Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes

The research article assesses the efficacy of a combined lifestyle intervention when applied on a long term basis that aimed to control the body weight and waist circumference in adults who were overweight, non-diabetic and lived in a low socio-economic community. The study highlighted that in the past decade, the global burden of diabetes has increased rapidly, and that type 2 diabetes accounts makes up for nearly 90% of the diabetes incident cases across the globe.

Running head: EPIDEMIOLOGY
Epidemiology of non communicable disease
Name of student:
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EPIDEMIOLOGY
Question1
The research article titled “Long-Term Effectiveness of a Lifestyle Intervention for the
Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community – An Intervention
Follow-Up Study on Reunion Island” written by Fianu et al. (2016) assessed the efficacy of a
combined lifestyle intervention when applied on a long term basis that aimed to control the body
weight (BW) and waist circumference (WC) in adults who were overweight, non-diabetic and
lived in a low socio-economic community. The study highlighted that in the past decade, the
global burden of diabetes has increased rapidly, and that type 2 diabetes accounts makes up for
nearly 90% of the diabetes incident cases across the globe. Lifestyle intervention was selected
for studying prevention of type 2 diabetes against the research evidence that such an intervention
holds the potential to delay or reduce the chances of developing the non communicable disease.
The mechanism by which the lifestyle intervention functions in light of the etiology of type 2
diabetes is well understood.
As opined by Rapp et al. (2017) physical inactivity and unbalanced diet are the key
modifiable factors that contribute to type 2 diabetes. Koivusalo (2017) has mentioned that dietary
habits have a significant part to play in the development of obesity, and therefore subsequent
diabetes. Fogelholm et al. (2017) had given a clear concept of how overweight due to poor diet
and sedentary lifestyle can lead to diabetes. People who are obese have increased pressure on the
ability of the body to utilize secreted insulin for controlling blood glucose level. Abdominal fat is
the cause of fat cells to produce pro-inflammatory chemicals that compels the body to be less
sensitive to insulin. The proposed mechanism is the disruption of the insulin responsive cell’s
functions and responsive ability.

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The research supported the assumption that impact of long-term lifestyle intervention
targeting type 2 diabetes is noteworthy. At inclusion, T2D risk factors were prevalent, like
family history of diabetes in first-degree relatives (42%), total obesity (43%, median BMI 29.1
kg/m²), women with a personal history of gestational diabetes (11%), and central obesity (71%).
At follow-up, the adjusted effect on imputed dataset was significant for WC -2.4 cm (95%
confidence interval: -4.7 to -0.0 cm, p = 0.046), non-significant for BW -2.2 kg (-4.6 to +0.2 kg,
p = 0.073) and BMI -0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). The interventions applied in
the study had an impact on total obesity and central obesity prevention, therefore paving the way
for future research in this direction. The findings were in support of the intervention of lifestyle
modification over a short period that is one year was also encouraging as there was a chance of
reduction in adiposity in individuals. Further, there was reduction in BMI, loss of body weight
and reduction in waist circumference in the group exposed to the intervention.
Question 2
Fianu et al. (2016) had provided a concise description of the lifestyle intervention that
was applied in the study. As per the researchers, randomized prevention trials for diabetes have
been carried out in a number of countries such as Japan, India, China, USA and Finland. The
clinical trials were carried out in settings that were resource-intensive and volunteers have been
recruited for this purpose. Further, there lies a rich pool of translation studies carried out in the
real-life settings for the evaluation of the intervention. The research also highlighted that the
recent meta-analysis in this regard has brought into focus that lifestyle intervention has resulted
in a 2.32 kg mean weight loss after 12 months (95% confidence interval: -2.92 to -1.72 kg).
Summarizing most of the existing literature on this topic, the researchers mentioned that four
recommendations can be outlined as the basis for lifestyle interventions for preventing diabetes.

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The article was successful in mentioning that against the light of the existing research there is a
need of conducting further studies to review the efficacy and usefulness of the intervention.
Further, it has also mentioned that limited studies existed that assessed the long-term
benefits of T2D prevention after lifestyle intervention discontinuation was considered. There was
also no research addressing the four recommendations highlighted. Gaps in existing literature
was therefore successfully pointed out which is noteworthy for critical appraisal (Flick 2015).
The drawback of the literature review presented on the intervention selected is that the sample
populations of the respective studies have not been mentioned. Further, the results have not been
mentioned in here in relation to the biological mechanism of diabetes (Katula et al. 2017).
Question 3
The present section would highlight the methodological limitations in the interpretations
of the findings of the study, and the degree to which the observed association can be attributed to
mechanisms other than the intervention. The study had numerous limitations including a small
sample size. It is known that a small sample size restricts the study result’s generalisability (Flick
2015). Further, the three month intergroup difference in follow up might have negligible impact
on the intention-to-treat analysis for the extraction of results (Silverman 2016). In addition, the
intention-to-treat analysis might have decreased the contrast in evaluation, thereby reducing the
effect-size (Flick 2015).
A temporal relationship between the intervention and the outcome is the inter-
propositional relation between the two. In the research there was a sequential relationship
between the intervention and the outcome as intervention was directly linked with reduction in
chances of developing diabetes (Franz et al. 2015). It is to be mentioned that there was no strong

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relationship between the intervention and the outcome as the result was statistically significant
for body waist circumferences (p=0.046) and non-significant for BMI and body weight (p=0.074
and p=0.073 respectively). A ‘p’ value of 0.05 or less denotes strong evidence against the null
hypothesis (Panneerselvam 2014).
Dose-response relationship describes the change in effect caused due to different levels of
doses or exposure (Arem 2016). In this study there was no such relationship as the follow up was
done after nine years and not in between. The impact of selection bias was noteworthy as more
number of females was recruited as compared to females (Taylor 2015). It is further to be
mentioned that the results of the study are likely to be affected by confounding factors such as
educational level, smoking, number of meals per day, and BMI.

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