Paper Example on Cardiovascular Effects of Metabolic Surgery on Type 2 Diabetes

Introduction

According to Pappachan & Viswanath, (2015), type 2 diabetes is among the diseases that bring about significant issues in the global public health arena. As evident, many countries in the world, the U.S. is among them have recorded type 2 diabetes as a significant ailment that poses challenges to clinicians while on their struggle to limit infections. As a remedy to check on lowering type 2 diabetes, clinicians have derived some interventions like; dietary control, and lifestyle modifications. Clinicians record that over the past decades, the majority of the population in the U.S. such as the Hispanic people record suffering from type 2 diabetes with obesity. Managing such a condition significantly challenges clinicians. By so doing, doctors have burned the midnight oil, and are out with a remedy that, metabolic surgery is the most promising management option to treat type 2 diabetes in people with obesity. As such, the clinicians have come up with some observational research accompanied by few randomized controlled attempts which have depicted vivid benefits of various bariatric procedures necessary among the obese population aiming at remitting and improving the type 2 diabetes condition. The bariatric procedures have positively brought about other benefits on the patient such as; improving on hypertension, lowering the obstructive sleep apnoea, treating the non-alcoholic fatty disease of the liver, and reduction of the osteoarthritis. However, some long-term uncertainties are accompanying the metabolic surgery intervention; they include, relapse of type 2 diabetes just after it undergoes remission, psychological as well as nutritional challenges, and issues of optimal body formation index in different ethnic groups. Therefore, the research explores various cardiovascular issues which associate with metabolic surgery on a patient with type 2 diabetes.

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Keywords: Cardiovascular, metabolic surgery, Type 2 diabetes, and Bariatric procedures.

Different Bariatric Procedures

Clinicians have over the past fifty years developed some bariatric procedures. The commonly used bariatric techniques in the present day clinical practices include the following; the adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and the biliopancreatic diversion (BPD) (Billeter et al., 2018). Depending on the efficacy levels, SG and AGB are procedures which predominantly clinicians restrict whereas BPD and RYGB are primarily mal-absorptive thereby lowers active area of nutrients fascination in the celiac mucosa (Clifton & Keogh, 2018). Food moves through the alimentary branch in the RYGB and BPD having gastrointestinal discharge in the biliopancreatic diversion mixing with vital nutrients whereby all the limbs form a common conduit (Pappachan & Viswanath, 2015).

When clinicians perform randomized controlled trials (RCTs), they obtained a mean percentage excess loss of body weight together (with the 95%CI in brackets) gained throughout one year as follows; AGB 33.39 (22.57-44.21), SG 69.70 (41.09-98.32) and RYGB 72..32 (64.60-80.04). Excess percentage weight loss (% EWL) by BPD was 76.89 1.53 being higher than RYGB that shows 67.17 1.43%. Basing on the data above, AGB procedures are with time losing popularity due to its inferior efficacy. Moreover, there are higher chances for repeating surgery after the initial surgery. Even though BPD associates to a significantly top percentage EWL as well as type 2 diabetes mellitus (T2DM) remission as compared to other bariatric techniques, the procedure is rendered a less preferred method due to its higher postoperative complication rates (Pappachan & Viswanath, 2015).

The meta-analysis of weight loss, as well as the remission of T2DM assessed in RCTs and reflexion studies (OBS) of bariatric surgery about the regular therapeutic period of over seventeen months, depicted that the (EWL) for bariatric surgery as 75.3% and conventional treatment set as 11.3%. Corresponding T2DM remission proportions are 63.5% and 15.6% respectively. The limitation of meta-analysis is that OBS is incorporated and the surgery is not directly compared to a more vigorous intervention of weight loss. More so, the technique is criticized for not having a standard definition of diabetes remission. Also, there is no clear specification on how bariatric processes were put in place and no definite criteria for performing the bariatric surgery (Pappachan & Viswanath, 2015).

Cardiovascular Effects following Bariatric Surgery in Obese Patients with Type 2 Diabetes

To examine the effects of bariatric surgery, the Swedish Obese Subjects (SOS) uses a controlled intervention survey which studies the impacts of bariatric surgery on Type 2 diabetes patient's cardiovascular operations. The survey associates Bariatric surgery with a reduction in myocardial infarction. As such, 38 events in the midst of 345 subjects in medicine cluster vs. 43 events among 262 subjects present in the control cluster; log-rank p=0.017; the adjusted ratio of hazard (HR) 0.56 (95% Cl 0.34-0.93); p=0.025). The resultant outcome depicts no effect of bariatric surgery on stroke incidences. The result of the operation to reduce myocardial infarction prevalence is stronger among individuals having higher serum total cholesterol as well as triglycerides at a baseline level (the interaction p-value = 0.02 in both the traits). BMI (of interaction p-value = 0.12) does not link to the surgery outcome. The Bariatric surgery is seen as a remedy to reduce incidences of myocardial infarction among obese patients who have type 2 diabetes. It is therefore efficient to integrate preoperative BMI with the metabolic parameters to maximize on the benefits accruing from the bariatric surgery (Romeo et al., 2012).

According to William et al. (2018), bariatric surgery improves long-term cardiovascular as well as bring about a positive renal outcome. Bariatric surgery limits all-cause deaths and the risk of cardiovascular ailment, lower progressive prolonged kidney disease, and albuminuria. Patients suffering from poor glycemic as well as those suffering from the microvascular disease may benefit more from a surgical approach. As such, they will stand to benefit from some outcomes such as; low sympathetic drive, enhanced natriuresis, diminution of glomerular hypertension, shifts in gut microbiota, reduction in both systemic as well as renal inflammation, reduction in the chronic cardiac remodeling and improvement in lipoprotein profiles of the patient.

More so, bariatric surgery enhances microvascular disease. The rate of the disease affecting the coronary artery or occurrences of cerebrovascular lowers when medicine is applied. Bariatric surgery shows effectiveness in controlling HbA1c, moreover, the same operations entails essential effects which benefit cardiovascular health and thereby improves glycaemic. The above argument explains why rigorous medication alone is not sufficient to improve the medical macrovascular results whereas the bariatric surgery is seen to shed light. Patients with a medical condition of a HbA1c rate less than 7.0%, a low-density lipoprotein saturated fat level lower than 100mg/dL, as well as a systolic blood pressure of lesser than 130mm Hg (Sheka et al., 2018). When such a patient is exposed on a five years follow-up period, about 23% of patients who will undergo surgery maintains a triple endpoint. The high population compares to about 4% of those patients who suffers a lifestyle medical control. Also, obese patients who suffer a surgical intervention experiences a mean weight loss of about 21.8% as compared to about 9.6% of obese patients who takes a lifestyle-medical intervention. Since the triple endpoint is an appropriate goal over glycaemic control, advances in such multiple parameters above are achieved mainly with the performance of bariatric surgery as an individual intervention (Sheka et al., 2018).

According to Beamish et al. (2016), Cardiovascular relating challenges especially affecting old people include the following; hypertension, inflammation, dyslipidemia, and type 2 diabetes mellitus. Therefore, it is essential for clinicians to reverse incidences of obesity among the old to realize the cardiovascular benefits. Through...