Question:

Research on Diabetes Education Program: Analysis of Evidence-Baced Practice/Inquiry.

Create a Systematic Review about the effectiveness of lifestyle and pharmaceutical interventions to delay or lower the risk of developing type 2 Diabetes in people with impaired glucose tolerance.

Answer to Question: NUR 401 Evidence Based Nursing Practice

Diabetes is a serious problem in the world. It causes premature death and complications such as blindness and amputation.

A lack of exercise and poor diet are well-known risk factors. These can be reversed by a small lifestyle change.

The western world has seen a dramatic increase in type 2 diabetes, which has reduced the life expectancy of 15 years.

Patients with diabetes are treated by approximately 5 % of NHS resources, and 10 percent of resources at health care facilities.

The burden of health care costs has been greatly reduced by interventions which prevent and delay the onset or progression of type 2.

Persons with impaired glucose tolerance are more likely to develop type 2 diabetes.

A lot of clinical trials have been focused on treatments that can prevent type 2 diabetics in those with impaired glucose tolerance (Hu 2011).

These interventions include lifestyle modification, herbal remedies, and pharmacological.

Many reviews have been done on prevention of type 2 diabetics, which focused on lifestyle and pharmaceutical interventions (Hu 2011, 2011).

To consolidate the evidence, we conduct a systematic overview.

A systematic review allows you to summarise the results of different trials and studies that were conducted on health interventions for one disease.

The systematic review covers all studies that dealt with lifestyle modification and medications to control type II diabetes in patients who have impaired glucose tolerance.

These studies were searched by Embase and PubMed using custom ranging of the search result from 2007 to 2017.

The PubMed Medical Subject Headings Terms were used to search the articles.

These search terms covered type 2 diabetes and prevention as well as impaired glucose tolerance.

To obtain expert opinions, we searched the Cochrane central list of controlled trials and Conchrane library for systematic reviews.

These criteria are important: The studies must be experimental and include lifestyle or pharmacological interventions. They must also have patients with impaired glucose tolerance. Patients with type 2 diabetes must be included or have a focus on prevention. All studies must be in English.

A selection of randomized controlled trials with high-quality evidence was made from the studies that met all criteria.

One hundred and twenty-eight citations from these 128 test articles were found.

Three studies met inclusion criteria.

Ime randomized controlled trials with measurable outcomes.Results:

Nearly 21 clinical research studies met the inclusion criteria. The systematic review included severe studies, which are listed in table 1.

These trials were heterogeneous in that they focused on different interventions, and included participants from various ethnicities and ages.

All trials had the same inclusion criteria.

Patients who have fasted blood glucose levels of 7.8 or more and their plasma glucose levels above or equal to 11.1mmol/l after receiving 75g glucose load for two hours are considered to be suffering from type 2 diabetes.

Patients with plasma glucose levels of 7.8 to 11.1mmol/L within two hours of receiving a glucose loading are considered to be impaired glucose tolerance. Centres for Disease Control and Prevention (2011).

The interventions were for 6 to 48 months, with a 6 to 9 month follow-up.

The intervention included diet modification and exercises, as well as an additional component.

Three studies provided individual and group counselling to participants. Two studies offered medication as an intervention to reduce the risk of developing diabetes.

This systematic review of clinical trials indicates that lifestyle interventions are just as effective at reducing the risk in type 2 diabetics in those with impaired glucose tolerance.

Diabetes is becoming more prevalent in westernized societies due to obesity and low levels of physical activity.

Lifestyle intervention is designed to increase activity and reduce obesity. This helps reduce the risk of developing type II diabetes (Hu, 2011).

The clinical trials that investigated increasing physical activity looked at the effectiveness and safety of progressive resistance, yoga breathing, aerobic exercise, yoga, breathing, mixed aerobic exercise program, and aerobic exercise.

These structured exercise studies found that regular aerobic and relaxation exercises led to a reduction in HbA1c (Yavari Hajiyev and Naghizadeh (2010).

The diabetes prevention program stated that withdrawal from medications like troglitazone or metformin could lead to type 2 diabetic complications.

Clinical trials indicate that the effects from pharmacological interventions didn’t last beyond the end of treatment.

Some participants in clinical trials experienced minor side effects, such as digestive problems (Tabak. Herder. Rathmann. Brunner. Kivimaki. 2012).

A long-term follow up is necessary to ensure patient compliance.

Lifestyle interventions may have less severe side effects than medications.

They may have a shorter-lasting effect than pharmacological therapies.

The recommendation for weight-reduction program and workout should be reinforced on an average basis.

In spite of high compliance among the participants to the lifestyle intervention during these trials, it is not known if that will continue after completion of the study.

The systematic review demonstrates the clinical efficacy of lifestyle and pharmaceutical interventions in decreasing the risk of developing type 2 Diabetes in individuals with impaired glucose tolerance.

In order to decrease the risk of type 2 diabetic complications, primary and secondary health care professionals can recommend lifestyle modifications for patients with impaired sugar tolerance. However, numerous problems remain unanswered.

However, there are many questions that remain unanswered.

The adverse effects of medications must be understood in order to minimize harms and maximize the benefits of pharmacological intervention.

For long term monitoring, it is necessary to evaluate participants.

Researchers must also determine whether lifestyle problems can be treated with long-term drug treatment.

