Non-insulin Diabetic Patients Research Articles

Enhanced recovery after spinal surgery protocol versus conventional care in non- insulin diabetic patients: A prospective randomized trial

ABSTRACT Background Enhanced Recovery After Surgery (ERAS) approach was proven in many surgical specialties. This prospective, randomized, single-blinded trial was designed to assess the effectiveness of ERAS on quality of recovery (QOR) after surgery in non-insulin-dependent diabetic patients. Patients and methods 72 patients undergoing elective lumbar decompressive surgery were randomly allocated to one of two equal groups receiving either ERAS protocol in group E or conventional care in group C. QOR after surgery using QOR-40 score, pain score, perioperative opioid consumption, time to early ambulation, serum markers of stress response, length of stay and possible perioperative complications were recorded. Results QOR-40 scores were significantly greater in group E at PACU, first postoperative day and second postoperative day (P = 0.015, 0.041 and 0.048, respectively). VAS was significantly lower in group E in the first eight hours postoperative. Time to first postoperative analgesic requirement was significantly longer in group E (P = 0.0001). Intraoperative fentanyl and postoperative nalbuphine requirements were significantly less in group E (P = 0.001, and 0.0001, respectively). Time to early ambulation was significantly less in group E (P = 0.006). Both CRP and interleukin-6 were significantly less at the second postoperative day in group E (P = 0.001, and 0.017, respectively). There was insignificant difference among groups in length of hospital stay and intraoperative insulin requirements (P = 0.251, and 0.347, respectively). Conclusion In non-insulin diabetic patients, enhanced recovery after spinal surgery improved quality of recovery, lowered pain scores, reduced perioperative opioid consumption, allowed early ambulation and decreased stress response but not length of hospital stay.

Metabolic Surgery: Roux-en-Y Gastric Bypass and Variables Associated with Diabetes Remission in Patients with BMI <35

Metabolic results of bariatric surgery have determined an expansion of its traditional indications, being increasingly performed in non-severely obese patients, especially in type 2 diabetes mellitus (T2DM). Our aim is to determine the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in T2DM remission in patients with body mass index (BMI) below 35kg/m(2) and the variables associated with T2DM remission after surgery. Retrospective analysis of diabetic patients with BMI <35kg/m(2) who underwent LRYGB in our center between 2002 and 2010 was done. We analyzed patient's demographics, comorbidities, BMI, excess weight loss percentage (EWLp), complications, and metabolic results at 3years. Univariate and multivariate analyses were performed to determine variables associated with T2DM remission. One hundred patients were included. Sixty patients (60%) were women; median age was 48years old (interquartile range (IQR) 42-54), and median preoperative BMI was 32.7kg/m(2) (IQR 31.6-34.1). Median preoperative duration of T2DM was 4years (IQR 2-7), with 49, 30, 2, and 18% on treatment with one, two, and three hypoglycemic agents and insulin, respectively. Ninety-four percent achieved 36-month follow-up, and at this time, median EWLp was 93% (IQR 67-121). A total of 53.2, 9.6, 25.5, and 11.7% achieved a T2DM complete remission, partial remission, improvement, and no improvement, respectively. T2DM remission only was associated with non-insulin use in multivariate analysis, with an OR = 15.1 (2.8-81.2) and p = 0.002. LRYGB is a reliable and effective treatment in diabetic patients with a BMI <35kg/m(2) at 3years. T2DM remission's best results are observed in non-insulin diabetic patients.

The use of fenugreek for breast feeding women.

Fenugreek is widely used as a culinary spice and is frequently used in Indian Ayurvedic and in Traditional Chinese Medicine, particularly as a galactogogue to encourage lactation. Little research appears to have been undertaken on the effectiveness of this spice and the majority of evidence for side-effects has arisen from case reports of complications. Skin test patching appears to suggest a significant proportion of patients susceptible to fenugreek allergy. For example, allergic reaction to inhalation of fenugreek seed powder has resulted in wheezing, rhinitis and fainting, while dermal application of fenugreek paste for dandruff of the scalp in an asthmatic woman caused facial oedema, numbness of the head and wheezing. Mild gastrointestinal symptoms have also been reported. This may be due to allergenic chemicals occurring naturally within the plant, or to the presence of substances such as nitrates from the soil in which the plant is grown, as has occurred in certain areas of Jordan. Research on the use of fenugreek by non-insulin diabetic patients has shown a small reduction in fasting and post-prandial blood sugar levels, but a more statistically significant decrease in total cholesterol and triglyceride levels of patients with coronary artery disease. Of more concern is the potential for fenugreek to interact with prescribed pharmacological medications, notably warfarin. It is also possible that fenugreek may potentiate antihypertensive and antidiabetic medication and increase the risk of bleeding in women requiring non-steroidal antiinfammatories, especially aspirin. With reference to women who are breast feeding, the following recommendations can be extrapolated from these findings: