Results:
The data collected suggests that there is evidence to support the working hypothesis that Bariatric surgery may be more effective in maintaining normal glycemic control in patients with T2DM compared to standard therapy.
Bariatric Surgery versus Standard Medical Therapy A randomized controlled trial carried out by Ikramuddin et al. (2013) compared conventional standard therapy with lifestyle modification to a single type of Bariatric operation (Roux-en-Y gastric procedure [RYGB]) and measured the effect on glucose control in patients with T2DM. The key outcome and measure of this study with respect to glycemic control was to attain a target HbA1c level below 7% (Ikramuddin et al., 2013). At baseline, these patients had
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Obese Patients with Type 2 Diabetes Mellitus In accordance with the previous findings, one particular trial (Cohen et al., 2012) specifically examined the long term effect of Roux-en-Y gastric bypass surgery on patients with T2DM with Class I obesity (BMI between 30-35 kg/m2). The study followed 66 patients who underwent this procedure for a period of six years and found that 88% of the participants were able to achieve euglycemia without the use of standard diabetic therapy and 11 % had an improvement in glycemic control in comparison to standard therapy (Cohen et al., 2012). Interestingly, the study (Cohen et al., 2012) points out that there was an improvement in Beta cell function in the pancrease due to an increase in C-peptide response to glucose after the procedure.
Likewise, the study conducted by Ikramudden et al. (2013) which evaluated the same RYGB procedure, found an improvement of glycemic control in T2DM patients who had a BMI between 30.0 to 39.9. The ‘Swedish Obesity Study’ by (Carlsson et al., 2012) examined the effects of Bariatric surgery (1658 patients) vs standard therapy (1771 patients) in the prevention of T2DM in Swedish patients with a BMI>34 kg/m2. The study (Carlsson et al., 2012) found that metabolic surgery was much more effective than conventional therapy where only a 110 subjects in the procedure group compared to 392 subjects in the
In Bijal P. Trivedi’s report, “The Bypass Cure” she details the history of gastric bypass surgery, its effect on type 2 diabetes, and the how one doctor is using his understanding of modern gastric bypass applications to save the life’s of his patients. The patient, Nancy Rubio was nearly twice the normal weight of a person her height. Her weight had slowly increased throughout her life, due to her unhealthy diet and having two kids. She eventually developed type two diabetes, which then led to other health issues, such as arthritic knee pain, high blood pressure, cholesterol and blood sugar. Fearing for her life, Rubio opted to receive a modern version of the Roux-en-Y. The Roux-en-Y involves reducing the lining of the stomach to a small pouch, which reduces the patient’s appetite and eating. The pouch is then connected to the lower section of the intestine. Do the nature of the surgery Rubio will lose weight very fast, but miraculously have her type 2 diabetes become remitted or possibly abolished.
Weight loss surgery, also known as bariatric surgery is recommended by many physicians to people who are unable to benefit from traditional weight loss methods. However, choosing to undergo weight loss surgery isn’t an easy decision. It is an important decision that will drastically and permanently impact a person’s life. Therefore, before making such a significant decision, an individual should be aware of both the risks and benefits associated with weight loss surgery (McGowan & Chopra ix).
In Bijal P. Trivedi’s report “The Bypass Cure,” she details the history of gastric bypass surgery, its effect on type two diabetes, and the how one doctor is using his understanding of modern gastric bypass applications to save the lives of his patients. Diabetes is a serious disease that affects over 25 million people in America, and 439 million people worldwide. Over 200,000 gastric bypasses are performed in America each year. Due to the cost many patients are unable to receive the life changing procedure. One of the patients who will be receiving this procedure is Nancy Rubio who was nearly twice the normal weight of a person her height. Her weight had slowly increased throughout her life, due to her unhealthy diet and having two children. She eventually developed type two diabetes which then led to arthritic knee pain, high blood pressure, increased cholesterol and elevated blood sugar. Fearing for her life, Rubio opted to receive a modern version of the Roux-en-Y. The Roux-en-Y involves surgically decreasing the lining of the stomach to a small pouch, which reduces the patient’s appetite and eating. The pouch is then connected to the lower section of the intestine. Due to the nature of the surgery Rubio will lose weight very fast, but also miraculously have her type two diabetes go into remission or possibly eliminated.
Interventions used in treatment of type 2 diabetes should be those that improve the probability that the patient will have better long term control of diabetes. It is therefore imperative that early diagnosis is given fast priority especially when metabolic abnormalities of diabetes are less severe. Lifestyle interventions are key in containing type 2 diabetes. It is common knowledge that sedentary lifestyle and over nutrition which lead to obesity and overweight increase the risk of type 2 diabetes (Peters & Davidson, 1996). Interventions that reverse or improve these factors have beneficial effects on control of glycemia in established type 2 diabetes.
