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Please no AI it will go through Turnitin. Discussion 5 is still on the continuation of the research. I will be attaching Discussion 4 and PICOT along side with it.
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DIABETES EVIDENCE BASED PRACTICE
Impact of Bariatric Surgery in Type II Diabetes Management
Name
Institution
Course
Professor
Date
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DIABETES EVIDENCE BASED PRACTICE
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Evidence-Based Intervention
The evidence-based intervention proposed involves the utilization of bariatric surgery as
a treatment intervention for individuals with type 2 diabetes mellitus (T2DM). Bariatric surgery
involves various surgical procedures designed to induce weight loss and improve metabolic
parameters in individuals with obesity and T2DM. According to Zhu et al. (2022), bariatric
surgery effectively controls weight loss and T2DM remission in obese adolescents with T2DM.
The primary surgical options include Roux-en-Y Gastric Bypass (RYGB) and laparoscopic
adjustable gastric banding (LAGB) aimed at promoting weight loss and improving metabolic
outcomes in individuals with obesity and T2DM. RYGB entails forming a pouch from the
stomach and directly linking it to the small intestine. Consequently, the procedure reduces the
stomach’s capacity to hold food and alters the digestive process, reducing calorie absorption and
weight loss.
Additionally, the rearrangement of the gastrointestinal tract affects the secretion of gut
hormones involved in glucose metabolism, contributing to improved glycemic control in
individuals with T2DM. On the other hand, LAGB involves the placement of an adaptable
silicone band around the upper section of the stomach, which results in a smaller stomach pouch.
As a result, food intake is restricted, which promotes satiety, leading to reduced calorie
consumption and weight loss. However, LAGB may have lower efficacy in achieving significant
and sustained weight loss and metabolic improvements than RYGB (Courcoulas et al., 2020).
Other bariatric surgical procedures may include sleeve gastrectomy, biliopancreatic diversion,
and duodenal switch. These procedures involve altering the anatomy of the digestive system to
achieve weight loss and metabolic improvements. For instance, sleeve gastrectomy involves
DIABETES EVIDENCE BASED PRACTICE
removing a portion of the stomach, reducing its size and capacity while preserving its natural
anatomy.
PICOT Question
Does bariatric surgery lead to improved weight loss, glycemic control, and T2DM
remission outcomes in adults with obesity and type 2 diabetes mellitus (T2DM) compared to
non-surgical interventions? This PICOT question seeks to investigate the effectiveness of
bariatric surgery as an intervention for individuals with obesity and T2DM. It aims to assess
whether bariatric surgical procedures improve outcomes compared to non-surgical interventions
regarding weight loss, glycemic control, and T2DM remission. The population of interest is
adults diagnosed with both obesity and T2DM. The intervention of interest is bariatric surgery,
which involves various surgical procedures aimed at inducing weight loss and improving
metabolic parameters in individuals with obesity and T2DM. The outcomes of interest include
weight loss, measured by changes in body mass index (BMI), glycemic control, and T2DM
remission rates. Moreover, the proposed comparison involves evaluating the effectiveness of
bariatric surgery versus non-surgical interventions, such as lifestyle modifications,
pharmacotherapy, or standard medical care, in achieving weight loss, improving glycemic
control, and achieving T2DM remission in individuals with obesity and T2DM.
