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Transcript of PICO Question
Blood Sugar Monitoring
Risk Factors for Type 2
Type 2 Diabetes
A Chronic condition that affects the way the body metabolizes glucose in the body
Progressive failure of pancreatic beta cells, causing high blood sugar
Body either resists the insulin
that is produced by the
body or does not make
Obesity contributes to T2DM
by causing insulin resistance
and inflammation, which impairs
increase of thirst and urination
increase of hunger
slow healing sore/ frequent infections
darkened areas of skin
By, Torre Easton, Angela Archuleta, Nely Lopez, AnnMarie Buczyna, and Kellyann Quinn
Gastric Bypass Surgery for T2DM
Gastric Bypass Surgery
Helps the person lose weight by limiting how much you can eat and/or reducing absorption of nutrients
One of the most common weight loss surgeries in the U.S.
Usually done after they have tried to lose weight by dieting and exercising
BMI is 40 or higher
Serious Health Problems
Must be willing to make serious life style changes
Types of Bypass Surgeries
Biliopancreatic divers with duodenal switch
laparoscopic adjustable gastric bonding
Vertical Banded gastroplasty
The Swedish Obese Subjects (SOS) controlled study compared bariatric surgery with medical weight-loss treatment in well-matched obese patients (Sjöström, Lindroos, Peltonen, Torgerson, Bouchard, Carlsson, Dahlgren, Larsson, Narbro, Sjöström, Sullivan, & Wedel, 2004; Keidar, 2011).
- Bariatric surgery caused an average 16.1% weight loss at 10 years
- Mean weight loss was greatest after RYGBP (−25.0 kg)
- The risk of developing diabetes was more than three times lower for surgically treated patients at 10 years, and recovery rates from diabetes were three times greater.
The surgery can lead to long-term vitamin/mineral deficiencies
Requires adherence to dietary recommendations
Can cause dumping syndrome
leaks in the GI system
Pros of Gastric Bypass Surgery
- Bariatric surgery offers vast improvement in weight loss and overall health & even complete disease remission.
- After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion (Kashyap et al., 2010).
- As many as 14,310 (90% of 15,600) diabetes-related deaths might be prevented by bariatric surgery over 5 years (Keidar, 2011).
Pros of Gastric Bypass Surgery
- A systematic review & meta-analysis from The American Journal of Medicine reported complete resolution of type 2 diabetes after bariatric surgery in 78.1% of cases
- increased to 86.6% when counting patients reporting improvement of glycemic control; diabetes resolution occurred with an average weight loss of 38.5 kg, which is 55.9% of the excess weight (Buchwald, Estok, Fahrbach, Banel, Jensen, Pories, Bantle, & Sledge, 2009; Keidar, 2011
A case-series study focused on T2DM outcomes after laparoscopic Roux-en Y gastric bypass (RYGBP) in 240 diabetic morbidly obese bariatric patients (Schauer, Burguera, Ikramuddin, Cottam, Gourash, Hamad, Eid, Mattar, Ramanathan, Barinas-Mitchel, Rao, Kuller, & Kelley, 2003; Keidar, 2011).
- After surgery, weight & BMI decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%.
- Fasting plasma glucose and HbA1C concentrations returned to normal levels (in 83%) or markedly improved (in 17%) in all patients.
- 80% reduction in use of oral antidiabetic agents and 79% reduction of insulin followed surgical treatment
- Patients with the shortest duration (<5 years), mildest form of type 2 diabetes (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of type 2 diabetes.
Identify the purpose of the study
Factors that could influence implementation
Phase 1 : Preparation
Phase II : Validation
Phase III: Comparative Evaluation/ Decision
Phase IV: Translation/ Application
Phase V: Evaluation
Assess sources for credibility and applicability
evaluate outcomes, willingness to implement, patient satisfaction
Cons of Gastric Bypass