Durability of Bariatric Surgery in Diabetes

Introduction

The essay is focussed on discussing a research topic for the evidence of the question “What is the impact of bariatric surgery vs lifestyle intervention in treatment of individuals suffering from type-2 diabeties?”. In this context, it discusses the durability and role of bariatric surgery in case of type-2 diabetic patients along with comparing the respite of type-2 diabetes mellitus through surgical and lifestyle treatment. This essay describes the randomised control study strategy developed for the literature review question about the outcomes of bariatric surgery in comparison to lifestyle intervention treatment for patients suffering from type-2 diabetes. For those seeking healthcare dissertation help, this analysis provides valuable insights into the comparative effectiveness of these treatments.

Background

The Information literacy is referred as hyper ability in the pursuit of knowledge to lead the individuals efficiently locate, identify, evaluate, effectively use as well as clearly communicate information for problem and issues at hand in different formats (Ross et al. 2016). Thus, it is prerequisite skill for individuals who are participating to effectively deliver information to the society in a successful manner. As mentioned by Arnold-Garza (2014), importance of information literacy is that it encourages thinking skills and approaches of problem-solving by exploring questions and attempting to find answers. This is done by finding information, developing opinions, examining sources and forming decisions for fostering successful learners with effective contribution to become confident individuals. The information literacy helps in executing effective evidence-based public health study because literacy leads individuals to properly collect evidence and information regarding public health management and diagnosis.

The Evidence-based public health refers to the public health endeavour in which evidence is used as explicit and judicious information that is derived from any form of scientific or social science research (Lhachimi et al. 2016). Thus, this informs two facets of evidence-based public health that is using particular nature of verification for informing public about decisions regarding health and developing emphasis based on clear reasoning process to interpret and appraise the found evidence. As asserted by Brownson et al. (2018), evidence-based public health is important because it helps to provide access to high-quality information regarding best practices for preventing a certain health disorder. This assists the healthcare professionals to choose the best practice for treatment of different individuals to offer them best health outcome. The evidence-based public health is also important because it offers greater likelihood of selecting and developing successful prevention policies and programs bringing in improved workforce productivity for the health professional to deliver quality care to the service users (Shelton et al. 2018). It leads to more efficiently use private and public resources in managing varieties of health disorders with success.

The literature review is a part of evidence-based practice which is referred to the current knowledge derived from a scholarly article (Hart, 2018). The review includes substantive information and theoretical as well as methodological understanding regarding a certain topic. The importance of literature review is that it describes the relation between the proposed research to a prior study through information. The present topic is related to the literature review question that informs about the outcomes of bariatric surgery in comparison to lifestyle intervention treatment for patients suffering from type-2 diabetes. In the UK, there are 3.2 million people in 2013 being diagnosed by type-2 diabetes with 90% of them being overweight or obese (assets.publishing.service.gov.uk, 2014). In most cases, the common intervention being made is making changes in the lifestyle of the individuals to help them reduce weight to resolve type-2 diabetes. However, in extensive cases, bariatric surgery is recommended to lose weight in controlling type-2 diabetes among these individuals. Thus, the literature review is developed to understand whether the methods (surgical method or non-surgical method or both) are more effective for people being obese along with having type-2 diabetes to resolve their health disorder effectively.

Search Strategy

The PubMed database is being used for identifying the journal related to the literature review question. This is because PubMed is a government-sponsored website that contains huge number of freely accessible journal articles related to the medical and nursing field. The other advantage of Pub Med is that it updates its database on a regular basis due to which current articles are easily available regarding any research topic (Coordinators, 2016). However, by using CINAHL, they provide many records of medical journals which are not fully accessible and some records contain only an abstract of the article regarding the topic (Wright et al. 2015). Thus, in such case, the literature review question cannot be effectively analysed and interpreted by developing effective information literacy for executing evidence-based public health practice for proper treatment of type-2 diabetes of individuals who are also obese or overweight. Moreover, Google Scholar provides wide-ranges of information rather than comprehensive ones which lead the researcher to require increased amount of time for selecting and identifying the required journal articles for the selected topic (Harzing and Alakangas, 2016). Thus, PubMed is being used as a database for selecting the journal article rather than using CINHAL or Google Scholar.