Identified Primary Research Studies
The first study, conducted by Zhu et al. (2022), was a multicenter, nonrandomized
retrospective study involving 202 obese adolescents with T2DM from three hospitals between
2017 and 2019. The study compared the clinical outcomes of bariatric surgery and medical
treatment in obese adolescents with T2DM. Among the participants, 109 adolescents underwent
bariatric surgery, while 93 received non-surgical treatment. The interventions included various
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DIABETES EVIDENCE BASED PRACTICE
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bariatric surgical procedures, and the medical treatment comprised standard approaches for
managing T2DM. The study evaluated outcomes such as weight loss, glycemic control, and
T2DM remission rates over the study period. The findings indicated that bariatric surgery was
more effective than medical treatment in weight loss, improving glycemic control, and achieving
T2DM remission. Additionally, significant differences were observed between the surgery and
control groups. For instance, bariatric surgery significantly reduced body mass index (BMI) and
improved glycemic parameters compared to medical treatment. DOI:
10.1016/j.asjsur.2022.10.079
The second study, conducted by Courcoulas et al. (2020), was a randomized controlled
trial conducted at the University of Pittsburgh, involving 61 participants with obesity and T2DM.
The study compared the effectiveness of bariatric surgical treatments with an intensive lifestyle
weight loss intervention (LWLI) program over a five-year follow-up period from February 2015
to June 2016. The participants were initially randomized to receive bariatric surgery or
participate in the LWLI program for one year, followed by four-year lower-level lifestyle weight
loss interventions. The primary outcomes assessed included diabetes remission rates, weight loss,
and glycemic control (Courcoulas et al., 2020). The findings demonstrated that surgical
treatments were more effective than lifestyle intervention alone in achieving T2DM remission
and improving metabolic outcomes. In detail, participants who underwent RYGB had the highest
percentage of individuals not requiring any T2DM medications at five years compared to the
LWLI group. Additionally, significant reductions in body weight and improvements in glycemic
control were observed in the surgical groups compared to the lifestyle intervention group over
the study period. DOI: 10.1210/clinem/dgaa006
Clinical Practice Guidelines
DIABETES EVIDENCE BASED PRACTICE
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The American Diabetes Association (ADA) and the International Diabetes Federation
(IDF) offer clinical practice guidelines that advocate for considering bariatric surgery as a viable
treatment option for individuals diagnosed with obesity and type 2 diabetes mellitus (T2DM)
who meet specific criteria. These guidelines indicate the potential benefits of bariatric surgery in
achieving significant weight loss, improving glycemic control, and even inducing remission of
T2DM in eligible patients. The ADA and IDF guidelines emphasize the importance of a
comprehensive assessment of the patient’s medical history, BMI, comorbidities, and willingness
to adhere to postoperative lifestyle modifications before recommending bariatric surgery as part
of the treatment plan for T2DM.
Governmental and Non-Governmental Support
Governmental support for using bariatric surgery in treating type 2 diabetes mellitus
(T2DM) includes healthcare policies and programs to improve access to surgical interventions
for eligible individuals (Chadwick et al., 2023). Many government health agencies recognize the
efficacy of bariatric surgery in promoting weight loss, improving metabolic outcomes, and
reducing the burden of T2DM. Additionally, governmental organizations may fund studies
investigating bariatric surgery’s long-term effectiveness and safety in managing T2DM. Nongovernmental support for bariatric surgery in T2DM treatment is often demonstrated through
advocacy groups, professional organizations, and patient support networks. These organizations
promote awareness regarding bariatric surgery’s advantages and offer educational materials for
patients and healthcare professionals. Moreover, non-governmental organizations facilitate
community outreach programs and patient education initiatives to empower individuals with
T2DM to make informed decisions about their treatment options, including bariatric surgery.
Strategies for Literature Search and Article Selection
DIABETES EVIDENCE BASED PRACTICE
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Key databases, including CINAHL, MEDLINE, Cochrane, and Joanna Briggs Institute,
were used to identify primary quantitative research studies on bariatric surgery and type 2
diabetes mellitus (T2DM) treatment outcomes. A variety of search terms such as “bariatric
surgery,” “type 2 diabetes,” “obesity,” “weight loss,” and “glycemic control” were employed in
combination to ensure a comprehensive exploration of available evidence. The selection criteria
prioritized primary research studies that examined the effectiveness of bariatric surgery
compared to non-surgical interventions in individuals with obesity and T2DM. Also, the studies
were required to include data on weight loss, glycemic control, and T2DM remission outcomes.
