Impact of The Roux- En- Y Gastric Bypass Surgery

Impact of The Roux- En- Y Gastric Bypass Surgery on Type II Diabetes Mellitus Compare to The Management Of Type II Diabetes Mellitus with Medication and Lifestyle Changes Name Institutional Affiliation Course Title Instructor Date Impact of the Roux-en-Y Gastric Bypass Surgery on Type II Diabetes Mellitus Compared to The Management of Type II Diabetes Mellitus with Medication and Lifestyle Changes Introduction While there have been significant pharmacotherapeutic interventions for patients with type II diabetes mellitus (T2DM), a small number of the population manages to attain normal blood pressure, hemoglobin A1 (HbA1c) and cholesterol levels (Pinchevsky, 2017). These observations, compounded with the increasing public and individual patient health burden caused by diabetes induced macrovascular and microvascular complications, signal the necessity of continued efforts to find newer approaches of treating cardiovascular and hyperglycemic risk factors among patients with diabetes (Halperin et al., 2014). Studies in recent years have investigated the benefits of other interventions such as bariatric surgery on obese patients with T2DMs and identified factors such as fasting blood glucose, HbA1c, and age, BMI, C-peptide, and duration of the disease (ABCD) score as predictors of the impact of bariatric surgery on T2DM patients (Kassem et al., 2017). Early research has consistently shown that surgical treatment of patients with morbid obesity results in dramatic improvement in the comorbidity status among most T2DM patients (Schauer et al., 2003). Halperin et al (2014) conducted a study to compare the long-term impact of bariatric surgery with medical management and lifestyle changes in the reduction of cardiometabolic risks and the improvement of glycemic control among obese patients with T2DM. In the study, the investigators compared Roux-en-Y gastric bypass (RYGB) surgery with medical and weight management program applicable in clinical practice. Results from these studies indicate substantial improvement in the management of dyslipidemia, hypertension and diabetes after bariatric surgery (Halperin et al., 2014). The present paper assesses the impact of Roux- En- Y-gastric bypass surgery on T2DM compared to the management of the disease with medication and lifestyle changes. Importance of Managing T2DM with RYGB T2DM and obesity are among the most frequently occurring chronic disorders among large populations in the world and remain to be a global challenge to healthcare systems. The link between diabetes and obesity is well established since obese patients are often faced with increased risk for T2DM. Similarly, about 90% of T2DM patients present with excessive body weight and effective weight loss among obese individuals with or without diabetes is associated with better metabolic conditions (Yan et al., 2016). There is a growing interest in assessing the comparisons between the risks and benefits associated with bariatric surgery with those linked to non-surgical medical and lifestyle management for patients with T2DM. Early studies (Halperin et al., 2014; Yan et al., 2016; Kassem et al., 2017) have found that randomized trial of RYGB compare with medical and lifestyle management for T2DM is feasible in the United States. These results are consistent with other reported trials elsewhere in the world (Halperin et al., 2014). Conventional management with medical and lifestyle changes consist of observing proper diet and workouts and administering drugs. However, taking the route of traditional medical and lifestyle management, few patients manage to achieve remission from T2DM. While bariatric surgery was originally developed as a weight loss therapy, studies have shown that the practice not only results in substantial loss of weight but also leads to the remission of T2DM among patients with obesity. It is an intervention of choice for patients with a body mass index (BMI) of more than 35-40 kg/m2 suffering from obesity-related conditions (Yan et al., 2016). Among nonseverely obese patients with BM of less than 35kg/m2, studies have shown that bariatric surgery might outperform medical therapy in terms of remission from diabetes, reduction of cardiovascular risk factors and improvement of metabolic conditions. As Yan et al (2016) have observed, a great number of T2DM patients seeking bariatric surgical interventions have mild to moderate obesity with 30<40 kg/m2. As most studies has shown, the remission rate from T2DM among the medical treatment group of patients is 0% while that of the surgical group is 56.81% (Yan et al., 2016). These results indicate that without RYGB intervention, the remission rates will significantly be lower among patients receiving medical treatment alone. Patient Population Globalization and the increased occurrence of obesity and unhealthy behaviors have increased the disease burden linked to diabetes globally. Unlike type 1 diabetes, T2DM displays a slow onset without patients presenting with acute metabolic disturbance. There are high prevalence rates among populations with increased risks of obesity. The disease is more prevalent among the African-Caribbeans and South Asians compared to while populations. While there is a small gender difference among people with T2DM globally, prevalence tends to increase with age in both genders (Forouhi & Wareham, 2014). While bariatric surgery is one of the successful treatments for weight loss, only a small number of clinically eligible individuals seek this procedure. This observation has led researchers to consider the role sex and race play in decision of patients to undergo bariatric surgery. A survey of more than 300 patients with severe obesity indicated that African Americans were less likely to consider bariatric surgery compared to Caucasians as they perceive lower social stigma thus having lower goals of losing weight (Wee et al., 2014). Further observations from this study show that African American patients are more likely to undergo surgery if a medical practitioner recommends the procedure. Populations in both developed and developing countries have failed in their efforts to control obesity, which is a major driver of T2DM (Zimmet & Alberti, 2016). Proposed Solution: Bariatric Surgery Traditionally, diabetes is viewed as a relentless and chronic disease where its main treatment objective is to delay end organ complications, but bariatric surgery has been shown to offer major improvement or completely afford patients with disease remission (Keidar, 2011). A large body of evidence has indicated a complete resolution of the disease in 78.1% of the cases following RYGB and a discontinuation of any medications related to diabetes treatment. Studies by Pories et al (1995) and Shauer et al (2003) focused on the outcomes of the disease following surgery with the former study recording a decrease in fasting blood glucose from diabetic levels to normal values and a decline in HBA1c to normal levels without administering diabetic medicines in 89% of the patients in the study. In another study, Schauer et al (2003) observed a decline in both BMI and weight from 50.1 kg/m2 and 308 lbs. to 34kg/m2 and 211 lbs, preseting a picture of the clinical outcomes from bariatric surgery without medical and lifestyle management interventions. While improvement in comorbidities and disease remission tends to occur in more than 90% of patients undergoing bariatric surgery, ethical issues such as informed consent become a challenge because of lack patient education and public knowledge (A. Puia, I. Puia & Cristea, 2017). A study in Romania indicated that private hospitals in the country offer the procedure at reduced prices compared to Wes...