Background of the study

Cummings et al. (2016) tried to validate data showing that RYGB enriches type 2 diabetes with randomised trials paralleling surgical and non-operative treatments. Participants were type 2 diabetes patients,comprising those with a BMI <35kg/m2. The objective of the study was to verifythe efficiency of nonsurgical and surgical mediations in the medication and prevention of type 2 diabetes. The study was guided by the necessity of deciding if lifestyle interventions were superior in managing of type 2 diabetes as compared to surgical and medical therapies. The study made significant contributions to the nursing profession by advocating for educating patients on improving their lifestyle as a feasible strategy in administration of type 2 diabetes.

Similarly, Ikramuddin et al. (2018) the research was purposed to compare the stability of Roux-en-Y gastric bypass (RYGB) employed in scrupulous lifestyle and therapy care in attaining diabetes control targets. The research question was to compare the five-year results of RYGB to lifestyle and therapeutic intervention in overweight grown ups with type 2 diabetes. The conclusions of the research are essential nursing as they assist nurses in making evidence-based decisions when deciding the most appropriate intervention for respective patients.

Relationship between articles and the PICOT question

The PICOT question was designed to determine the role of therapeutic patient empowerment with an emphasis on healthy lifestyle activities compared to standard diabetes management strategies affects the health outcome of patients in six months. In this regard, answering this question demanded a selection of research articles that elaborately responded to this question. Cummings et al. (2016), addressed this question by affirming that intensive lifestyle intervention that includes a healthier diet and being more physically active plummeted the rates of readmissions and enhanced the overall quality of life for patients. Similarly, Ikramuddin et al. (2018) revealed that educating patients on healthy lifestyles is effective in minimising diabetes-associated complications that often result inpatient readmissions.

The comparisons in the articles are similar to the PICOT questions as they were focused on comparing the efficacy of lifestyle intervention and medical intervention in type 2 diabetes management and prevention. Both studies compared RYGB against intensive lifestyle interventions in managing type 2 diabetes and offered findings affirming the assertions of the PICOT question.

Method of study

The articles used the experimental research methodology. In an experimental research method, a research variable is manipulated and applied to one or more dependent variables to measure their effect on the latter. The researchers usually observe and record the impact of the independent variables on dependent variables overs some time, to assist them in the formulation of rational conclusions regarding the relationship between these two variable types.

The researcher method was appropriate for these studies because it gives the researcher significant amounts of control. The researchers could isolate specific variables to ensure the desired outcomes could be achieved. The researchers controlled each variable independently or in different combinations to study what possible results are available for the hypothesis. Also, the methodology provides specific conclusions. Since experimental research offers a high degree of control, it can deliver results that are precise and relevant with consistency. This makes it easier to determine success or failure, making it possible to assessthe validity of a theory in a shorter period. While the methodology was appropriate for the studies, it has notable flaws. First, it is highly vulnerable to human error due to its dependency on variable control that may be implemented improperly. These inaccuracies could disregard the cogency of the experiment and the research being conducted.

Results of the study

Ikramuddin et al. (2018) found that membersof the gastric bypass cluster had an average weight loss of 22.9 per cent compared to 6.3 per cent in the lifestyle medical care community at five years of age. There was no partial or full remission of diabetes at any time with the lifestyle-medical administrationset, apart from two members who had chosen gastric operation in the third year.An additional 21 patients in the gastric bypass program reported partial recovery before deterioration by year 5. Total recovery was reached in 9 members in the gastric bypass cluster in 2 years but decreased in year 5. In the gastric bypass collection, 14 cases of surgical complications and 15 and 16 intestinal events were adversely affected, respectively in the gastric bypass and lifestyle supervision categories. Bone cracks were formerly identified in the category of the gastric bypass but disappeared in years 3 to 5. The study also showed that RYGB had severe adverse effects than conventional lifestyle treatment, most commonly gastrointestinal and surgical problems such as stretching, mild intestinal difficulties and leakages. The gastric bypass had anupsurge in parathyroid hormone, but there was no variance in B1 deficit.

According to Cummings et al. (2016), systolic blood pressure in the surgical arm declined from zero to a year but no observable change in the ILMIsection. Diastolic blood pressure was equal to zero and 12 months in both classes and did not increase meaningfully with both interventions. Average health scores in each group improved at baseline and 12 months, but there was no difference in the degree of improvement among groups. Therefore the study found that RYGB produced more type 2 diabetes reduction in trivial to ascetically overweight participants drafted from a conversant, population-based sample matched with the most comprehensive ILMI yet tested against surgery in a randomised pilot.

Implications of the study on nursing

The studies agree that rigorous lifestyle interventions were integral in management and treatment of type 2 diabetes as paralleled to the standard treatment strategies. Empirical evidence indicates that adherence to these healthy lifestyle interventions is low due to lack of sufficient knowledge on the benefits of these lifestyle practices and techniques that can be adapted to maintain a healthy lifestyle (Pandey, 2018). Therefore, these studies will ensure patients are well trained regarding lifestyle interventions to assist in type 2 diabetes treatment and prevention. The research will encourage nurses to integrate education in patients’ care plan.

Ethical considerations

Critical ethical considerations include informed consent, benevolence, respect for privacy and discretion. Informed consent ensures the participant’s right to independence is preserved to ensure people participate in the research voluntarily after being informed of potential risks and benefits of the investigation. The ethical principle of beneficence details the Hippocratic of ensuring research is designed to serve the participants and promote the welfare of participants. The researcher has to assess and balance the dangers and proportionate gains of the study to the participants. If the risks outweigh the benefits, the study should be reviewed.

Cummings et al. (2016) approached participants through mail and phone before screening them utilising a multi-levelenrolment process. A study GPacquired in-person approval from participants and ensured concealed allocations. Ikramuddin et al. (2018) confirmed that all research sites had obtained official review board authorisation and printed informed permission from all members.

References

Cummings, D. E., Arterburn, D. E., Westbrook, E. O., Kuzma, J. N., Stewart, S. D., Chan, C. P., … &Flum, D. R. (2016). Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: The CROSSROADS randomised controlled trial. Diabetologia, 59(5), 945-953. DOI: 10.1007/s00125-016-3903-x

Ikramuddin, S., Korner, J., Lee, W. J., Thomas, A. J., Connett, J. E., Bantle, J. P., … & Chong, K. (2018). Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobinA1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. Jama, 319(3), 266-278. DOI: 10.1001/jama.2017.20813

Pandey, A. (2018). Non-adherence to Lifestyle (Diet and Exercise) Modification Recommendations among the Type 2 Diabetes Mellitus Patients in a Tertiary Level Hospital. Journal of Institute of Medicine, 41(2), 78-80.