The medical world is of the view that Metabolic Surgery is the most suitable treatment procedure for type 2 diabetes mellitus. In general bariatric procedures have proved how efficacious in controlling the complications of Type Two Diabetes Mellitus[T2DM]. Better glycemic control, durable weight loss and overall improvement in quality of life can be achieved using bariatric procedures more especially metabolic surgery.
Metabolic Surgery can be divided into restrictive and combination type
Restrictive Metabolic Surgeries
Malabsorptive type [bilio-pancreatic division with duodenal switch (BPD/DS)], laparoscopic adjustable gastric banding (LAGB) or laparoscopic sleeve gastrectomy (LSG)] and
Combination type Metabolic Surgeries
Both above types of metabolic surgeries are helping in achieving diabetes remission using different ways, depending on the degree of the physic-anatomical alteration of gastro-intestinal tract.
Durable weight loss can be achieved by inducing rapid nutrient delivery to the hindgut, reducing adipocyte mass. Other possible benefits could be improved insulin resistance, decrease in satiety.
One of the important aim of metabolic surgeries is halt the progress of diabetes disease by regulating the glycemic in the long run, other supplementary benefits include reduction of cardiovascular risk. Research in US has found that only 50% of diabetic population is able to achieve glycated haemoglobin with medical therapy. At the same time Bariatric Surgery is able to achieve better diabetic remission.
Now lets try to understand how bile acid and microbiota play a crucial role in controlling T2DM.
Hepatic metabolism is impacted with the release of incretin when Bile acids act as key stimulus for the farnesoid X receptor. Post operative increases in bile acids can contribute to the metabolic benefits of bariatric surgery.
The presence of microbiota in the intestines impacts the control of energy metabolism. Altered gut microbiota is one of the root cause of obesity in humans.
Some animal studies have shown altered gut microbiota when probiotics like lactic acid bacteria was added as part of diet in obese mice. Further human studies are being done to understand how weight-gain suppression can be achieved using probiotics.
Metabolic Surgeries in early obese diabetics
Very good levels of glycemic control & weight loss can be derived if bariatric surgery is done in early stage of diabetic onset in the obese. A study found people with BMI of of 30-35 kg/m2 glycemic control was better than those with higher BMI.
Other studies also point at how effective metabolic surgeries were in achieving glycemic control in advance T2DM cases.
This better glycemic control in less obese people also has long term benefits like decreased risk of cardiovascular ailments.
When to opt for Metabolic Surgeries
Ideally poorly managed diabetic patients whose BMI is greater than 35 kg/m2 should consider surgical procedures. In this set of obese people if the subjects are poorly managing their diabetic problem, like not actively going for physical exercises or not disciplining their food habits then they are the right candidates for metabolic procedures.
Metabolic profile of obese patients needs to be analyzed by a qualified bariatric surgeon before they can take a call on the suitability of bariatrics in solving their obesity.