Both characters Iggy Lee and Loretta Lee are first described as huge beer gut,with blue tattoos,and red barbed wire. And Loretta was described as scrawny,hard eyes and blurry red. If we were to judge them solely on their appearance we might assume that they smoke and drink alcohol. In fact when we first saw their appearance, Iggy Lee behavior was the nice person
“I think I may go out on the town today and see what kind of fun things I can do.” Mommy look at that fat girl, fat people shouldn’t be allowed out, quack quack waddle fat girl, hey shamu go back to the water. These are some of the things that I have endured and heard on a day-to-day when going out in public as an obese individual. Like myself, a lot of other obese individuals have embarked on many failed weight loss attempts only to gain instead of lose weight. Bariatric Surgery is a great lifelong tool to help aid in weight loss and manage the success;, however, many individuals shy away from the surgery because many health professionals only state the risks over the benefits. Bariatric surgery has become very popular in the United States, but there are many factors to consider such as the risks and benefits, success rates, and procedure options offered. Bariatric surgery has afforded many obese individuals a new lease on life. Medical doctors and insurance companies seem to be down playing the benefits as a way to keep patients with many obesity related ailments to keep them in business. The benefits that bariatric surgery has greatly outweigh the risks and allows for new beginnings.
Some of them are still under development, but others have already been approved by the FDA in the USA, or are currently used in Europe and South America. Its main assets are its higher safety profile, its greater effectiveness as compared with hypo-caloric diets and modification of habits, and its lower price and greater availability than bariatric surgery. Endoscopic bariatric therapy is gaining acceptance as more effective and less invasive than bariatric surgery. In addition, it can be used as an adjunctive therapy for patients with obesity who are unable to manage the disease with lifestyle interventions alone, or used prior to bariatric surgery.3-5 The goal of primary EBT is to induce weight loss and improvement in medical co-morbidities, with a safety and efficacy profile similar to operative bariatric therapy. Endoscopic bariatric therapy can consist of any of the following procedures: intragastric balloon (IGB) placement, endoscopic sleeve gastroplasty, gastric-bypass revision, and aspiration therapy.3,5. Multiple devices and procedures are currently being evaluated for clinical use or are currently in clinical
In regards to proper nutrition, a diet that has a low glycemic index has been found to improve blood sugar control. Unfortunately, diet and exercise aren’t enough to achieve glycemic control for some individuals. At this time, medication is usually introduced to the treatment regimen. Oral medications such as Metformin, sulfonylureas, nonsulonylurea secretagogues, alpha glucosidase inhibitors and thiazolidinediones are available. However, Metformin is usually the first line of treatment. In some patients, insulin can be added to their medication regimen. Consequently, in cases where the individual is morbidly obese and lifestyle modifications with medication therapy prove to be ineffective in maintaining glycemic control, weight loss surgery can be considered (Polonsky, 2014).
Long-term weight loss is the desired end-result following gastric bypass surgery. However, this long-term goal is contingent upon lifestyle changes, including nutrition and exercise. More importantly, postoperative gastric bypass patients often have limited knowledge with regard to how to maximize weight loss. In order to measure changes and progress, two critical concepts to achieve optimal weight loss results are body mass index (BMI) and calculation of daily caloric intake. It is imperative to find out the status of respondents in post gastric bypass surgery (P), if ongoing nutrition and lifestyle training (I) compared to standard postoperative guidance (C) result in greater weight loss and decreased BMI (O) over a period of time (T)?
Bariatric surgery is the last resort for morbidly obese patients who have tried other options, such as diet and exercise, but have fallen short from obtaining their desired health goals. The surgery is safe and effective, but as with any surgery, there are risks involved. Furthermore, the National Institutes of Health (NIH) has put forth very specific criteria that must be met before bariatric surgery can be performed on a patient. The Obesity Action Coalition
Diabetes type II is a devastating disease. It has been established that the higher a person’s body mass index (BMI) the more likely they are to develop diabetes type II. 96.4% of type II diabetes can be directly attributed to obesity. This disease often results in daily medication usage and hospitalization. It can even result in loss of organs or limbs. Often diabetic patients suffer from failed kidney function and must rely on daily dialysis. The direct cost of obesity related type II diabetes in 1995 was $32.2 billion and the indirect cost was $30.74 billion.
The results indicated bariatric surgery can alter gut bacteria and help people to lose weight. This could be a benefit for people with diabetes who are combating obesity.
A Canadian study published in September 2004, have shown that surgery improves or even cures conditions stated above. It was common for most patients who were on insulin before the surgery to go off it the day of or after surgery for good. 90 percent of these patients that have high blood pressure or high cholesterol, shown great improvement or their problem went away all together. I found that improvement or possible cure was only found in patients who had a BMI of 40 or lower compared to patients who had a BMI of 40 and greater in a study done on 796 patients in 11 different studies all
The average fat loss rate of patients was 0.124 kg/day between baseline (pre-surgery) and 6 months post-surgery. A regression plot was made in order to study any possible relation between fat loss and changes in energy expenditure.
“A major concern at this time is the rapid climb in incidence of Type 2 diabetes, with prevalence now estimated at about 9% (18 million) of the population greater than 20 years of age.” Obesity and Type 2 diabetes are commonly associated (Gould & Dyer, 2011). In addition to the two types of diabetes, there are signs and symptoms that are easily detected and some that develop after diagnosis.