AIIMS Expert Warns of India’s “Double Epidemic”: Uncontrolled Diabetes Can Be Controlled Through Surgery

At a press interaction in New Delhi, Dr. Manjunath Marutipol, Additional Professor, Department of Surgical Discipline, AIIMS, delivered a detailed and urgent explanation about what he calls India’s “double epidemic” — diabetes and uncontrolled diabetes. According to him, while diabetes is widely recognised, uncontrolled diabetes has silently grown into a severe national health threat, leading to rapid organ damage, disability and early mortality.

“Uncontrolled Diabetes Is an Epidemic in Itself”

Dr. Manjunath explained that people commonly understand diabetes only in terms of "too much sugar" or “control of sugar levels." But this is a misconception. “The primary focus of diabetes treatment is not just lowering sugar — it is preventing complications.” He emphasised that persistent uncontrolled diabetes leads to kidney failure, heart attacks, stroke, paralysis, limb amputations, and blindness. These life-altering consequences are the true danger.

Why India Is at High Risk: Thin-Fat Phenotype & Visceral Obesity

Research has consistently shown that Indians often fall under the “thin-fat” phenotype— looking thin externally but carrying high amounts of visceral fat around the abdominal organs.

This fat contributes to:

• Insulin resistance
• Metabolic syndrome
• Hypertension
• Lipid abnormalities

Referring to a 2025 Lancet paper, Dr. Manjunath noted: “BMI alone is not enough. Visceral adiposity is a major problem in Indian diabetics.”

When Is Diabetes Considered “Uncontrolled”?

Dr. Manjunath explained the globally accepted and AIIMS-specific criteria:

• Taking three or more diabetes medicines (with or without insulin)
• HbA1c persistently above 7.5 for at least two years
• Despite lifestyle changes and adherence to medication

He stressed that high HbA1c directly predicts organ failure. He gave practical timelines:

• HbA1c 12–13 → organ damage may occur within 6 years
• HbA1c 8 → risk increases in 8 years
• HbA1c below 6.5 → organ failure timeline may extend to 15 years

This, he said, is why maintaining HbA1c is critical.

Why Metabolic Surgery Becomes Necessary for Some Patients

Dr. Manjunath clarified that surgery is not the first treatment.
It is considered only after:

1. Diet modification

2. Lifestyle measures

3. Medications

When all three fail, surgery becomes a scientifically validated, globally recommended option.

He strongly clarified a common myth: “This is NOT a surgery on the pancreas. It is done on the stomach and intestine.”

How the Surgery Works

The procedure involves:

• Reducing the stomach size
• Connecting it to the small intestine
• Bypassing the duodenum

This leads to:

• Release of GLP-1 and other incretin hormones in physiological rhythms
• Reduction of anti-incretin factors
• Rapid improvement in blood glucose levels

Dr. Manjunath compared surgery with GLP-1 medicines, noting that medicines typically reduce HbA1c only moderately and can cause unhealthy weight loss due to protein deficiency, while surgery corrects hormonal pathways at the physiological level.

Immediate Benefits Seen in Patients

Dr. Manjunath shared striking clinical examples:

Case Example 1:

A patient with 15 years of diabetes and severe hyperglycemia (FBS 390, PP >400) refused insulin.
After surgery, he said, “nn the same day—Friday morning surgery, by Friday evening—his sugars were normal.”

Case Example 2:

Another patient’s HbA1c reduced from 11.7 to 7.6 in three months without medicines.

He added that in AIIMS:

• More than 100 surgeries have been performed
• 35% were purely for diabetes, not obesity
• Many had early-stage kidney issues that improved after surgery

He highlighted that proteinuria normalises, triglycerides improve, and progression of retinopathy is halted.

Safety: Why Surgeon Experience and Dedicated Centres Matter

Dr. Manjunath repeatedly stressed, “choose an experienced surgeon and a dedicated centre.”

Complications are rare but can occur if:

• Follow-up is poor
• Nutritional protocols (like essential protein intake) are ignored
• Surgery is done by inexperienced teams

He narrated a real incident where a patient suffered prolonged vomiting simply because she stopped consuming prescribed protein powder — a small but crucial detail that only trained centres handle well.

Can Diabetes Return After Surgery?

Dr. Manjunath explained:

• Diabetes can return only if patients go back to unhealthy lifestyles
• But 95% of patients maintain discipline because they feel they have been “reborn”
• Weight regain and diabetes recurrence occur in less than 5%

Age Criteria and Special Situations

Current guidelines allow surgery for:

• Ages 18 to 65
• Rare cases below 18 (e.g., a 16-year-old girl operated for obesity at AIIMS)

Don’t Wait for Organ Failure. Don’t Lose Hope.

AIIMS continues to refine and expand access to metabolic surgery, offering hope to patients living with uncontrolled diabetes across India.

Dr. Manjunath’s emphasises that there is option for uncntrolled diabetes.

1. Do not wait for irreversible organ damage.

2. Do not think you have no options. Surgery exists for those who need it.