Stringent research and medical advancement have now rendered the fallacy of diabetes being an incurable disease as untrue.
This was the basis of over a decade of research and findings put forward by Honorary Consultant Professor of Diabetes, Metabolic Medicine, Endocrinologist, Bariatric Physician Dr Iskandar Idris.
Speaking exclusively to Business Today recently, Professor Dr Iskandar, who hails from Butterworth, said recent interest has emerged regarding the effects of Very Low-Calorie Diet (VLCD) in people with type 2 diabetes. He performed many systematic reviews to investigate the effects of VLCD on HbA1c (a blood test which measures one’s average blood sugar levels over the past 3 months), weight and cardiovascular risk profile outcomes as well as its safety and tolerability among people with Type 2 Diabetes.
“For many years, we thought that if your overweight and you’ve got diabetes, the cause of being overweight is due to insulin, in the person’s body, not working very well. The reason one gets diabetes is because the persons pancreas is not producing enough insulin. But actually, research being conducted in Newcastle, England showed positive signs where patients have been cured of the disease.
“VLCD is where those inflicted with the disease consume up to 800 kcals per day, and this has shown a high potential such patients can be cured of diabetes.”
“Many years before we thought diabetes is not curable. Today, there are studies to show that if one limits calory intake, you can actually cure diabetes. The objective of this treatment is to remove fat from the pancreas. These fats are blocking the pancreas from producing insulin, once you address that, sufficient insulin will be produced and diabetes can be cured,” he said.
Dr Iskandar said he is continuing the research on VLCD as to the nature of how its impact one’s metabolic rate. One of the drawbacks of VLCD, is that not many would want to comply to the treatment, particularly in Malaysia.
He added that he spoke to a professor at a local university on research into VLCD, and she commented that the take up is so poor that she had to relax the calory content.
Apart from non-compliance, when one consumes such low calories, there is a possibility of losing muscle mass. We are now looking into changing the strategies of the studies to maintain muscle mass because once muscle mass is lost correspondingly the metabolic rate goes down and the possibility of weight regain increases.
VLCD is a proactive treatment to avoid serious complications a patient will face.
“VLCD is working very well. We have studies which compare VLCD patients to other forms of treatment and the results have been remarkably successful. One of my PHD students in Nottingham University in England, who is from Kelantan, conducted research comparing VLCD on its own versus VLCD with exercise on the impact of muscle mass, to prevent weight regain while maintaining weight loss. Results have been positive.
Another aspect which I have explored is bariatric surgery – also known as a gastric bypass which involves making changes to your digestive system to help you lose weight. This is where the gullet is connected directly to the small intestine bypassing the stomach, he said Dr Iskandar.
“I lead in this field in my region. When the capacity to store food is reduced the potential of a cure was noticed. Not every body is suitable for such a surgery and we have to conduct dietetic intervention on a patient which can take a year or two, to ensure suitability.
“What’s interesting about bariatric surgery, is that such patients are cured of diabetes before they actually lost weight. We are conducting research on the relationship between the various organs like the pancreas, brain and heart to see how does these function upon diabetes remission,” he added.
If diabetes if cured before weight loss, then there can be some other mechanisms, he said, citing now we are seeking the cause of this. Research here involves using dynamic MRI imaging to look at how these changes occur because if we can understand this than maybe we can replace bariatric surgery with a drug which has a similar affect instead of evasive surgery.
Also, over the last 5 years, there are new forms of treatment to treat diabetes and obesity, while protecting the heart. Some of these treatments are Ozempic and Tirzepatide which are weekly injections proven to be potent drugs which induce weight loss.
Asked on the implications of diabetes on people as well as the nation, Dr Iskandar said the numbers are rising yearly and many Malaysians will be inflicted with the disease. The rise in diabetes will lead to complications, which means a significant increase in healthcare cost.
There is a study conducted in Hong Kong which shows that the risks of blindness are prevalent in certain ethnic groups while the risk of kidney failure and heart disease are seen in other ethnic groups. Malaysia is multi-racial — so complications are expensive, like dialysis, for example.
He said the major cause of death is cardiovascular (heart) problems and such treatment is very costly.
There is also definitely a societal cost, not only for the patient and the healthcare system but also the care givers. Diabetic complications include painful neuropathy, loss of sensation in the legs, blood vessel damage potentially leading to amputations, heart failure, just to name a few. This affects one’s performance. The are also silent complications, where symptoms can go unnoticed, especially connected to heart issues.
In dealing with diabetes in Malaysia, Dr Iskandar said, the number are increasing and despite best efforts, this is caused by weight gain, poor diet and lack of exercise. Malaysians must be mindful of sugar and fat content and exercise is a must.
He added that any patient must comply with the treatment given as now diabetes is no longer an incurable disease and there are many cases where diabetes have been reversed by aggressive lifestyle intervention.
“I would advise Malaysians to seek help early, screen for eye disease yearly as it has been shown that a third of diabetics have eye complications, they have to undergo frequent urine tests to diagnose possible kidney problems so that early treatment can begin.
“And, in terms of prevention, lead a healthy lifestyle.”
Dr Iskandar who is based in Burton, Derby specialises in Diabetes and Metabolic Medicine at the University of Nottingham in England.
His journey of eagerness, strife and a quest to heal began at the early are of 15, he recalled, after spending many hours with his grandmother who was admitted in hospital frequently at that time.
Dr Iskandar, obtain a seat to study medicine at the Nottingham University, UK soon after passing SPM with flying colours.
Originally a graduate he undertook his general medical training in Birmingham and completed his specialist training in 2004 within the Mid-Trent postgraduate deanery in Diabetes, Endocrinology and General Medicine.
He was a lecturer at the Division of Vascular Medicine, University of Nottingham from 2000-2002, where he undertook research on ‘Experimental Pharmacology of Endothelial Permeability and Insulin Resistance’ leading to a Doctor of Medicine degree.
He is now a Professor of Diabetes and Metabolic Medicine at the University of Nottingham, England and Honorary Consultant Physician and lead physician within the East Midlands Bariatric & Metabolic Institute at the Derby Teaching Hospital.
He is also a member of the Association of Physician Specialising in Obesity UK (APSO-UK).
He has ongoing academic and research interests in the field of therapeutic and nutritional aspects of obesity, muscle metabolism and vascular complications of diabetes.
Within the University of Nottingham, he is Principal Investigator within the MRC/ Arthritis Research UK Centre for Musculoskeletal Ageing Research and the Vascular Medicine Research group.
He has published widely in the field of diabetes, obesity pharmacology and vascular complications. He also lectures widely (locally and nationally) in this clinical and research area. Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycemia of diabetes is associated with long-term systemic dysfunction.
