Special Correspondent

‘But, it is to be done only if drugs, diet and insulin do not control the disease'

COIMBATORE: GEM Hospital here claimed on Saturday that an intestinal surgery has helped in curing people of diabetes, thereby changing the view held so far that the disease could not be cured but only controlled.

Yet, an explanation of the post-surgical regimen to be followed emphasised disciplined diet; one that had been advised for and adhered to by diabetics till the surgery. It also came with a note of caution that the surgery was only for persons in whom oral drugs, insulin, diet and exercise did not help in controlling diabetes.

“This is only for those in the ‘terminal' stage of diabetes,” Medical Director of the hospital and laparoscopic surgeon C. Palanivelu told presspersons. People who could control diabetes through time-tested methods should not rush to hospitals to undergo the surgery.

And, surgery did not lift the ban on diet control. Dr. Palanivelu pointed out that the surgery was only to reverse the situation from an uncontrollable stage and not to enable a diet holiday for the patients for the rest of their life.

The surgery involved the connecting of the distal portion (ileum) of the small intestine to the duodenum (the first part of the organ) by bypassing the middle portion, the jejunum.

The surgeon said this was an improvement on an earlier technique that involved connecting the ileum with the jejunum. This surgery was called ileal transposition and developed by Brazilan surgeon Aureo de Paula.

The transposition was said to help in increasing the secretion of the gastro-intestinal hormone Glucogon-like Peptide (GLP)-1. This hormone, in turn, helped in the increased secretion of insulin that was needed to process glucose. It also stimulated the Beta cells of the pancreas that produced insulin.

Inadequate insulin or resistance to insulin processing glucose led to diabetes, Dr. Palanivelu explained.

Dr. Paula improved upon this and developed the second type and this was called Duodenum-Jejunal Bypass. “The second type doubled the GLP-1 secretion over the first one,” Dr. Palanivelu said. Both types hastened the processing of the undigested food because of the transposition of the ileum. But, the second one did it at a faster pace, he said.

“We have done 35 cases using the second type of surgery and three with the first one. The results are good in both. The patients have reported normal sugar levels and have even been taken off drugs to control diabetes. They have also reported the reversal of micro-vascular problems that affect the kidneys, heart, liver, brain and the nervous system,” Dr. Palanivelu said.

“We, however, are into conducting a research on which of the two procedures is better,” he said.

As for the micro-vascular problems, he said the reversal could happen only if these were in the process of setting in and not if they had already done some damage to the organs.

Asked what sort of validation of the results had been done so far, he said the sugar level readings were an indication of the efficacy of the surgery. But, validation by diabetologists and endocrinologists would also be sought.

The surgeons would have to team up with these specialists to form guidelines on who could undergo the transposition or bypass procedures, popularly called diabetic surgery.

“We are looking at having a common platform (consisting of laparoscopy surgeons doing this procedure, the diabetologists and endocrinologists) and also the guidelines in place before the conference of the Association of Minimal Access Surgeons of India in Chennai in November this year,” he said.