Surgical Treatment of Type 2 Diabetes

According to the International Diabetes Organization, one in every 11 adults has diabetes around the World. There are 415 million people whor are trying to deal with disease. The Numbers are continue to rise gradually.

Countries mostly spend % 12 percent of their health budgets for diabetic patients. Every 6 seconds a person dies due to diabetes and its related diseases. While the incidence of diabetes was 7.2-11.4 percent in 2015, $ 673 billion was paid for healthcare spending.

Type 2 diabetes is the most common type, accounting for about 90 percent of all diabetes cases. The incidence of diabetes is increasing between the ages of 40-59 and most people who have type 2 diabetes may not know that they are sick. The latest estimates show a global prevalence of 382 million people with diabetes in 2013, expected to rise to 592 million by 2035.

A cross-sectional survey, TURDEP conducted in 1997-1998, comprising a nationally representative sample of 24.788 adult showed that the prevalence of diabetes was 7.2 but it rapidly increased to % 16.2. The number of people with diabetes has increased by 90 percent and the number of obese people by 44 percent in the last 10 years. 33 percent of Turkish people are obese and two out of three are overweight.

Unhealthy eating habits, physical inactivity and growth in the number of older persons are the leading causes of diabetes.

Diabetes is not just an irregular sugar level. It is a metabolic disease and a serious health problem waiting for an urgent solution at the global level. Constant high blood sugar can lead to blindness, loss of limbs, heart attacks and kidney diseases.

Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. Obesity and physical inactivity are both independent risk factors for type 2 diabetes. 90 percent of diagnosed cases are type 2 diabetes.

Type 2 diabetes is directly linked to the gastrointestinal tract. Various medications can be used in medical treatment. Typically, the doctor will recommend insulin when a combination of non-insulin drugs is no longer enough to control blood sugar levels. Because people are not willing to quit their bad eating habits, number of diabetics are continue to rise. So there is a need for long term solutions. Since 2016, the option of metabolic surgery has been added to diabetes treatment.

Weight loss surgery, demonstrated to successfully achieve meaningful and sustainable weight loss in a large number of patients who undergo these procedures. Additionally, the benefits observed across a number of metabolic disorders such as type 2 diabetes mellitus and hyperlipidemia, are often to a degree, independent of the weight loss. Reducing the excess body fat, basically solved the problem. Attempts for the small intestine, which play an important role in insulin regulation, have become prominent. Hormones secreted from the small intestine, such as GLP-1 ive GIP, increased insulin secretion and efficacy and delayed gastric emptying, causing a feeling of satiety. Because of these effects, the term metabolic bariatric surgery has become a better descriptor.

 

Who are the candidates of Diabetes Surgery?

1- Type 2 diabetics

2- Type 2 diabetics whose blood levels cannot be controlled by drugs and insulin

Different methods such as sleeve gastrectomy, gastric by pass, doudenal switch, SADI-S, Partition, Ileal interposition are can be performed, depending on surgeon and patient.

 

Selection of Surgical Methods

To determine which variety of bariatric surgery is the best for person, depends on the degree of patient’s obesity. There are different types of obesity categories:

1st grade obesity: Body Mass Index (BMI) 30-35

2nd grade obesity: BMI 35-40

3rd grade obesity: BMI 40 and above

While tube stomach and similar methods are sufficient in 3rd grade morbid obese patients, operations such as Partition, SADI-S should be recommended for 1st and 2nd grade patients.

Ninety-five percent of bariatric operations are performed with minimally invasive laparoscopic technique. Open surgery is not applied unless it is necessary. The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Patients may need to be hospitalized for 3-4 days.

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