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This project is important for the attempts to develop an evidence-based solution that would be applied to the management of patients with type 2 diabetes, both postoperatively and preoperatively. Due to the high burden of diseases, rigorous treatment and intervention are needed to reduce the risks of adverse outcomes (World Health Organization, 2014). The developed PICOT question aims to address the challenges linked to the surgical treatment of patients with type 2 diabetes before and after surgery to ensure that such challenges as infections of surgical site and poor control of blood sugar do not limit recovery (Akiboye & Rayman, 2017). The challenge of treating patients with a diabetes diagnosis is that there is no single pattern of insulin use, while combination therapy calls for multiple adjustments (Kong et al., 2020; ADA, 2020). In addition to glycemic control, the operative management of patients requires continuous assessments of patients before and after the scheduled surgery to optimize such parameters as electrolytes and ketones (Jefferies et al., 2018). All of the mentioned challenges are expected to be addressed with the help of the current project.
The project is planned to be implemented in both pre- and post-surgical hospital settings concerning patients diagnosed with type 2 diabetes. The implementation of rigorous treatment will be compared with the outcomes of various therapeutic interventions in order to decrease complications and possible infections. Rigorous treatment is expected to include a range of procedures targeted at addressing the challenges associated with type 2 diabetes. These can include glargine U300 and U100 treatment (Pasquel et al., 2020), the consumption of lupin biscuits post-surgery for glucose control (Skalkos, Moschonis, Thomas, McMillan, & Kouris-Blazos, 2020), sodium-glucose cotransporter 2 (SGLT2) inhibitors administration (Mazer et al., 2020), or the implementation of duodenal mucosal resurfacing (Baar et al., 2020). Therapeutic interventions that may be administered to type 2 diabetes patients may include hourly monitoring of blood sugar levels before and after surgery (Ferrera et al., 2019) or the monitoring of such parameters as electrolytes and ketones (Jefferies et al., 2018). Depending on the outcomes of the rigorous treatment or various therapeutic interventions before and after surgery, the recommendations for further practice will be made.
In surgical patients, the diagnosis of type 2 diabetes is associated with increased rates of mortality and morbidity, with the perioperative mortality rate being 50% higher compared to non-diabetic patients (Pontes, Mendes, Vasconcelos, & Batista, 2018). Thus, this project is important to facilitate the understanding of how the challenges of operative management of the target group can be addressed. The expected outcomes of the implementation of the project include the improvement of pre- and postoperative care for patients diagnosed with type 2 diabetes (Golden et al., 2017). The reasons for surgical treatment may differ, ranging from bariatric surgery, specifically targeting diabetes-associated obesity (Koliaki, Liatis, le Roux, & Kokkinos, 2017) to generic issues such as appendicitis. The project is expected to reveal best practices that would help practitioners understand whether rigorous treatment is effective enough for managing the challenges associated with the pre- and postoperative care of type 2 diabetes patients. In addition, based on the findings of the project, it is expected to develop a framework that could be used for further testing and evaluation of techniques used for solving the complications associated with the operative interventions of patients with diabetes.
References
Golden, S. H., Maruthur, N., Mathioudakis, N., Spanakis, E., Rubin, D., Zilbermint, M., & Hill-Briggs, F. (2017). The case for diabetes population health improvement: Evidence-Based programming for population outcomes in diabetes. Current Diabetes Reports, 17(7), 51.
Koliaki, C., Liatis, S., le Roux, C. W., & Kokkinos, A. (2017). The role of bariatric surgery to treat diabetes: Current challenges and perspectives. BMC Endocrine Disorders, 17(1), 50.
Pontes, J., Mendes, F., Vasconcelos, M., & Batista, N. (2018). Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist. Brazilian Journal of Anesthesiology, 68(1), 75-86.
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