Times of India
06 June 2011
By Sumitra Deb Roy
Mumbai, India

A combination surgery involving the intestine and stomach offers ‘sweet’ tidings to the lean diabetics of the country who are otherwise not considered ideal candidates for surgical intervention to control the sugar disease. Currently, up to 11% of India’s urban population and 3% of the rural is believed to be suffering from diabetes.

A study by doctors at Bombay Hospital showed that by repositioning a portion of the intestine and at the same time reducing the size of the stomach, the production of diabetes–causing hormones in the body could be regulated successfully. The study recently published in the International Journal of Diabetes in Developing Countries underlined how the procedure, called Ileal Transposition with Sleeve Gastrectomy (SGIT), could offer hope to millions who suffer from Type II diabetes despite having normal weight.

As part of the study, five patients between the agegroup of 44 to 53 years and having a Body Mass Index (BMIs) between 23–35 had undergone the SGIT procedures. In less than six months following the surgery, three of them were completely taken off insulin, while two of them required just one basic diabetes medication in a day.

Stomach trimmed, hunger hormone cut
Mumbai: A team of doctors at Bombay Hospital studied the SGIT technique on five diabetic patients aged 44 to 53 and with a BMI between 25 and 35. In all five patients, the problem of uncontrollable sugar levels was successfully taken care of as their HbA1c (vital parameter to determine diabetes control) level had dropped below seven. While in a normal non–diabetic, the HbA1C is 3.5–5.5%, for diabetics about 6.5% is considered good. For all the five patients whose HbA1c levels were between 7.6 to 11.7% before the surgery, it had gone down to less than 6.5% after the procedure.

The principal investigator of the study, bariatric and metabolic surgeon Dr Ramen Goel, explained that SGIT represents a landmark treatment of Type–II diabetics in non–morbidly obese patients. Globally, sleeve gastrectomy is still considered a weight loss surgery for the morbidly obese.

But, the relevance of sleeve gastrectomy changes for diabetics as reducing the stomach size also brings down the production of the hunger–causing hormone Ghrelin. "Worldwide, scientists have found a correlation between the ghrelin hormone (which stimulates the brain, giving rise to an increased appetite) and diabetes," said Goel.

Sleeve gastrectomy is then combined with the ileal transposition surgery, wherein a small portion of the intestine is positioned closer to the stomach. Goel explained that the production of another hormone majorly associated with diabetes GLP–1 takes place at the end of the small intestine.

"In this surgery, we cut that portion of the intestine and place it next to the stomach. So, food that reached the end of the intestine in an hour now reaches in 10 minutes," he said. This automatically leads to a faster production of the GLP–1 hormone and boosting of insulin secretion.

India is the only country apart from Brazil to carry out the combined surgeries. A team of doctors in Hyderabad too is performing the surgery, believed to bring down insulin dependence in 90% of patients. A senior metabolic surgeon from a leading hospital, however, said that normal weighing patients also stand a chance of losing too much weight. "An additional risk of developing vitamin and iron deficiency also remains," said the surgeon.

Goel, however, defended the procedure saying that patients can fight Vitamin B 12 and iron deficiency simply by having supplements for a year. "The body weight of the patient also stabilizes after a few months," he added.

About The Surgery T he procedure could cost anything above Rs 3 lakh. It is only performed in two private hospitals of the city. The patient has to be on a strict diet regimen even after the surgery.

Deficiency of Vitamin B 12 and iron is common but supplements can fix that. Weight loss up to a kilo a month could happen in the period following the surgery.

Any diabetic who is not morbidly obese can also undergo the surgery. Mortality rate for the surgery is negligible, though normal surgical complications remain.

Who Qualifies For The Surgery

• Diagnosed with Type II diabetes for over a year
• Inadequately controlled blood glucose, or HbA1C over 7
• Both men and women aged between 25 and 65 years
• Able to provide informed consent
• Able to comply with follow–up procedures