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UWI TODAY
– SUNDAY 4 MARCH, 2018
MEDICINE
Type 2 diabetes has reached epidemic proportions
in
Trinidad andTobago.The International Diabetes Federation
puts the number of adult cases at 117,400. Region-wide the
number of cases is estimated to be between 10 to 15 percent
of the adult population. The disease takes lives and limbs,
an estimated 500 limbs per year in Trinidad alone, says
Health Minister Terrence Deyalsingh. The Minister put its
annual cost to T&T at $3.5 billion.
Yet type 2 diabetes is a lifestyle disease, so the
standard treatment has been, along with diet, exercise and
medication, to make better lifestyle choices. Doctors have
possibly found a better way: surgery.
“The data is so strong to use surgery to treat diabetes
that in the future hopefully when someone gets the disease
it will be treated just like appendicitis,” says Professor Dilip
Dan, head of the Department of Clinical and Surgical
Sciences at UWI’s Faculty of Medical Sciences. “You
consider surgery for it.”
In an interview at his office at the Eric Williams
Medical Sciences Complex, Professor Dan spoke about
his vision for metabolic (diabetes or other metabolism-
related) surgery in T&T and the Caribbean. The interview
followed his February 1 professorial lecture held at the
Daaga Auditoriumat the St. Augustine Campus.The packed
lecture, titled “Crossing Boundaries: FromScarless Surgery
to Surgery for Diabetes,” was very much a snapshot of his
career as a pioneering surgeon and educator.
Professor Dan placed special emphasis on metabolic
surgery:
“It’s hard to conceptualise taking a lifestyle disorder
and having surgery for it. You have no diseased organs.
But the surgery changes some things so that your intestinal
hormones work in a different way improving glucose
control. And the results have been phenomenal.”
Numerous studies have shown incredible results for
Diabetesmellitus type 2 patients throughmetabolic surgery.
Studies have shown that patients who had the surgery
within five years of their diagnosis have a greater than 70
to 75 percent chance of complete remission. Between 83
and 85 percent of patients experienced early (within days)
and sustained improvement over five years.
“Sustained” is the key word, because like most lifestyle-
based treatments, traditional medical treatment for diabetes
depends on the patient changing how they live. This is
notoriously difficult to maintain.
“When you look at themedical treatments (medication,
diet and exercise), the patient’s blood sugar comes down
but this is not sustained over time,” Professor Dan says.
Interestingly enough, the results of metabolic surgery
were initially the unintended outcome of another type of
surgery. Bariatric surgery (gastric bypass) is a procedure
that reduces the size of the stomach and bypasses the small
intestine to spur weight loss. The surgery is extremely
effective. However, surgeons noticed that within days of
carrying out the procedure, patients with diabetes were
experiencingmajor positive effects within a few days. Many
were off diabetes medications in less than a week.
The surgery reactivates hormones in the small
intestine that stimulate insulin production and receptivity.
The prevailing theory is that by bypassing the proximal
small intestine where hormone-producing cells are
defective, the food gets access to the normal ones further
down thereby improving gut hormone production.
“If we had to re-invent diabetes today it wouldn’t
be a disease of the pancreas it would be a disease of the
small intestine,” Professor Dan says, quoting Professor
Paul Teelucksingh, who has done considerable work in
the area of diabetes.
With its effectiveness, metabolic surgery has become
an increasingly compelling treatment for type 2 Diabetes.
In September 2015, at the 2nd Diabetes Surgery Summit
in London, the leading diabetes agencies from around
the world agreed that the surgery should be included to
the algorithm for the treatment of the disease. In T&T,
metabolic surgery is practised by private doctors and was
also on a lesser scale in the public health system due to
budgetary constraints.
“In the future we should consider metabolic surgery
as a first line treatment for newly diagnosed young
diabetics. When you are young, newly diagnosed, you
have your whole life ahead of you. That is the best time
to fix it. If you wait ten years when complications set in
then reversibility is affected.”
Professor Dan concedes that there will always be
risk in a surgical procedure. But the risk of the disease far
outweighs the surgery, especially since the development
of minimally invasive (laparoscopic) surgical procedures.
In fact, the professor is the pioneer of laparoscopic
surgery in the region and has trained a cadre of surgeons
throughout the Caribbean in the method.
“Surgery is the love of my life,” he says. “As a young
doctor, if you are a person who wants to see results and
you want to see them quick then surgery can offer you
that.” He adds, laughing, “now with it comes risk and
stress.”
As does the position he has held as the Head of
Clinical and Surgical Studies at The UWI. And unlike
surgery, progress can be slow in administration.
Nevertheless he is pleased with the progress he has made
at the Faculty of Medical Sciences and looks forward to
doing more to enhance medical education in T&T and
the region. In particular, he is focusing on postgraduate
education to improve the quality of new doctors.
Asked about the professorial lecture, he says: “I
was quite happy to see that the hall was filled. That
makes you feel appreciated. It makes you feel that the
contribution you have made has helped to change the
lives of a lot of people. I don’t mean just patients, but all
the medical students and the doctors in training at the
post-grad level.”
And with his work and advocacy for metabolic
surgery, perhaps the next milestone for which Dilip Dan
will be remembered is contributing to the defeat of the
scourge of type 2 diabetes.
Metabolic Surgery for Diabetics
Doctors find an unexpected bonus
B Y J O E L H E N R Y
Professor Dilip Dan with his wife Sarita and daughter, Anjanaa,
and son, Pavan at his Inaugural Professorial Lecture on February
1. The lecture, delivered to a packed Daaga Auditorium, was titled
“Crossing Boundaries: From Scarless Surgery to Surgery for Diabetes.”
PHOTOS: KEYON MITCHELL
PROFESSOR DILIP DAN:
“Surgery is the love of my
life. As a young doctor,
if you are a person who
wants to see results and you
want to see them quick then
surgery can offer you that.”
