good control over diabetes, hypertension and other complications.
All metabolic problems we can be managed with this surgery. We now have 95 per cent remission rate of diabetes in gastric bypass route, and 85 per cent in MGP (Matrix gla protein) group. We have followed these patients for over 10 years now, and only 5 per cent of them develop diabetes again. After the surgery many of the patients will stop taking insulin, few who develop diabetes will require very a minimal dose. We have observed long term results of every surgery.