A Potential Cure for Diabetes: Metabolic Surgery

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Today, 1 in 9 Singaporeans has diabetes. Can this breakthrough help us win the war against this “silent killer”?

Ever since the Ministry for Health declared a “War on Diabetes” in April 2016, this illness that hits without noticeable signs has been receiving considerable attention in Singapore. It was under the limelight once again in August last year when Prime Minister Lee Hsien Loong reiterated the idea during his National Day message and called upon Singaporeans to fight this debilitating disease.

This garnered much awareness across the country, and people have become more accepting, or even curious about this condition, according to Ms Heng Pei Yan, a diabetic patient who has lived with this illness for the past two decades since her diagnosis at the age of 10.

“However, one lingering misconception is that people with diabetes cannot eat anything sweet. That’s not true. We can eat everything. We just need to mind the quantity and adjust our insulin accordingly,” she explains.

Ms Heng used to be in denial, especially during her teenage years. “Back in high school and even university, I often skipped my lunchtime injections. I refused to deal with it or to be inconvenienced by it. Sometimes I would just plain forget,” she confesses.

However, an event organised by the International Diabetes Federation changed her perception towards her condition. It was an eye-opener for her and she decided to take greater ownership of her health. She even started a Facebook group called SGDoc (which stands for Singapore Diabetes Online Community) to help any diabetic patient in need of support and encouragement.

Treating Diabetes
It has been a known fact by now that to treat diabetes, one needs to control his blood sugar levels in the body. Most people do it by medications, dietary changes and exercise. But, did you know that there’s a surgical method to treat diabetes?

According to Dr Melvin Look, the Director and Consultant Surgeon at PanAsia Surgery in Mount Elizabeth Hospital and Parkway East Hospital during an interview with Exquisite, he shares his insights on this breakthrough in diabetes treatment.

“The first step to the treatment of diabetes is a calorie restriction diet to achieve a healthy weight,” explains Dr Look. “Oral medication and insulin injections are often required to bring down the blood sugar levels. Good control of this is the key to avoiding the end-organ complications of diabetes.”

However, he reveals that metabolic surgery may now be an excellent alternative for diabetic patients who want to consider surgery for a long-term cure. “Randomised control trials have shown that post-surgical patients showed better improvements in quality of life and overall health compared with those who only received medication alone,” notes Dr Look.

“One of the commonest metabolic surgery operation we do is the Laparoscopic Sleeve Gastrectomy. It is a keyhole surgical procedure that coverts the stomach into a long narrow tube about the shape and size of a banana. This limits the amount of food the patient can eat and enhances the effect of intestinal hormones to bring down blood sugar.”

Metabolic Surgery VS Medications
According to Dr Look, metabolic surgery is highly effective in helping obese diabetics lose their excess weight. “The majority of patients will achieve an excess weight loss of about 70 to 80% after 18 to 24 months. In addition, these operations also have a complex adaptive effect on our gastrointestinal hormones which play an important role in controlling blood glucose levels,” he explains.

As a result, this surgery has an additional beneficial effect on the control of diabetes beyond weight loss alone. “Almost all patients will experience an improvement in their blood glucose control. About 70% will require less medication or no medication at all,” says Dr Look.

So, will weight regain and recurrence of diabetes happen after the surgery? “Yes, but this is rare and usually in non-compliant patients who are not motivated in maintaining their dietary recommendations,” says Dr Look.

“It takes about 2 hours to perform this keyhole surgery, and the patient stays in the hospital for about 3 to 5 days. Majority of the patients are back to work and their normal routine 2 weeks after the surgery,” he continues.

Who should undergo the surgery?
He suggests that patients who require more than one medication for diabetes, or who are poorly controlled despite multiple medications, should consider surgery. “The best results are when patients come for surgery early, when they are young, rather than when they are older and have developed complications due to diabetes,” says Dr Look.

Risks and Side Effects of the Surgery
Dr Look explains, “Laparoscopic Sleeve Gastrectomy is a very safe operation and serious complications, such as bleeding and leakage of the staple line, are rare. The main long-term side effects are heartburn and reflux, especially if the patient is already prone to this even before the surgery.”

The estimated total cost is between $25,000 and $40,000, depending on hospital preferred and whether there are associated medical problems which require concomitant management. Many medical insurance policies do cover for these surgeries if the indication is medical and not cosmetic for elective weight loss alone.

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