Diabetes mellitus (DM) is a worldwide epidemic, which is on the rise without much cure. Besides, it’s associated with a number of short and long-term complications resulting in devastating late complications and reduced life expectancy.
is a major cause of morbidity in patients with diabetes mellitus. The incidence of blindness, for example, is 25 times higher in diabetic patients than in non-diabetic people.
If all complications of DM were combined, individuals with intensive diabetes management would experience 15.3 more years of life without significant microvascular or neurologic complications of DM, compared with individuals who received standard therapy. This translates into an additional 5.1 years of life expectancy for individuals in the intensive diabetes management group.
Eighty percent of patients with type 2 diabetes are obese or overweight, and weight reduction is one of the most efficient ways to achieve control of this illness. However, it is difficult to achieve normal blood sugar level readings with just the conventional treatments comprising diet, exercise, oral tablets and insulin.
On the other hand, impressive improvement in diabetic status of patients undergoing bariatric and metabolic surgery has stimulated interest in medical science as a potential cure for type 2 diabetes.
Research shows there are intestinal hormones that have a striking effect on pancreas and insulin secretion, especially in response to food intake. Thus Ileal Transposition was devised - a laparoscopic operation that is proving very helpful in controlling diabetes, and avoiding future diabetic complications.
A long segment of ilium (ending portion of small intestine) if shifted to the upper small intestinal area, where food particles reaching immediately after the meal can cause an immediate secretion of a hormone, GLP-1, which acts on the B-cells of pancreas to secret insulin, to immediately control blood sugar. If there is no intake of food, this will not happen, so there is no danger of low blood sugar (hypoglycemia).
Newer discoveries
It was originally thought that the control of diabetes was secondary to the resultant weight loss. However, more recently, it has been noted that insulin impairment is reversed merely days after a metabolic procedure and therefore, could not be solely due to the weight loss.
Ileal transposition takes around four hours and costs four to four-and-half lakh rupees. The patient can start walking the day after the operation and begin work in a week.
India has been declared the diabetic capital of the world. It is estimated that by 2025, India will be home to more than 80 million diabetics and most of these will be type 2 diabetics. Stress should be therefore laid on creating awareness of availability of the Ileal Transposition procedure as a cure to diabetes. The procedure should be able to do a lot of good for Indian diabetics.
This operation is ideal for surgical cure of diabetes in non-morbidly obese patients also, as there is no malabsorptive element leading to the weight loss. Patients can stop all medicines within few months, at times even within two to four weeks post the surgery. Good improvements are seen in their triglycerides, cholesterol and kidney functions as well as much relief in the case of leg pain.
Since there is no loss of intestinal length and no diversion of food, there are no long-term side-effects and no nutritional deficiency. The only lifestyle change required is that patients need to consume smaller portions of food at one time to enjoy a disease-free, longer and healthier life.
There is a role of Ileal Transposition for treatment of DM2 in non-morbidly obese patients. This procedure could resolve DM2 for patients who are facing serious life-threatening complications.
(The author is obesity bariatric surgeon, Seven Hills, Cumballa Hill and Agrawal hospital, Mumbai)
Published 20 February 2015, 15:47 IST