Chairman

Institute of Minimal Access, Metabolic & Bariatric Surgery (iMAS) Sir Ganga Ram Hospital | New Delhi

Medical Director

Bhatia Global Hospital & Endosurgery InstitutePaschim Vihar | New Delhi
  • What is Diabetes Surgery
  • Metabolic surgery

What is Diabetes Surgery


Dr. Francine Kaufman coined the term diabesity (diabetes + obesity). Diabesity can be defined as a metabolic dysfunction that ranges from mild blood sugar imbalance to full-fledged type 2 diabetes. 

Recommendation
 
• At each patient encounter, BMI should be calculated and documented in the medical record.
 
DIET, PHYSICAL ACTIVITY AND BEHAVIORAL THERAPY  
 
Recommendations                                                     
 • Diet, physical activity, and behavioral therapy designed to achieve .5% weight loss should be prescribed for overweight and obese patients with
type 2 diabetes ready to achieve weight loss.
• Such interventions should be high intensity (<16 sessions in 6 months) and focus on diet, physicalactivity, and behavioral strategies to achieve a
500–750 kcal/day energy deficit.
• Diets should be individualized, as those that provide the same caloric restriction but differin protein, carbohydrate, and fat content are equally 
effective in achieving weight loss.
• For patients who achieve short-term weight loss goals, long-term (<1-year) comprehensive weight maintenance programs should be prescribed.
 Such programs should provide at least monthly contact and encourage ongoing monitoring of body weight (weekly or more frequently),
continued consumption of a reduced calorie diet,and participation in high levels of physical activity (200–300 min/week).
 • To achieve weight loss of .5%, short-term (3-month) interventions that use very low-caloriediets (#800 kcal/day) and total meal replacements
may be prescribed for carefully selected patients bytrained practitioners in medical care settings with close medical monitoring. To maintain weight loss, such programs must incorporate long-term comprehensive weight maintenance counseling (weekly or more frequently), continued.
 
PHARMACOTHERAPY
 
Recommendations 
 
• When choosing glucose-lowering medications for overweight or obese patients with type 2 diabetes, consider their effect on weight.
• Whenever possible, minimize the medications for comorbid conditions that are associated with weight gain. Weight loss medications may be effective as
adjuncts to diet, physical activity, and behavioral counseling for selected patients with type 2 diabetes and BMI <27 kg/m2. Potential benefits
must be weighed against the potential risks of the medications.  
• If a patient’s response to weight loss medications is, >5% weight loss after 3 months or if there are any safety or tolerability issues at any time,
the medication should be discontinued and alternative medications or treatment approaches should be considered

 
METABOLIC SURGERY                                                     
 
 Recommendations
 • Metabolic surgery should be recommended to treat type 2 diabetes in appropriate surgical candidates with BMI <40 kg/m2 (BMI <37.5 kg/
m2 in Asians), regardless of the level of glycemic control or complexity of glucose-lowering regimens, and in adults with BMI 35.0–39.9 kg/
m2 (32.5–37.4 kg/m2 in Asian Americans) when hyperglycemia is inadequately controlled despite lifestyle and optimal medical therapy Metabolic
surgery should be con- sidered for adults with type 2 diabetes and BMI 30.0–34.9 kg/m2 (27.5–32.4 kg/m in Asian Americans) if hyperglycemia is
inadequately controlled despite optimal medical control by either oral or injectable medications(including insulin).
• Metabolic surgery should be performed in high volume centers with multidisciplinary teams that understand and are experienced in the management
of diabetes and gastrointestinal surgery.
• Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery,
according to guidelines for postoperative management of metabolic surgery by national and international professional societies.
• People presenting for metabolic surgery should receive a comprehensive mental health assessment.
Surgery should be postponed in patients with histories of alcohol or substance abuse, significant depression, suicidal ideation, or other mental
health conditions until these conditions have been fully addressed.
• People who undergo metabolic surgery should be evaluated to assess the need for ongoing mental health services to help them adjust to medical and
psychosocial changes after surgery.