Annotated Bibliography on Non-Pharmacological Intervention for Type 2 Diabetes Mellitus

This annotated bibliography focuses on the effectiveness of non-pharmacological intervention for managing type 2 diabetes mellitus. It includes a literature evaluation and PICO framework. The articles cover topics such as gestational diabetes, lifestyle interventions, and pharmaceutical drugs.

ANNOTATED
BIBLIOGRAPHY

Table of Contents
Research question...................................................................................................................................3
INTRODUCTION.......................................................................................................................................3
Annotated bibliography..........................................................................................................................5
Literature evaluation...............................................................................................................................9
CONCLUSION.........................................................................................................................................10
REFERENCES..........................................................................................................................................11

Research question
Does non - pharmacological intervention plays important role than pharmacological
medicine to manage type 2 diabetes?
INTRODUCTION
Diabetes mellitus is a disorder in which body does not produce enough insulin that result
in causing blood sugar (glucose) level to be abnormally high. Urination and thirst are increasing
and people are suffering from high loss of weight because of Diabetes mellitus. It causes damage
to nerves and cause problem with sensation. Furthermore, the diabetes mellitus has lead in
increasing the risk of stroke, chronic kidney diseases, heart attack and vision loss. So, mainly in
this blood sugar is measure in order to diagnosed Diabetes mellitus. In this report, Annotated
bibliography will be done related to one of the key health issue named as Diabetes mellitus
through making use of four relevant article. All these article has make use of different method
and techniques to complete the study and gathered sufficient information in context of Diabetes
mellitus.
The problem I have identified is diabetes mellitus. Diabetes is one of the major global
health problems and the 8th leading cause of death in the world in year 2012 and 2013 (Tao et al.,
2015). Further, the growing burden of diabetes is one of the important concerns in public health
which is affecting more than 400 million people worldwide (Khursheed et al., 2019). If it is not
managed properly, about 592 million people will die of this disease by the end of year 2035 (Tao
et al., 2015) and leads to more life threatening complications. Different pharmacological and non
pharmacological approaches have been used for the treatment of diabetes but both of them are
not fully successful. The main focus should be given on the use of non pharmacological
approaches like, physical activities, health education and diet management (Khursheed et al.,
2019).One of the researches done on different people of China, Canada and India shows that the
main cause of diabetes is their lifestyle, high calories and sugar intake and low physical activities
(Tao et al., 2015).
PICO (Patient, Intervention, Comparison, and Outcome) model was used for the final research
question which is stated as follows:

In people with type 2 diabetes (T2DM), non pharmacological intervention plays important role
than pharmacological medicine to manage diabetes.
Here, ‘P’ specifies the Patient with diabetes, ‘I’ describes non pharmacological approach, ‘C’
denotes pharmacological comparison and ‘O’ describes effective management of diabetes.
I have chosen PICO framework for my study as it focuses on quantitative systematic review and
is more helpful in clinical question (Methley et al., 2014). Further, PICO allow us for full
comprehensive searches which help us to get clearer and detail result for the research, mostly
used in health care settings and provide systematic review in evidence based practices (Frandsen
et al., 2020). For the research purpose, Meta analysis review will be done, as it will help us
providing future guidelines for clinical trials and is one of the best forms used in evidence based
medicine (Cheung, 2015).
ARTICLES
The main cause for the development of type 2 diabetes is unhealthy lifestyles. One in
every 11 adults of world population has diabetes and to control the main focus should be given
on management of obesity which is the consequences of unhealthy eating habits and less
physical activity (Raveendran et al., 2018). Likewise, number of researches and peer reviewed
articles have shown that people who are more concerned about their eating habits and engage in
more physical activities and life style changes are able to manage their T2DM (Schwarz et al.,
2012).
Similarly, one of the systematic review and network meta-analysis which focus on non
pharmacological management of T2DM found that physical activities, self management
education and nutritional therapy were more effective than medicine as it helps in controlling
glycaemic and other metabolic outcomes (Leite et al., 2020). Further, research done on 240
patients over 18 months of time frame shows that people engaged in exercise, meditation and
healthy eating habit were able to reduce blood glucose more easily then the people using
medicine (den Braver et al., 2017).

