Bariatric surgery versus lifestyle modifications for decreasing glycated haemoglobin in obese persons living with type 2 diabetes

Abstract

Introduction: Type 2 diabetes mellitus is a chronic disease characterized by high blood sugar levels; it develops due to insulin secretory defects or insulin resistance. Obesity plays a key role in the aetiology of type 2 diabetes; this is being referred to by the term ―diabesity‖. Treating type 2 diabetes in obese individuals is challenging but a reduction of just 5% body weight is associated with better glycaemic control and a reduced risk of morbidity and mortality. Objective: To investigate the use of bariatric surgery if it is more effective than lifestyle modifications in reducing HbA1C serum levels to a normal range. The formulated re-search question being; Is bariatric surgery more effective than lifestyle modification at decreasing HbA1c levels to normal range in obese individuals with type 2 diabetes mel-litus? Method: Research that has been conducted between 2012 and 2017 was considered for this dissertation. The following databases were used for the identification of relevant articles: Academic Search Complete via EBSCO, Cumulative Index of Nursing and Al-lied Health Literature (CINAHL) via EBSCO, and Medline via ProQuest. Eight articles met the inclusion and exclusion criteria and were included in this dissertation. The CASP and AMSTAR critical appraisal tools were utilised to assist in identifying the strength and weaknesses of the methodology used. Ethical issued were also addressed and taken into consideration throughout this review. Findings: Results revealed that bariatric surgery is more effective than lifestyle modifi-cation in achieving reduced HbA1c serum levels to a normal range. Results also re-vealed that it was not just the weight reduction that contributed to the diabetes control and remission, but also endocrine changes. Conclusion: As revealed from the literature findings, an individual with a lesser magni-tude of obesity (a BMI that range from 30 to 35 kg/m²), and an early diagnosis of T2DM, has a greater chance to benefit from bariatric surgery to achieve T2DM remis-sion (therefore reduced Hba1c to normal range (53mmol/mol) without the use of oral hypoglycaemic agents) than with lifestyle modifications.