"An innovation will get traction only if it helps people get something that they're already doing in their lives done better".
There is now overwhelming evidence of the use of surgery as a powerful tool in the management of diabetes mellitus especially in people with a high BMI or inadequately controlled diabetes of the type II variety. Surgery improves type II diabetes in nearly 90 percent of patients by: lowering blood sugar, reducing the dosage and type of medication required and improving diabetes-related health problems. Surgery causes type II diabetes to go into remission in 78 percent of individuals by: reducing blood sugar levels to normal, eliminating the need for diabetes medications. This has also been seen in patients over a long time.
Recent studies have pointed towards the superiority of gastric bypass surgery over lifestyle-medical management albeit with greater adverse events including nutritional problems. The effects of surgery seem to wane with time in time and it needs to be seen who are the real beneficiary of this procedure.
However, the cornerstone of diabetes management is lifestyle and behavioural modification in the form of nutritional changes, increased exercise and motivation to do so over a prolonged period of time. Surgery alone is not the panacea of diabetes but sustained medical and lifestyle management is needed to reap the benefits of surgery and provide good long term results. Similarly, it is quite imperative that at diagnosis, the person is taken through a period of lifestyle adaptation and medical management before any surgery is done.
These need improved patient education, awareness and support right through the entire journey. There needs to be pragmatic thinking that even if we do well with surgery for 5-10 years, this is little in the long life of people. Now, with ever increasing life expectancy, this maybe an opportunity to improve the health of people not just from a medical perspective but also from a holistic perspective.
Mobile and digital health can play a very vital role. Dissemination of accurate information, education and engagement, monitoring of multiple parameters in real time and intervention including psychological and mental health in appropriate times can help give people with diabetes a voice and influence their own management in a positive way.
The shifting paradigm of management of diabetes with surgery throws up new challenges which necessitates closer monitoring and action for optimal results. It is imperative that people with diabetes need a coordinated multidisciplinary approach to care so that more but appropriate people can reap benefits.