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Discuss about the Bariatric Surgery Versus Conventional Medical.

Research Design and Conclusion of the Systematic Review

Diabetes is among the commonest chronic conditions listed by the Australian Institute of Health and Welfare in their website. There are quite a number of medical approaches which can be used to abate this malady but standard or conventional therapy and bariatric surgery are the most used (Yan et al 2016). These are the two methodologies which will be looked into in this systematic review. The first step in developing my PICOT question was the identification of a certain group of Patients/Population (P) in this case, patients diagnosed with Diabetes. Secondly, I came up with a variable of interest (Intervention) (I) that is bariatric surgery. The third step involved a Comparison, C (conventional medical therapy) as an alternative method of remising diabetes. I also mentioned the Outcomes (O) of the investigation that is remission of diabetes malady.

Ribaric, Buchwald, McGlennon, (2014) conducted a systematic review and meta-analysis with an aim of assessing diabetes and weight outcomes of bariatric and standard or conventional medical therapy. The research design applied by the researchers is at question because they mainly relied on an electronic literature search of materials published in 2013 coming forward. This design though relatively reliable might not have provided reliable information regarding the subject matter at hand. Data extracted was then passed through a stringent process of analysis using SPSS software to reach to the conclusions. The entire procedure followed in this study can be said to be somewhat reliable and consistent since it led the researchers into viable outcomes. All studies incorporated in the entire research undertaking obtained ethical review board protocol and local institutional approval. This evidently proves that Ribaric, Buchwald, and McGlennon considered the ethical aspect of their research project. The findings of this research proved that patients who’s their BMI ranged from 30.2-51.5 relied on bariatric surgery which substantially remitted their diabetes, reduced their weight, and HbA1C  more than conventional medical therapy. Irrespective of the study design employed in the investigation and its limitations, the outcomes can be deemed as accurate and factual. 

The research topic aims at gauging the effectiveness of conventional medical therapy and bariatric surgery in abating the progress of diabetes chronic condition. These two curative approaches have different degree of efficiency in remitting this disease and thus it is important for patients to comprehend which one to go for when the need arises (Rees et al, 2016). A study aiming at comparing conventional medical therapy to bariatric surgery could aid people suffering from diabetes and other associated maladies to make more informed decisions when undergoing treatment. Bariatric surgery, for instance, has emerged a powerful tool used to combat against diabetes disease and given its role in remitting type 2 diabetes and other diseases like obesity, this surgical procedure has a wide array of uses (Wood, Mirshahi, Still, & Hirsch, 2016). Conventionally, it was used to treat obesity, but now it is a reliable process for curing diabetes not only in obese victims but also in moderately or normal overweighed patients. Explorations have proved that bariatric surgery, particularly biliopancreatic diversion and gastric bypass is more efficient than conventional medical therapy in controlling diabetes chronic condition (Cummings, 2016). In a nutshell, the research of this review will enable patients and medical specialists to augment the treatment outcomes. It presents them with a meaningful target to handling this malady since it provides them with the best clinical and biological ways of remitting it. According to recently released recommendations and guidelines, suggesting the best procedure of curing a certain illness through research aids patients regardless of their financial abilities, knowledge or any other factor to make the most appropriate medication decisions (World Health Organization, 2015).

Benefits of Bariatric Surgery in Treating Diabetes

In this research, Mingrone and others conducted a research meant to investigate the effectiveness of Conventional Medical Therapy and Bariatric Surgery in treating Type 2 Diabetes. They concluded that in relentlessly obese victims suffering from type 2 diabetes, bariatric surgery led to better glucose control than medical therapy. In this research, they compared optimized standard medical treatment with two forms of bariatric surgical treatments namely, gastric bypass and biliopancreatic diversion and in clients diagnosed with type 2 diabetes with a BMI of 35 or more. Just like other studies which have been done in this topic, this exploration has proven a significant subject matter that can be applied in future works to improve any sort of treatment income. It has evaluated several medium-term benefits of bariatric surgery and how this procedure can be useful in abating a chronic disease like diabetes disorder.

Mingrone and others carried out a research in Italy where in their open-label they randomized regulated test at a diabetic center. In this undertaking, they noted that surgery is more efficient as compared to medical management for the lasting remission of obese people suffering from type 2 diabetes and ought to be considered in the healing algorithm of this ailment. However, they note that constant examination of glycaemic control is necessary due to possible relapse of hyperglycaemia, a state in which a too much amount of glucose circulates in the blood plasma. This is an indication that for medical practitioners to surge patient outcomes they need to consider other effects which may be as a result of a certain medication. This research prompts them to be vigilant whenever administering any medication simply because it can lead to other negative effects if not well checked. What is more, after-treatment services such as consistent checkups may also help to prevent reoccurrence of another or similar sickness.

