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PICO Question

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AnnMarie Martinez

on 27 April 2015

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Transcript of PICO Question

In patients with type 2 diabetes and obesity, is gastric bypass more effective than standard medical therapy at increasing probability of remission of diabetes.
PICO Question
Healthy eating

Weight Loss

Physical Activity


Blood Sugar Monitoring

Bariatric Surgery

Risk Factors for Type 2
abdominal fat
family history
having pre-diabetes
gestational diabetes

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
glucose regulation

increase of thirst and urination
increase of hunger
weight loss
blurred vision
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

Sleeve gastrectony

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

Anastomotic leaking

Very expensive

blood clots
lung/breathing problems
leaks in the GI system
bowel obstructions

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

Case Study
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.

Case Study
Identify the purpose of the study

Factors that could influence implementation
Stetler Model
Phase 1 : Preparation
Phase II : Validation
Phase III: Comparative Evaluation/ Decision
Phase IV: Translation/ Application
Phase V: Evaluation
Assess sources for credibility and applicability



Substantiating evidence

If implemented:
evaluate outcomes, willingness to implement, patient satisfaction
Cons of Gastric Bypass
Full transcript