NUR 302 Nursing
Question:
Topic: Diabetes management in surgical patient
Management of diabetes in patients undergoing elective surgery is an arduous affair. Diabetes cause severe complications in patients who are undergoing elective surgery and have serious postoperative complications. Therefore, the aim of this work was to elucidate the process improvement strategy that might be helpful in the identification of candidates having poorly controlled diabetes and undergoing elective surgery. The evidence is gathered through literature search and relevant information available in this context was retrieved from Google Scholar. The evidence revealed that preoperative management of diabetes would be helpful to avoid the postoperative complications after elective surgery. The surgery as gastric bypass can be helpful in the treatment of type 2 diabetes for better health outcomes.
Better management of glycemic condition before surgery can be helpful in the prevention of diabetic complications post operation. The management of elective surgery can be done through preoperative and improved glycemic control. Surgical outcomes may also be improved through attention being given to other co-morbid factors alongside glycemia. The co-morbid risk factors that are caused due to glycemia, cholesterol and blood pressure in obese patients (mild to moderate) with type 2 diabetes can be mitigated by bariatric bypass surgery. From the obtained results, it can be concluded that early intervention for the management of diabetes and improvement of postoperative complications. Appropriate glycemic monitoring and control management before surgery can also be helpful to combat the co-morbid risks following the surgery. Gastric bypass surgery is the best option so far recommended for glycemic treatment following surgery.
Answer:
Literature Review
The Google Scholar database was searched meticulously for gathering relevant information pertaining to the chosen topic. Keywords such as ‘diabetes management’, ‘surgery’ were used to procure pertinent data as mentioned in suitable articles. Articles published in peer-reviewed journals in past five years from 2013 until 2017 were utilized for perusal.
Individuals having poorly controlled diabetes undergoing elective surgery need to be differentially diagnosed through multidisciplinary interventions whereby the glycated hemoglobin test must be modified for suitable improvement in preoperative phase (Underwood et al., 2014).
Bariatric surgery comprising of Roux-en-Y gastric bypass surgery is the choicest procedure for causing reversal of insulin treated type 2 diabetes mellitus (Ardestani, Rhoads & Tavakkoli, 2015).
Co-morbid risk factors due to glycemia, blood pressure and cholesterol for mild to moderate obese patients with type 2 diabetes may be mitigated through gastric bypass surgery (Ikramuddin et al., 2013).
Improved glycemic control is seen in case of preoperative and inpatient diabetes management in case of elective surgery condition (Garg et al., 2017).
Bariatric surgery is nowadays considered as the metabolic surgery that has the potential of treating the type 2 diabetes (American Diabetes Association, 2017).
Poor preoperative glycemic control might culminate in accentuating the risk for postoperative morbidity and mortality after elective surgery (NHS Diabetes, 2017).
Discussion
Strategies to combat the adverse outcomes due to diabetes in case of patients undergoing elective surgery have garnered considerable attention. Diabetes being a lifestyle metabolic disorder that might impair the functioning of the body organs and cause serious repercussions must be intervened at early hours to prevent the onset of hyperglycemia or other serious risks. Abatement of postoperative complications may be streamlined through preoperative regulation of glycemia. Gastric bypass surgery may be considered as a choicest option for treating such conditions to treat type 2 diabetes and result in positive outcomes for the patient.
Conclusion
Diabetes might pose serious threats to the lives of people undergoing surgery and cause postoperative complications. Therefore, early intervention to manage diabetes and glycemia holds the scope of improving the postoperative outcomes by adopting appropriate measures for monitoring and treating glycemia alongside abating other co-morbid risk factors following surgery phase.
References
American Diabetes Association (2017). Standards of Medical Care in Diabetes—2017. Care.diabetesjournals.org. Retrieved 27 September 2017, from https://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf
Ardestani, A., Rhoads, D., & Tavakkoli, A. (2015). Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes care, 38(4), 659-664.