The PICO framework is referred to the technique being used in executed evidence-based research practices for framing as well as answering a healthcare or clinical care related question. The PICO framework stands for population, intervention, comparison and outcome (Gabb et al. 2016). The keywords identified in this research by using PICO framework are Population= obese individuals with Type-2 Diabetes, Intervention= effectiveness of Bariatric surgery and lifestyle changes, C= none and O= prevent type-2 diabetes. The search conducted in the PubMed database includes the first keywords to be obese AND type-2 diabetes AND treatment. They are seen to produce only five results out of which none of the articles found could be able to effectively answer the literature review question of “What are the outcomes of bariatric surgery in comparison to lifestyle intervention treatment for patients suffering from type-2 diabetes?”. The Boolean operator AND was frequently used as it helped to develop conjunction between words to research and find out the most suitable results required for fulfilling the literature review question.

In further searches, alternative keywords were being used to develop results which are effectiveness OR improvement of type-2 diabetes AND intervention. This search produced more than 500 results which have many articles which can be fully accessed regarding the topic with various publication dates. In the third search, the same keywords were being used but the publication dates of the articles were reduced to “2014-2018” along with the language being changed to English. It was done to identify current and updated information to resolve the raised question. This resulted to narrow down the research to less than 43 articles out of which the article named “Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type-2 Diabetes Mellitus Treatment” was chosen as it was seen to effectively fulfil and answer the raised question in the literature review.

Appraisal of article

The chosen article named “Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type-2 Diabetes Mellitus Treatment” has the key aim to find out the durability and role of bariatric surgery and lifestyle intervention related to obese individuals suffering from type-2 diabetes. The objective of the article was to develop comparison between the respite of type-2 diabetes in obese individuals by following surgical and non-surgical treatment (Dunkley et al. 2014).

The study was a randomised clinical trial which is being executed at the Medical Centre of the University of Pittsburgh from October 2009, to June, 2014. As mentioned by (), randomised clinical trial is the study design in which the participants are randomly assigned for the intervention to be tested to identify alternative treatment or efficiency of the selected treatment. The randomised clinical trials have the benefit to properly determine the cause-effect relation existing between the treatment process and outcome for the patients. The participants belong from the Pittsburgh, Pennsylvania who is assessed for 3 years. In executing the study, 61 participants were selected who were between the ages of 25-55 years suffering from type-diabetes and are obese in nature. The study was conducted by randomly selecting participants to be given either weight-loss lifestyle of intensive nature for the first year which is followed in the next 2 years by low-level lifestyle or offering them surgical treatment such as laparoscopic adjustable gastric banding [LAGB] or Roux-en-Y gastric bypass [RYGB] which is followed by two to three years of low-level lifestyle intervention [LLLI] (Dunkley et al. 2014).

The key result informed in the discussion section of the study was that LAGB+LLLI and RYGB+LLLI are seen to be acting as superior treatment rather than only providing lifestyle intervention at the end of three years for respite of the type-2 diabetes mellitus. The discussion informs that those individuals who underwent surgery along with intervention of low-level lifestyle showed increased likeliness towards achieving as well as maintaining glycemic control in comparison to other individuals who only received low-level and intensive lifestyle therapy regardless of their class of obesity. Further, it was noted that 2/3 rd of the participants in the RYGB group and ½ of the participants in the LAGB group showed no requirement of medication after their 3 years type-2 diabetes mellitus treatment procedure. Moreover, significant reduction of bone and lean mass were seen in the RYGB group (Dunkley et al. 2014).

The strengths identified by the authors regarding the study was that it was able to deliver information about the way a standardised nonsurgical treatment procedure is to be implemented which are intensive in the first year of treatment procedure and lower-level in the later years in effectively modelling Diabetes Prevention Program. The other strength of the study was that the trial included broader inclusion criteria for type-2 diabetes mellitus. It is seen to result in recruitment of subjects also with less severity of the disease in comparison to other randomised studies where the individuals with uncontrolled type-2 diabetes were only targeted. The limitation of the study was that the sample size was smaller in nature due to which the generalisation of the participants can be affected. Moreover, it may affect the reliability of the study as smaller sample size leads to higher variability leading to basis in nature (Dunkley et al. 2014).

The authors identified the value of the study to be that it has been able to develop evidence that a longer-term following of surgical treatment which includes RYGB and LAFB along with low-level lifestyle intervention are superiors in nature in comparison to only lifestyle intervention in remission of type-2 diabetes among individuals with BMI rate 30-35. The authors inform that in future impact of the mentioned treatments on long-term macrovascular and microvascular complication along with perceiving mechanisms through which the bariatric surgical procedure effects can be induced are to be identified (Dunkley et al. 2014).

Conclusion

The understanding regarding the way scientific literature is to be used in public health is important to allow health professionals to develop better leadership abilities which support strategically using scientific resources in efficiently resolving health issues of patients. Moreover, the understanding regarding the reviewed topic is helpful to develop better intervention programs for offer improved health outcome for a longer time in case of obese patients with type-2 diabetes.

References

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