India is home to nearly 62 million diabetics – second only to China which has over 92 million diabetics.
Diabetes management has become a huge business opportunity and the last few years have seen an array of non-intrusive insulin delivery methods and non-needle glucose monitoring systems – flooding the markets in different shapes, sizes and price tags.
A recent such discovery which is likely to reach diabetics in the next few years is by tech giant Google – where the company is testing a ‘smart contact lens’ that can help measure glucose levels in tears.
Google’s new ‘Smart Contact Lenses’ are good, but the key issue was never measurement of blood sugar – most of the experienced diabetics know their average blood sugar levels.
However, it will be an excellent tool for new diabetics, who are also not averse to wearing contact lenses.
While the focus of majority of this research happening worldwide today is aligned with the goal of diabetes treatment i.e. to achieve and maintain healthy blood glucose levels, it is also necessary to look at its life-long cost implications.
A majority of diabetics are unable to keep sugars under control despite adequate medication and follow ups. This is because the primary pathology in type 2 diabetics is not insulin deficiency but body’s resistance to insulin.
In view of the rising demand for insulin in the country, there is a pressing need for the government and the regulator to bring the prices down. The newer insulin products and analogues are costlier than older ones and out of reach for many patients.
In some cases, even treatment with insulin does not help in sugar control in many patients.
Social media has seen a deluge of diabetes afflicted men and women expressing their angst and seeking remission as against management… here’s where metabolic surgery comes in.
We now have the opportunity to redirect the diabetes care from just plain management to sustainable remission.
Metabolic surgery which was started in 1950s primarily for weight loss in significantly obese people was seen to result in diabetes control in most of the patients. Since 2004, various research studies have shown that 80-90 percent diabetic patients may have remission of diabetes post this surgery.
Remission is defined as normal blood sugar levels without requirement of medicines.
Initially considered a side benefit of weight loss procedure, now it has been accepted that diabetes remission is a direct impact of this surgery and not an after effect of weight loss.
In most of the patients, blood sugar becomes normal within 3-7 days after the surgery, even before any substantial weight loss begins. This surgery impacts the intestinal hormones called incretins, which are now believed to be responsible for type 2 diabetes.
Metabolic surgery has been accepted by International Diabetes Federation (IDF), American Society of Metabolic & Bariatric Surgery and Obesity Surgery Society of India. Now, this surgery can even be offered to non obese (>27.5 BMI) Asian diabetic patients, as mentioned in IDF position statement.
The purpose of such surgery is not weight loss any more but diabetes control only. This change in approach has given benefit to millions of non-obese diabetic Indians.
The results here have also become better with time. Surgeons like Francesco Rubino, Phil Schauer etc have demonstrated exceptional documented results.
It is a matter of time before the tables are turned and 80 percent diabetic Indians will not only be controlled diabetic but also have freedom from daily injections or consuming tablets for sugar control.
By 2030, India’s diabetes numbers are expected to cross the 100 million mark according to a 2012 report by International Diabetes Federation. The economic burden due to diabetes in India is among the highest in the world.
In the Middle East too, where I consult patients regularly, the prevalence of type 2 diabetes has increased dramatically over the last three decades. As many as six Middle East countries are among the Top 10 countries globally in terms of T2D prevalence – Kuwait (24 percent), Qatar (23 percent), Saudi Arabia (23 percent), Bahrain (22 percent), UAE (19 percent) and Lebanon (17 percent).
These are large numbers and we need to train more young doctors, who in turn will take the message of remission to more and more people across the world.
(Mumbai-based Ramen Goel is one of India’s senior-most metabolic and bariatric surgeons and a pioneer in diabetes remission through surgery. The views expressed are personal)