Metabolic surgery can help prevent organ damage, failure due to uncontrolled diabetes: AIIMS doctor

New Delhi: While uncontrolled diabetes is unfolding as a silent crisis in India, resulting in organ damage and failure, metabolic surgery can help prevent it, according to a doctor at the All India Institute of Medical Sciences (AIIMS) Delhi on Wednesday.

India is already known as the diabetes capital of the world, but Dr Manjunath Maruti Pol, Additional Professor, Department of Surgery at AIIMS, New Delhi, shared that uncontrolled diabetes is surging complications such as kidney failure, heart attacks, strokes, neuropathy, and retinopathy, among others.

In India, 70 million people suffer from diabetes, and 50 per cent of them have uncontrolled diabetes, shared the doctor, noting that the worldwide criteria for HbA1c (a measure of blood sugar control) is 7. But in India, it is 7.5.

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"Uncontrolled diabetes can be defined as when HbA1C levels continue to remain at 7.5 despite taking 3 or more than 3 medicines and controlling diet and lifestyle for at least 2 years," Pol said.

He stated that HbA1c is inversely related to the occurrence of complications. In other words, if HbA1c increases, organs will begin to fail in a short duration, leading to death.

"Surgery is now an internationally recommended treatment for selective uncontrolled Type-2 Diabetes Mellitus (T2DM)," the expert said. Surgery as a treatment for diabetes was formally recognised in 2016 by the International Diabetes Federation (IDF).

How it is done

According to the guidelines, this surgery can be performed on patients aged 18 to 65 years.

Unlike Type-1 diabetes, where surgery is conducted on the pancreas, the surgery for uncontrolled Type 2 diabetes is done on the stomach and intestine.

"The stomach is made small and small intestine is joined, with this, the stomach is sized like a tube, the size of that stomach varies depending on the metabolic profile of the patient, and small intestine, we join that small tube, so that the food goes directly to the intestine, bypassing the duodenum,” Pol said.

So when the food goes directly there, there are certain GLP or hormone release, in a physiological dose and rhythm, time, quantity, he added, noting that the surgery halts the damage.

"In our own retrospective analysis, we have performed over 100 surgeries, with 35 per cent on patients with uncontrolled Type-2 diabetes. All of them are currently off diabetes medications,” the expert stated.

He lauded the rapid pace of improvement post-surgery. Many patients show near-normal blood sugar levels from the first post-operative day, proving that the benefits are weight-independent.

“The cost of the surgery, done via laparoscopy or robotic, is between Rs 3 and 6 lakhs,” Pol said, adding that the benefits are indeed significant.

Metabolic Surgery Can Prevent Organ Damage in Uncontrolled Diabetes: AIIMS Doctor- chatgpt

New Delhi: With uncontrolled diabetes emerging as a silent but rapidly growing health crisis in India, metabolic surgery can play a crucial role in preventing organ damage and failure, said a senior doctor from the All India Institute of Medical Sciences (AIIMS), New Delhi, on Wednesday.

India, often referred to as the diabetes capital of the world, is witnessing a surge in diabetes-related complications, including kidney failure, heart attacks, strokes, neuropathy and retinopathy, warned Dr Manjunath Maruti Pol, Additional Professor, Department of Surgery, AIIMS Delhi.

Highlighting the magnitude of the problem, Dr Pol said that around 70 million people in India suffer from diabetes, and nearly 50 per cent of them have uncontrolled disease. While the global target for HbA1c — a key marker of blood sugar control — is 7 per cent, the acceptable threshold in India is higher at 7.5 per cent.

“Uncontrolled diabetes is defined as a condition where HbA1c levels remain above 7.5 despite the patient being on three or more medications and following diet and lifestyle modifications for at least two years,” Dr Pol explained.

He cautioned that rising HbA1c levels are directly linked to faster onset of complications. “As HbA1c increases, the risk of organ failure rises sharply, and in a short duration it can lead to fatal outcomes,” he said.

Dr Pol noted that surgery is now an internationally recommended treatment for select patients with uncontrolled Type-2 Diabetes Mellitus (T2DM). The role of metabolic surgery in diabetes management was formally recognised by the International Diabetes Federation (IDF) in 2016.

How the Surgery Works

According to established guidelines, metabolic surgery can be performed in patients aged 18 to 65 years. Unlike Type-1 diabetes, where surgical intervention involves the pancreas, surgery for uncontrolled Type-2 diabetes targets the stomach and small intestine.

“The stomach is reduced in size and reshaped into a tube, and the small intestine is connected in such a way that food bypasses the duodenum and reaches the intestine directly,” Dr Pol explained. This anatomical change triggers the release of beneficial gut hormones, such as GLP, in physiological doses, helping restore metabolic balance and halt organ damage.

Sharing outcomes from AIIMS, Dr Pol said that in a retrospective analysis of over 100 metabolic surgeries, nearly 35 per cent were performed on patients with uncontrolled Type-2 diabetes, and all of them are currently off diabetes medications.

“The improvement is remarkably rapid. Many patients achieve near-normal blood sugar levels from the very first postoperative day, indicating that the benefits are not solely dependent on weight loss,” he added.

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