The key to positive lifestyle interventions’ success is compliance. To help participants comply, strategies to aid compliance must be carefully considered and implemented.

Table 1: Literature Review

Author, yearStudy duration/ Follow-upDietExercise

CounsellingControl GroupBo et al, 2007

12 months to three years

Setting individual goals, following NIG guidelines, recommended daily calorie distribution150 min. week moderate PA. Individualized

Individual and group counselling for lifestyle modification

Regular or emergency careOh et al, 2010

6 Months

Low calorie and low carbohydrate diet

Yoga, stretching and warm-up with aerobic dance, yoga, yoga and stretching

The nurse researcher provided 20-minute counseling on food and exercise adherence

A booklet was created to provide basic education on the metabolic disorder.Lu et al. 2011

2 years

Face to face lecture regarding diet modification

Face to face lecture on exercise

Acarbose (50mg three times daily) metformin 0.25h three days a day

Once Diabetes educationWing et al., 2010

4 years to 11 years

Caloric restriction, meal replacement, increased fruit, vegetable intake, low fat intake

Initial start with 50 min/week moderate PA. In 6 months, increased to >175 minutes/week

This strength training exercise was provided

Lifestyle counsellors were available to provide behavioural guidance for individual and group behavioural plans.

Orlistat, which was not prescribed for patients who lost more than 10 percent of their initial weight, was administered to those who were not able to lose that much.

Three years of support for social or group educationToobert et al, 2011

6 mon/12 MON

Mediterranean diet, adapted to Latin American subculctures

30 min/d exercise

These techniques are used to manage stress.Usual careChristian et al, 2008

12 Months

Reduction in calories

Participation motivated to increase physical exercise (PA)

3 months of diabetes educationUsual standard careSamuel-Hodge et al, 2009

8 months to 4 months

Healthy eating

Increase in PA. Exercises for 15 minutes

Individual and group counselling

2 pamphlets and a bimonthly newsletter about general health information were sent to me.Reference:Bo, S., Ciccone, G., Baldi, C., Benini, L., Dusio, F., Forastiere, G., … & Gentile, L. (2007).

The effectiveness of a lifestyle intervention in metabolic syndrome.

A controlled randomised trial.

Journal of general medicine, 22(12), 1695-1703. DOI: 10.1007/s11606-007-0399-6

Centers for Disease Control and Prevention. (2011).

Diabetes: Successes, Opportunities for Population Based Prevention and Control-At A Glance 2011.

Atlanta: Centers for Disease Control and Prevention. Accessed at www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm on 20 July 2017.Christian, J. G., Bessesen, D. H., Byers, T. E., Christian, K. K., Goldstein, M. G., & Bock, B. C. (2008).

Clinic-based support to aid overweight patients with type-2 diabetes increase their physical activity, and lose weight.

Archives of Internal Medicine. 168(2). 141-146. DOI: 10.1001/archinternmed.2007.13Hu, F. B. (2011).

Globalization and Diabetes: The role for diet, lifestyle, genes.

Diabetes Care, 34(6) 1249-1257. Doi:10.2337/dc11-0442Lu, Y. H., Lu, J. M., Wang, S. Y., Li, C. L., Zheng, R. P., Tian, H., & Wang, X. L. (2011).

Participants with impaired glucose regulation in China: Outcomes of intensive integrated treatment

Advances and Therapy, 28(6), 511-519. DOI: 10.1007/s12325-011-0022-4Oh, E. G., Bang, S. Y., Hyun, S. S., Kim, S. H., Chu, S. H., Jeon, J. Y., … & Lee, J. E. (2010).

Study of the effects of lifestyle modification interventions over 6 months on cardiovascular risk factors and other health-related characteristics of women with metabolic syndrome. Metabolism, 59(7), 1035-1043. DOI: 10.1016/j.metabol.2009.10.027Tabak, A. G., Herder, C., Rathmann, W., Brunner, E. J., & Kivimaki, M. (2012). Prediabetes: A high-risk state for developing diabetes. Lancet, 379(9833), 2279-2290. Doi: 10.1016/S0140-6736(12)60283-9Toobert, D. J., Glasgow, R. E., Strycker, L. A., Barrera, M., Radcliffe, J. L., Wander, R. C., & Bagdade, J. D. (2003).

Mediterranean lifestyle program results in quality-oflife and biologic outcomes.

Diabetes Care, 26(8) 2288-2293. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/12882850Samuel-Hodge, C. D., Keyserling, T. C., Park, S., Johnston, L. F., Gizlice, Z., & Bangdiwala, S. I. (2009).

A randomized trial of a program that helps African Americans with type-2 diabetes to manage their diabetes at home.

The Diabetes Educator. 35(3), 439-454. DOI: 10.1177/0145721709333270

Wing,R.R. Look AHEAD Research Group. (2010).

Long-term effects of lifestyle changes on weight and cardiovascular risks factors in type 2 diabetics: Results of the Look Ahead trial, four years.

Archives of internal Medicine, 170 (17), 1566. DOI: 10.1001/archinternmed.2010.334Yavari, A., Hajiyev, A. M., & Naghizadeh, F. (2010).

Exercise and the effect on glycosylated hemoglobin for type 2 diabetes patients.

The Journal of Sports Medicine and Physical Fitness, 50(4). 501-505. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/21178937