Annotated bibliography
Morampudi, & et.al., 2017. The challenges and recommendations for gestational diabetes
mellitus care in India: A review. Frontiers in endocrinology. 8. p.56.
https://www.frontiersin.org/articles/10.3389/fendo.2017.00056/full
The articles is related with the study of gestational diabetes mellitus that is majorly
prevailing in India. This is highly found in the women. Management of GDM play a crucial role
because women with GDM would raise the chances of diabetes after 5-10 years of pregnancy.
GDM have a significant impact towards the pregnant women. As per the views of Morampudi,
and et.al there are variety of factors that are related with the raise chances of GDM among the
women and that may include the age, diet, obesity, family history and various other. Within India
alone five million women are affected by the GDM. In order tom make the analysis of the
prevalence and the impact of GDM among the women in India a qualitative method of research
is used. This would enable the review of various studies of the authors and articles regarding the
GDM. With this method a detailed analysis of the research would be able to get performed. The
data regarding the study is being extracted from the health policies, diabetes management, health
service research and various other aspects. With this mode of analysis, a detailed analysis of the
research would be able to get performed. This has resulted an in-depth analysis of the research.
other aspects including the physician’s forums, physician associated websites, blogs a various
other are given. While making an analysis it is identified that the overall health system of the
India is evaluated that how the Indian system is meeting the GDM. It is further determined that
the healthcare facility are not evenly distributed in India in terms of rural and urban areas. This
has resulted in the high persistence of the GDM.
The article also results and depict the observation that there is a persistence of various
challenges that may be occurred in India and has an impact towards the GDM diabetes among
women. These may include the challenges related with the self-management that is related with
the social taboo, cultural habits, screening cost and various other. Likewise, with the persistence
of aspect that there is an existence of poor interaction among the health care professionals and
the patients would lead to have an impact towards the raising rate of GDM diabetes. Likewise, it

bear certain suggestion that a system of universal screening would play an important role in the
reduction of the rate of GDM diabetes.
However, at the same time it bears certain limitation in terms of not approaching the
quantitative methodology. This is because performance of research on the basis of the articles
would be not impactful while making it compared it with the practical approach that would be
adopted in the quantitative method that would be consisted towards the survey under which a
direct sample would be analysed. Overall it would be right to said that the article and the author
review played an important role towards the meeting up of its main aim regarding the
determination of challenges and recommendation regarding the GDM Diabetes.
Raveendran, A. V., Chacko, E. C., & Pappachan, J. M. (2018). Non-pharmacological treatment
options in the management of diabetes mellitus. European endocrinology. 14(2). 31.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182920/
As per this article it is determined that 2 diabetes mellitus is one of the largely prevailing
disease in worldwide. Diabetes is highly associated with the obesity that has resulted from the
sedentary lifestyle. With the due course of pandemic the physical workout has reduced that has
resulted in the spreading of diabetes mellitus. Various individual use different treatment that
include the use of insulin. However as per the views of the Raveendran, Chacko, and Pappachan,
non-pharmacological treatment plays an important role. This is because with a high focus on diet
and lifestyle the type 2 diabetes mellitus would be easy to dealt. This is also observed that the
non-pharmacological intervention would be equally beneficial for the type 1 diabetes.
The study is being conducted through the mode of reviews which is a secondary research type
that would include an in-depth analysis and theoretical review of the information and articles.
This is considered as one of the major type of research method because with this method various
perspective in regard to the concept of diabetes-2 mellitus would be able to get analysed. This
has also enable to understand that what are the study and research of other articles and review of
the information mean. As per this study it is being analysed that one in every 11 adult has an
issue of diabetes that would impact its health. The articles also shows that as per the intervention

