Amid Surge In Uncontrolled Diabetes, AIIMS Calls For Wider Access To Metabolic Surgery

Although global guidelines have already recognised the metabolic surgery’s efficacy in diabetes management, fresh evidence from All India Institute of Medical Sciences (AIIMS) Delhi has reinforced that the procedure offer a critical lifeline to patients struggling with uncontrolled diabetes---helping them avert long-term damage to vital organs and, in many cases, freeing them from lifelong dependence on medication.

“In our cohort of 120 patients who underwent surgery for central obesity over the past 15 months, nearly 30% of those with uncontrolled diabetes were able to discontinue all diabetes medications after metabolic surgery,” said Dr. Manjunath Maruti Pol, Additional Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Delhi.

The findings show that timely surgical intervention can correct dangerous biochemical imbalances long before irreversible complications emerge. “People need not wait for their kidneys, eyes, nerves or heart to fail. There is a scientifically validated way out,” Dr. Pol, a bariatric and kidney transplant surgeon, said.

He noted that metabolic surgery was formally recognised in 2016 by international clinical guidelines, including those of the International Diabetes Federation (IDF), as an effective treatment for uncontrolled Type-2 diabetes—even among individuals who are not obese.

The AIIMS milestone offers a rare ray of hope for India, which, as Dr. Pol describes, is facing not just diabetes but a “double epidemic” of uncontrolled diabetes.

“Most people still think diabetes means only ‘high sugar, low sugar’,” he said. “What they do not realise is that persistently elevated glucose quietly and steadily injures the kidneys, eyes, nerves and heart for years—often without any warning.”

By the time many Indians receive a diagnosis, nearly 50% of their insulin-producing beta cells have already been destroyed, he explained. “And when a patient finally reaches the stage of requiring insulin injections, barely 10% of these cells are left.”

This silent decline, he stressed, is what makes timely metabolic intervention so critical.

Patients often live with the fear of kidney failure, heart attacks, amputations and blindness, he added. “But they must know there is a scientifically validated option available before organs begin to fail.”

He cited the example of a Member of Parliament with a BMI of 27 and HbA1c of 11.7, whose fasting glucose exceeded 300 mg/dL. “He had diabetes for 10 years. After metabolic surgery involving the stomach and intestine, he is now stable and off all medications,” Dr. Pol said.

On being asked how the surgery works, he clarified, “The objective is not weight loss. Metabolic surgery does not repair the pancreas. It works through the stomach and intestine.”

In the procedure, the stomach is reshaped into a small tube and a segment of the small intestine is bypassed. These re-routing boosts gut hormones—especially GLP-1—leading to improved insulin sensitivity, better cholesterol and triglyceride profiles, and overall metabolic correction.

Importantly, many patients show near-normal blood sugar levels from the very next day, far earlier than any weight loss can explain. “This confirms the metabolic and hormonal basis of the surgery,” he said.

Post-surgery, however, patients must adhere to lifelong follow-up such as good diet, exercise and nutritional guidance.

India has nearly 70 million people living with diabetes, and a rising share progressing to uncontrolled Type-2 diabetes. Delayed treatment, Dr. Pol cautioned, contributes to silent and often irreversible organ damage. While global HbA1c standards recommend maintaining levels below 7, India often considers 7.5 acceptable—worsening long-term outcomes.

Metabolic surgery, performed laparoscopically or robotically, costs between Rs3 lakh and Rs6 lakh. But Dr. Pol emphasised that preventing dialysis, amputations or cardiac events yields far greater long-term savings. “It is a classic case of a stitch in time saves nine.”

Conversely, patients with HbA1c between 6 and 6.5 do not require surgery and can manage through medication, diet and lifestyle changes. Surgery is less effective for patients with very long-duration diabetes (over 25 years) who rely on high-dose insulin—around 100 units a day. Those with Type-1 diabetes are not eligible, Dr Pol clarified.

The best candidates are those who have had Type-2 diabetes for 8–10 years, have persistently high sugars despite multiple medications, and are at high risk of organ damage.

A recent study from Dayanand Medical College & Hospital, Ludhiana, and Kular College & Hospital, Punjab, evaluating seven-year outcomes of a modified one-anastomosis gastric bypass (M-OAGB) in low-BMI but severely diabetic patients, has also shown significant improvement in glycaemic control and metabolic health. The study is published in the journal 'Obesity Surgery'.

“Metabolic surgery triggers powerful hormonal changes that restore glucose regulation independently of weight loss,” said Dr. Pol.

Calling for wider awareness, he added, “For many living with uncontrolled diabetes, this surgery may be the difference between a life threatened by complications and a life reclaimed. Accurate information must reach people—urgently and responsibly.”

Dr. Manjunath Maruti Pol, Additional Professor, Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Delhi