In this research article, the researchers still maintain that bariatric surgery when conducted together with intensive medical therapy is more effectual than intensive medical therapy alone in lessening, or in some cases curing, hyperglycemia. In their Observational explorations and randomized, controlled trials proved that bariatric surgery, when applied distinctively to cure diabetes, considerably develops glycemic control and at the same time decreases cardiovascular risk factors. Nevertheless, bariatric as hinted in this study has some noteworthy effects on diabetes control. After undergoing bariatric surgical procedure, clients lose more body weight than with conventional weight-loss ways— approximately up to 25% of their total weight. Despite its effectiveness in remitting diabetes, bariatric surgery comes along with other side effects which also need to be controlled before they subject the patient to more health risks. This implies that for nurses to enhance the health outcomes of their patients they must take the side effects associated with a certain process into consideration.

Recommendation for Future Research

According to the results of this research, bariatric surgery is a potentially helpful approach for the treatment of type 2 diabetes. This allows a lot of clients to attain and sustain curative targets of glycemic regulation that if not would not be attainable with intensive medical treatment alone. Some victims in this research had whole diabetes reduction, while others had a noticeable decrease in the need for pharmacologic treatment. Other benefits of surgical procedure accounted in the study included a noteworthy development in the quality of life. From this it worth noting that patient safety is the keystone of high-quality healthcare. Much of the work that defines client safety and practices that avert hurt have concentrated on harmful outcomes of care, such as morbidity and demise. Thus, in order to surge patient outcome and experience, medical practitioners should take the critical role to the surveillance and coordination that lessen such unfavorable outcomes.

As depicted in most of the studies, Bariatric Surgery is associated with some long-term outcomes and it is important to conduct a research on. When carried out, this process results in several short-term benefits but after some time some negative outcomes such as weight loss take place (Arterburn et al, 2015). For the investigation to be successful, data collection from the field through approaches such as interviews and use of literature review can be applied. Researchers can sample a group of around 200 participants aged 25 years and above and have undergone a bariatric surgery for a period of not less than 5 years ago. Giving them a chance to express themselves would give the researchers detailed information of repercussions associated with the procedure. Besides, the researchers can make use of the underlying electronic literature from sources such as peer reviewed journal articles. Materials like these ones contain reliable information regarding the long-term outcomes of bariatric surgery. Materials used to gather data should be those published in 2015 coming forward to avoid collecting archaic statistics. After that process of data collection, the researchers can commence their data analysis by use of appropriate data analysis tools in accordance with the nature of data being analyzed. In so doing, they will gather adequate information regarding the long-term outcomes of bariatric surgery.

References

Arterburn, D. E., Olsen, M. K., Smith, V. A., Livingston, E. H., Van Scoyoc, L., Yancy, W. S., ... & Maciejewski, M. L. (2015). Association between bariatric surgery and long-term survival. Jama, 313(1), 62-70.

Cummings, D. E. (2016). Diabetes remission off medications is not a suitable endpoint for comparing bariatric/metabolic surgery with pharmacotherapy. Reply to Halpern B, Cercato C, Mancini MC. Diabetologia, 59(9), 2042-2044.

Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Leccesi, L., ... & Rubino, F. (2012). Bariatric surgery versus conventional medical therapy for type 2 diabetes. New England Journal of Medicine, 366(17), 1577-1585.

Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Nanni, G., ... & Rubino, F. (2015). Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. The Lancet, 386(9997), 964-973.

Rees, J., Gaida, J. E., Silbernagel, K. G., Zwerver, J., Anthony, J. S., & Scott, A. (2016). Rehabilitation of tendon problems in patients with diabetes mellitus. In Metabolic Influences on Risk for Tendon Disorders (pp. 199-208). Springer, Cham.

Schauer, P. R., Bhatt, D. L., Kirwan, J. P., Wolski, K., Aminian, A., Brethauer, S. A., ... & Kashyap, S. R. (2017). Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. New England Journal of Medicine, 376(7), 641-651.

Schauer, P. R., Bhatt, D. L., Kirwan, J. P., Wolski, K., Brethauer, S. A., Navaneethan, S. D., ... & Kashyap, S. R. (2014). Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. New England Journal of Medicine, 370(21), 2002-2013.

Wood, G. C., Mirshahi, T., Still, C. D., & Hirsch, A. G. (2016). Association of DiaRem score with cure of type 2 diabetes following bariatric surgery. JAMA surgery, 151(8), 779-781.

World Health Organization. (2015). The Selection and Use of Essential Medicines: Report of the WHO Expert Committee, 2015 (including the 19th WHO Model List of Essential Medicines and the 5th WHO Model List of Essential Medicines for Children) (No. 994). World Health Organization.

Yan, Y., Sha, Y., Yao, G., Wang, S., Kong, F., Liu, H., ... & Zhang, X. (2016). Roux-en-Y gastric bypass versus medical treatment for type 2 diabetes mellitus in obese patients: a systematic review and meta-analysis of randomized controlled trials. Medicine, 95(17).

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