of non-pharmacological it would be right to states that with the aspect of focussing over the
issues related with the health including a focus towards the diet and the physical exercises would
lead to play an important role in treating with diabetes mellitus. The study also shows that with
the aspect of dietary intervention and focus towards the balanced diet it would be easy to meet
the 2 diabetes mellitus. This is because with the control over the diet the weight loss would be
able to get achieved that would further lead to assist the treatment of type-2 diabetes mellitus.
The strength of the article is related with the choosing of the review methodology because with
this methodology it would be easy to make study the various perspective of the diabetes mellitus.
Likewise, with the aspect of review method an in-depth analysis and research regarding the
diabetes mellitus and its treatment would be able to get studied and evaluated.
The study would also bear a limitation that is related with the choosing of secondary and
review methodology. This is because the result of this methodology would be more significant if
the practical exposure would be enabled in terms of the adoption of the quantitative
methodology. Also it is to be noted that as per the intervention of non-pharmacological a focus
over the pharmacological intervention which involve the use of medicines and drugs would lead
to have a direct impact towards the treatment of diabetes mellitus. This is because it would be
easy to control the diabetes and its impact with pharmacological interventions too with reference
to the emergency situation.
Gareth R. Dutton, PhD and Cora E. Lewis, The Look AHEAD Trial: Implications for Lifestyle
Intervention in Type 2 Diabetes Mellitus,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501472/>.
Gareth R,. Dutton and Cora E. lewin are two author that has completed study related to
The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus. It
has mentioned about the increased risk of type 2 diabetes mellitus and cardiovascular. The
inclusion criteria that has been used for the study is that people belonging to age group of 45-74
years old, BMI>250 kg/m, type 2 diabetes mellutis contribute in determining the self report with
objectives verification. On the other hand, exclusion criteria pertaining to the study is inadequate
control of comorbid condition, blood pressure>160/100mm Hg and fasting triglycerides. Study

sample include around 1545 participants for intensive lifestyle intervention and diabetes support
and education. Among which the average age of participants is 58.7 years, in which 37% are
racial/ ethnic minotires, having body mass index around 36.0 and 60% women.
The outcome that has been gained through pursing the study related is composite variable
of CVD mortality I.,e CVD dealth, non fatal stroke, non- fatal MI and hospitalised angina. It was
also identified that there are various clinical outcome including body weight, lipids, medication
use, health care cost and gylcated hemoglobin. Likewise, through the study it has been extracted
that intensive lifestyles intervention number used in men is around 232 while in 171 in women.
There are some of the factor that has limit the adherence to intervention such as unable to give
informed consent or communicate with the staff, lack of support has been gained from primary
care provider, weight loss> 10ib in previous months and self reported for alcohol abuse within 12
months. Moreover, the article provide guidelines related to AHEAD trial include guidelines
related to older adults >45 year old facing from issue of diabetes and its application on CVD risk
reduction among younger patient. In this LOOK ahead participants has been selected and
screened for adhering long term intensive lifestyles intervention program and exercise test to
insure safety of intervention.
Jana Blahova, Monika martiniakova and Vladimira Mondockova, 2015, Pharmaceutical
Drugs and Natural Therapeutic Products for the Treatment of Type 2 Diabetes Mellitus
ncbi.nlm.nih.gov/pmc/articles/PMC4501472/#R1
Jana Blahova, Monika martiniakova and Vladimira Mondockova has complete study
related to” Pharmaceutical Drugs and Natural Therapeutic Products for the Treatment of Type 2
Diabetes Mellitus”. As per the article type 2 diabetes mellitus is widespread having characteristic
of ineffective insulin, insulin resistance, hyperglycemia, ineffective insulin secretion and action.
In primary care, patient are provided with drugs that consist of insulin sensitisers, alpha-
glucosidase inhibitors and sodium-glucose co-transpoter 2 inhibitors. But in long run the
application of these have harmful side effect on health and well- being of person. Furthermore,
the study has helped in understanding that number of people suffering from diseases have
increased almost by two-fold in next 10 years.