Garg, R., Schuman, B., Bader, A., Hurwitz, S., Turchin, A., Underwood, P., … & Lortie, M. (2017). Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes after Elective Surgery. Annals of Surgery, 20(20), 1-5.
Ikramuddin, S., Korner, J., Lee, W. J., Connett, J. E., Inabnet, W. B., Billington, C. J., … & Ahmed, L. (2013). Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Jama, 309(21), 2240-2249.
NHS Diabetes (2017). Management of adults with diabetes undergoing surgery and elective procedures: improving standards. NHS Diabetes Retrieved 27 September 2017, from https://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_Surgery_Adults_Full.pdf
Underwood, P., Seiden, J., Carbone, K., Chamarthi, B., Turchin, A., Bader, A., & Garg, R. (2014). Early identification of individuals with poorly controlled diabetes undergoing elective surgery: improving A1C testing in the preoperative period. Endocrine Practice, 21(3), 231-236.
American Diabetes Association (2017). Standards of Medical Care in Diabetes—2017. Care.diabetesjournals.org. Retrieved 27 September 2017, from https://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf
The paper has outlined the measures that are integral to the management of diabetes in a more holistic manner. Bariatric surgery reckoned as a metabolic surgery may be adopted in case of obese individuals for mitigating risk of type 2 diabetes. Risk amelioration for other conditions may also be achieved.
Ardestani, A., Rhoads, D., & Tavakkoli, A. (2015). Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes care, 38(4), 659-664.
The study focused on the effects of bariatric surgeries on insulin treated type 2 diabetes through comparison in cohorts undergoing Roux-en-Y gastric bypass surgery and laparoscopic adjustable gastric banding. Reversal of insulin treated type 2 diabetes may be made possible through Roux-en-Y gastric bypass surgery causing cessation of insulin secretion.
Garg, R., Schuman, B., Bader, A., Hurwitz, S., Turchin, A., Underwood, P., … & Lortie, M. (2017). Effect of Preoperative Diabetes Management on Glycemic Control and Clinical Outcomes after Elective Surgery. Annals of Surgery, 20(20), 1-5.
The study evaluated the efficacy of preoperative diabetes management in improving the glycemic control and clinical outcomes following elective surgery. Perioperative and postoperative outcomes are improved subjected to glycemic control in preoperative and inpatient diabetes management condition in addition to reducing the incidences of hypoglycemia indicative of improved clinical outcomes.
Ikramuddin, S., Korner, J., Lee, W. J., Connett, J. E., Inabnet, W. B., Billington, C. J., … & Ahmed, L. (2013). Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Jama, 309(21), 2240-2249.
This study compared the Roux-en-Y gastric bypass with lifestyle and intensive medical management meant for attaining control of co-morbid risk factors associate with glycemia, cholesterol and blood pressure. Gastric bypass surgery has been mentioned as the choicest method for dealing with mild to moderate obese patients having type 2 diabetes.
NHS Diabetes (2017). Management of adults with diabetes undergoing surgery and elective procedures: improving standards. NHS Diabetes Retrieved 27 September 2017, from https://www.diabetologists-abcd.org.uk/JBDS/JBDS_IP_Surgery_Adults_Full.pdf
This article has emphasized on preoperative glycemic regulation so that the postoperative morbidity as well as mortality may be well mitigated. Recommendation has been made with respect to keeping the glycatec hemoglobin value below 69 mmol/mol before the surgery for the sake of managing the condition in an adept manner.
Underwood, P., Seiden, J., Carbone, K., Chamarthi, B., Turchin, A., Bader, A., & Garg, R. (2014). Early identification of individuals with poorly controlled diabetes undergoing elective surgery: improving A1C testing in the preoperative period. Endocrine Practice, 21(3), 231-236.
The study aimed to elucidate the process improvement strategy that might help in identification of candidates having poorly controlled diabetes and undergoing elective surgery. Glycated hemoglobin measurement in preoperative state through multidisciplinary involvement alongside access to specialized care and glycemic control all accounted for improving diabetes in elective surgery condition.
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