Exquisite March 2018

Wellnessdiabetes
A Potential Cure for Diabetes:
Metabolic Surgery
Today, 1 in 9 Singaporeans has diabetes. Can this breakthrough help us win the war
against this “silent killer”? By Alan Li
Treating Diabetes
It has been a known fact by now that to treat diabetes, one
needs to control his blood sugar levels in the body. Most
people do it by medications, dietary changes and exercise. But,
did you know that there’s a surgical method to treat diabetes?
According to Dr Melvin Look, the Director and Consultant
Surgeon at PanAsia Surgery in Mount Elizabeth Hospital and
Parkway East Hospital during an interview with Exquisite, he
shares his insights on this breakthrough in diabetes treatment.
“The first step to the treatment of diabetes is a calorie
restriction diet to achieve a healthy weight,” explains Dr Look.
“Oral medication and insulin injections are often required to
bring down the blood sugar levels. Good control of this is the
key to avoiding the end-organ complications of diabetes.”
However, he reveals that metabolic surgery may now be an
excellent alternative for diabetic patients who want to consider
surgery for a long-term cure. “Randomised control trials have
shown that post-surgical patients showed better improvements
in quality of life and overall health compared with those who
only received medication alone,” notes Dr Look.
“One of the commonest metabolic surgery operation we do is
the Laparoscopic Sleeve Gastrectomy. It is a keyhole surgical
procedure that coverts the stomach into a long narrow tube
about the shape and size of a banana. This limits the amount
of food the patient can eat and enhances the effect of intestinal
hormones to bring down blood sugar.”
Dr Melvin Look
Metabolic Surgery VS Medications
Who should undergo the surgery?
According to Dr Look, metabolic surgery is highly effective in
helping obese diabetics lose their excess weight. “The majority
of patients will achieve an excess weight loss of about 70
to 80% after 18 to 24 months. In addition, these operations
also have a complex adaptive effect on our gastrointestinal
hormones which play an important role controlling blood
glucose levels,” he explains.
He suggests that patients who require more than one
medication for diabetes, or who are poorly controlled despite
multiple medications, should consider surgery. “The best
results are when patients come for surgery early, when they are
young, rather than when they are older and have developed
complications due to diabetes,” says Dr Look.
Ever since the Ministry for Health declared a “War on
Diabetes” in April 2016, this illness that hits without
noticeable signs has been receiving considerable
attention in Singapore. It was under the limelight once
again in August last year when Prime Minister Lee Hsien Loong
reiterated the idea during his National Day message, and called
upon Singaporeans to fight this debilitating disease.
This garnered much awareness across the country, and people
have become more accepting, or even curious about this
condition, according to Ms Heng Pei Yan, a diabetic patient who
has lived with this illness for the past two decades since her
diagnosis at the age of 10.
Ms Heng used to be in denial, especially during her teenage
years. “Back in high school and even university, I often skipped
my lunchtime injections. I refused to deal with it, or to be
inconvenienced by it. Sometimes I would just plain forget,” she
confesses.
However, an event organised by the International Diabetes
Federation changed her perception towards her condition. It
was an eye-opener for her and she decided to take greater
ownership of her health. She even started a Facebook group
called SGDoc (which stands for Singapore Diabetes Online
Community) to help any diabetic patient in need of support and
encouragement.
As a result, this surgery has an additional beneficial effect on
the control of diabetes beyond weight loss alone. “Almost
all patients will experience an improvement in their blood
glucose control. About 70% will require less medication or no
medication at all,” says Dr Look.
So, will weight regain and recurrence of diabetes happen after
the surgery? “Yes, but this is rare and usually in non-compliant
patients who are not motivated in maintaining their dietary
recommendations,” says Dr Look.
“It takes about 2 hours to perform this keyhole surgery, and the
patient stays in the hospital for about 3 to 5 days. Majority of
the patients are back to work and their normal routine 2 weeks
after the surgery,” he continues.
Risks and Side Effects of the Surgery
Dr Look explains, “Laparoscopic Sleeve Gastrectomy is a very
safe operation and serious complications, such as bleeding
and leakage of the staple line, are rare. The main long-term
side effects are heartburn and reflux, especially if the patient is
already prone to this even before the surgery.”
The estimated total cost is between $25,000 and $40,000,
depending on hospital preferred and whether there are
associated medical problems which require concomitant
management. Many medical insurance policies do cover for
these surgeries if the indication is medical and not cosmetic for
elective weight loss alone.
“However, one lingering misconception is that people with
diabetes cannot eat anything sweet. That’s not true. We can eat
everything. We just need to mind the quantity and adjust our
insulin accordingly,” she explains.
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