According to author natural therapies are more better as compared to pharmaceutical
drugs such as in the study it has explained about natural health substance I.,e non flavonoid
polyphenols, flavonoid, plants, fruits and vegetable are safer method of treatment in comparision
with pharmacology therapy. In the study, or review it has been suggested that the initial; aproach
of T2 DM involves both combination of efficient lifestyle's changes and making use of
pharmaceutical drugs. Furthermore, it has been derived that it is one of the best suitable method
to control metabolic. Healthy diet and physical activity are two lifestyle's changes that individual
might may make use to stay healthy and fit and away from diseases such as diabetes Mellitus.
In the article the author has make review of different studies or make use of secondary
sources in order to extract useful information related to “Pharmaceutical Drugs and Natural
Therapeutic Products for the Treatment of Type 2 Diabetes Mellitus”. In order to gathered
information which method of treatment is the best suitable for type 2 diabetes mellitus. The
advantage of making use of review method is that information gathered more different sources
results in accumulating more necessary and required information related to the study. But
limitation is that there is lot of time as well as efforts of author has been wastage in order to
extract necessary information pertaining to the study.
Literature evaluation
Morampudi, & et.al., 2017 has presented study related to The challenges and
recommendations for gestational diabetes mellitus care in India: A review. Frontiers in
endocrinology. The study has helped in understanding gestational diabetes mellitus that is highly
found in women. Article has not make use of quantitative approach to complete the study that
has not helped in gathered statistical facts, figure and information related to the same. At the
same time, the study has helped in understanding the poor interaction among healthcare
professional and patient that have impact towards raising rate of GDM diabetes. The second
article present in the annotated bibliography is Non-pharmacological treatment options in the
management of diabetes mellitus. It is one of major problem faced by maximum number of
people across worldwide. In the study author has mentioned that because of less physical
activities people the chances of diabetes mellitus has been increased. Mode of review has been
used to complete the study in which different previous secondary study is taken to gathered
information related to impact of making use of Non-pharmacological treatment on people health.

Through review method, different studies related to Non-pharmacological treatment
options available for individuals is find out and the way it can contribute in improving health and
well being. All the treatment are effectively evaluated in order to select the best method that
could be used to treat the patient from diabetes Mellitus. While, from the view of cora E and
Gareth R, Dutton, is third articles in annotated bibliography that has make use of inclusive and
exclusive method to complete the study in desired manner. This strategy has helped researcher in
including only those information's that are relevant to the study while avoiding unnecessary to
gathered more relevant, accurate information related to the study. Moreover, in this look ahead is
the trial that is used to study related to implications for lifestyle intervention in type 2 diabetes
Mellitus. In this it has included risk for type 2 diabetes mellitus by test hypothesis that an
intensive lifestyle's intervention in order to achieve the weight loss. Therefore, in this study
information related to what all implication's lifestyle intervention has on type 2 diabetes
melliutus is study and necessary information has been gathered relevant to it.
Jana Blahova, Monika martiniakova and Vladimira Mondockova in its study has revealed
that natural therapeutically is good in comparison with pharmaceutical drugs. As there are less
disadvantages or negative impact of natural therapeutic on human being as comparision with
pharmaceutical drug. The study is also based on review method that means author has review
different articles in order to accumulate necessary information related to the method that is best
suitable for treatment of patient condition. So, in the article there is clear mentioned of action and
negative effect of the both treatment on health and well being of person.
CONCLUSION
From the above four articles and annotated bibliography it can be stated that diabetes is
an group of diseases that affect or impact on the manner in which the body make use of blood
sugar. It results in increasing Urination and thirst, at the same time people may be also suffering
from lose weight. Furthermore, it can be stated that lifestyle's intervention could be the best
intervention that could be used to treat the patient suffering from Diabetes mellitus. At last, it can
be summarized that the artciles has helped in understnading the increasing risk pertaining to the
health problem and the way non - pharmacological intervention is better as compared to
pharmacological intervention.

REFERENCES
Book and Journals
Gareth R. Dutton, PhD and Cora E. Lewis, The Look AHEAD Trial: Implications for Lifestyle
Intervention in Type 2 Diabetes Mellitus,
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501472/>.
Jana Blahova, Monika martiniakova and Vladimira Mondockova, 2015, Pharmaceutical Drugs and
Natural Therapeutic Products for the Treatment of Type 2 Diabetes Mellitus
ncbi.nlm.nih.gov/pmc/articles/PMC4501472/#R1
Morampudi, & et.al., 2017. The challenges and recommendations for gestational diabetes mellitus care in
India: A review. Frontiers in endocrinology. 8. p.56.
Raveendran, A. V., Chacko, E. C., & Pappachan, J. M. (2018). Non-pharmacological treatment options in
the management of diabetes mellitus. European endocrinology. 14(2). 31.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182920/