After retrieving relevant articles, titles, abstracts, and full texts were reviewed carefully to assess
their alignment with the PICOT question and research objectives. Consequently, the two primary
research studies were chosen because of their study designs, large sample sizes, and
comprehensive assessment of clinical outcomes related to weight loss, glycemic control, and
T2DM remission. Moreover, the selected articles provided comprehensive evidence supporting
bariatric surgery as an effective intervention for improving metabolic outcomes in individuals
with obesity and T2DM. At the same time, they contributed insights into the comparative
effectiveness of bariatric surgery and medical and lifestyle therapy for T2DM management.
DIABETES EVIDENCE BASED PRACTICE
References
Chadwick, C., Burton, P. R., Brown, D., Holland, J. F., Campbell, A., Cottrell, J., MacCormick,
A. D., Caterson, I., & Brown, W. A. (2023). Bariatric Surgery Efficiency, Safety and
Health Outcomes in Government Versus Privately Funded Hospitals. Obesity Surgery,
33(4), 1160–1169. https://doi.org/10.1007/s11695-023-06489-3
Courcoulas, A. P., Gallagher, J. W., Neiberg, R. H., Eagleton, E. B., DeLany, J. P., Lang, W.,
Punchai, S., Gourash, W., & Jakicic, J. M. (2020). Bariatric Surgery vs Lifestyle
Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial. The
Journal of Clinical Endocrinology and Metabolism, 105(3), 866–876.
https://doi.org/10.1210/clinem/dgaa006
Zhu, X., Zhou, G., Gu, X., Jiang, X., Huang, H., You, S., & Zhang, G. (2023). Comparing
bariatric surgery and medical therapy for obese adolescents with type 2 diabetes. Asian
Journal of Surgery, 46(10), 4337–4343. https://doi.org/10.1016/j.asjsur.2022.10.079
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NURS 6843: PICOT Worksheet
Learner Name_____________________________________
One sentence PICOT statement:
Does bariatric surgery, when compared to conventional medical treatment, enhance weight
loss, glycemic control, and remission of type 2 diabetes mellitus over a 12-month duration in
adults aged 18 and above with obesity and T2DM treated at an urban hospital?
P
Population
I
Intervention
C
Comparison
O
Outcome
T
Time
The population consists of adults over 18 years diagnosed with obesity and
type 2 diabetes mellitus treated at an urban hospital. Inclusion criteria include
adults with a confirmed diagnosis of type 2 diabetes mellitus and obesity
based on BMI criteria. Exclusion criteria include individuals with
uncontrolled comorbidities contraindicating surgery, those with type 1
diabetes, and individuals unwilling or unable to undergo surgical intervention.
The evidence-based intervention proposed is bariatric surgery, including
procedures like Roux-en-Y gastric bypass (RYGB) and laparoscopic
adjustable gastric banding (LAGB). The main goal of using this intervention
is to improve metabolism among the target group while achieving weight loss
and improved overall functioning. Bariatric surgery has been shown to
effectively promote weight loss, enhance glycemic control, and induce
remission of type 2 diabetes in select patient populations.
The primary intervention will be compared with conventional/nonsurgical
treatment. Conventional medical/nonsurgical treatment encompasses lifestyle
modifications, dietary changes, exercise regimens, and pharmacological
interventions aimed at managing obesity and controlling blood glucose levels
in individuals with type 2 diabetes.
The specific, measurable outcome of interest includes improvements in
weight loss, glycemic control, and remission of type 2 diabetes mellitus.
Once the intervention is implemented, it is expected that the intervention
group will experience weight loss, increased remission rate, and
improvements in HbA1c levels among others.
The timeframe for the intervention and observation of outcomes is 12 months.
This duration allows for adequate weight loss monitoring, glycemic control
changes, and remission rates of type 2 diabetes following bariatric surgery or
conventional medical treatment.
