Background:
Oman on the Arabian Gulf, sits within an Obesity belt, high on the global ratings for the disease. Diabetes type II increased significantly over the past decade to a prevalence of around 20%. The WHO, anticipated an increase of 190% in the twenty years till 2025. Till recently and as in other countries, the offer of surgery to ameliorate this problem has been a distant notion.
Objective:
To offer a glimpse of the influence of surgery done on Diabetic Obese patients at the biggest centre in Oman and the unique challenges faced to establish this.
Methods:
Retrospective analysis from a prospective data base of all patients operated for Obesity with or without Diabetes at the Royal hospital in Muscat, between January 2012 and December 2016
Results:
Surgery for Obesity and/ or its related complications was done in 237 patients. Of these, 84(35.4%) had either frank Diabetes 67(80 %) or Pre-Diabetes 17(20%).
The majority 76( 90.4%) had a Sleeve Gastrectomy (SG) alone, while 8(9.5%) underwent SG with Duodeno-jejunal bypass.
On follow up, preoperative mean FBS dropped from 8.1mmol to 5.0 while the HbA1c went from 9.5% to 5.7%. Alternatively, 84% and 70% stopped taking Oral hypoglycaemic and Insulin respectively. The surgical effect on the associated metabolic syndrome and lifestyle progress was also analysed.
Conclusion:
Surgery for Diabetes in Oman had an uphill challenge to establish itself, while backed by the growing global evidence to become part of the pathway of managing the disease .
Gastric sleeve remains the mainstay of practice, however If any ( more metabolic) bypass is to be done, it has to take in context the high prevalence of Gastric cancer in the region.
These early results are the first from Oman and are encouraging to expand this field of Metabolic surgery in Diabetes control.