Diabetes is the main metabolic disease of interest currently worldwide. Why? The following can explain:
- Currently 371 million people have DM worldwide.
- 8 million people died of DM complications only in 2012.
- The ONLY chronic disease that has not decreased in the last 20 years (increasing in every country).
- Number expected to double by year 2030.
- 6 trillion US dollars will be spent annually on DM complications in the next 30 years (13-15 thousand $ annually per patient, 471 billion dollars spent in 2012 alone).
In Jordan, it has to become the main interest, since Diabetes and obesity are on the rise, and affecting the younger generation, unfortunately, increasingly. 24.9 % of the Jordanian population either has Type II Diabetes or Borderline Diabetic. The burden financially on such a small country is horrendous. According to studies from National Diabetes center by Dr. Kamel Al-Ajlouni, it is estimated that Diabetic patients cost 1.2 billion Jordanian dinars in direct and indirect way. Such a burden cannot continue, it has to be tackled by individuals, families, schools, hospitals, Ministries, and the government.
It is our duty in GBMC and Jordan Hospital to educate people that there is a solution to this metabolic problem to many people, especially if uncontrolled and is associated with obesity (Body Mass Index (BMI) > 30 Kg/m2). Medical control, Weight loss programs, and surgical procedures are offered. However, the bariatric literature and now the International Diabetes Federation (IDF) support bariatric surgery, especially gastric bypass (Laparoscopic Roux-En-Y Gastric Bypass (LRYGB)) for patients with BMI > 35 Kg/m2 as a primary option, or a secondary option for patients with BMI > 30 Kg/m2.
It carries high remission rates: 84-95% in patients diagnosed early (< 5 years), and a lower rate of remission after 10 years (55%). STAMPEDE Trial at Cleveland Clinic has put any doubts about the superiority of LRYGB compared to Sleeve Gastrectomy and intensive medical control to rest. LRYGB also offers the patients resolution of some of the complications of Type II Diabetes like Nephropathy (effects of DM on the Kidney).
A lot of studies are ongoing to understand the mechanism of remission, which is not fully understood yet. But to date, Bariatric surgery offers the patients, remission, improvement, or at least control of their Diabetes, and a long-term weight loss.
Duodenal Switch operation (BPD/DS) was studied only in the surgical literature. It is superior to gastric bypass in weight loss and Diabetes remission. Click here for more information on the procedure. It can offer long-term Diabetic patients (> 10 years), or Insulin requiring Type II Diabetes remission rates higher than 80%.
All these procedures can be done at GBMC and Jordan Hospital with great success, low complication rates and great patient satisfaction.