List two original research articles (meet criteria on the
levels of evidence chart) that support the intervention:
1. Courcoulas, A. P., Gallagher, J. W., Neiberg, R. H.,
Eagleton, E. B., DeLany, J. P., Lang, W., Punchai, S., Gourash,
W., & Jakicic, J. M. (2020). Bariatric Surgery vs Lifestyle
Intervention for Diabetes Treatment: 5-Year Outcomes From a
Original Research articles: Randomized Trial. The Journal of Clinical Endocrinology and
Full-text article permalink Metabolism, 105(3), 866–876.
is REQUIRED for all
https://doi.org/10.1210/clinem/dgaa006
articles.
2. Zhu, X., Zhou, G., Gu, X., Jiang, X., Huang, H., You, S., &
Zhang, G. (2023). Comparing bariatric surgery and medical
therapy for obese adolescents with type 2 diabetes. Asian
Journal of Surgery, 46(10), 4337–4343.
https://doi.org/10.1016/j.asjsur.2022.10.079
Include Clinical Practice
Guideline or major agency
recommendations, if
applicable.
The American Diabetes Association (ADA) and the
International Diabetes Federation (IDF) provide clinical
practice guidelines recommending the consideration of bariatric
surgery as a treatment option for individuals with obesity and
type 2 diabetes who meet certain criteria.
International Diabetes Federation – (2017). IDF Clinical
practice recommendations for managing type 2 diabetes in
primary care. IDF.
https://idf.org/media/uploads/2023/05/attachments-63.pdf
References
Courcoulas, A. P., Gallagher, J. W., Neiberg, R. H., Eagleton, E. B., DeLany, J. P., Lang, W.,
Punchai, S., Gourash, W., & Jakicic, J. M. (2020). Bariatric Surgery vs Lifestyle
Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial. The
Journal of Clinical Endocrinology and Metabolism, 105(3), 866–876.
https://doi.org/10.1210/clinem/dgaa006
Zhu, X., Zhou, G., Gu, X., Jiang, X., Huang, H., You, S., & Zhang, G. (2023). Comparing
bariatric surgery and medical therapy for obese adolescents with type 2 diabetes. Asian
Journal of Surgery, 46(10), 4337–4343. https://doi.org/10.1016/j.asjsur.2022.10.079
Discussion 5: Developing Literature Support for
Evidence-Based Practice – Available
In this discussion, you will be asked to share the literature support that you have identified to
support your evidence-based practice project. You have demonstrated literature support for the
practice problem and elaborated on the significance of the problem, as well as developed a
compelling PICOT statement to drive inquiry. The next step is to continue to search for the best
current evidence. It is imperative that the intervention has demonstrated an impact on the
outcomes from your PICOT within the literature search.
**Please share your PICOT at the top of your discussion post response**
Complete any revisions to the PICOT or literature base from previous assignments and
discussions based on the feedback of your professor.
Please share the permalink for two primary research studies that you plan to use to support your
PICOT. Utilize the articles from the PICOT worksheet assignment. If you were asked to review
your PICOT or literature from the PICOT DRAFT and FINAL assignments, please complete
the required revisions before completing this assignment. They must be quantitative. Do not
include qualitative literature to support your project. All literature must be contemporary
(published within the last 5 years) and found from credible and reliable sources.
Consider these reflective questions/statements as you formulate your post:
1. What are the key search terms utilized for your search?
2. What is the primary type of evidence that you found in your search?
3. Were there any limitations that you identified in the literature shared this week?
4. Use the Johns Hopkins Table Level and Quality Guide to share the evidence level and quality
for the two primary research studies included in your discussion this week.
Engage in meaningful dialogue with substantive posts, as well as incorporate at least three (3)
different scholarly sources each week – include an in-text citation for each source using APA
7th edition formatting. Review the Discussion Guidelines and Rubric document for more
information.
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