Effectiveness of Lifestyle Modifications in Type 2 Diabetes Management

This article discusses the effectiveness of lifestyle modifications in reducing complications associated with type 2 diabetes and promoting recovery. It includes an extensive literature review and analysis of research findings.

Running head: EVIDENCE BASED NURSING
Evidence Based Nursing
Name of the Student
Name of the University
Author Note

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EVIDENCE BASED NURSING
Introduction
According to the Australian Institute of Health and Welfare [AIHW] (2018) long
lasting disease condition characterised by persistent symptoms are characterised as chronic
diseases. The economic and social complications associated with chronic diseases disrupt the
health-related quality of life of the affected individuals. AIHW highlights 8 major health
conditions under chronic health diseases and these include asthma, cancer, arthritis, back-
pain, chronic obstructive pulmonary disease, cardiovascular disease, diabetes and mental
health conditions. The following assignment will highlight extensive literature review over
type 2 diabetes management.
Research Question
P Population Individuals with Type-2 Diabetes
I Intervention Lifestyle modifications
C Comparison Diabetes education and social support
O Outcome Improvement in health related quality of life of individuals with
type-2 diabetes mellitus (T2DM)
Research question
According to Chatterjee, Khunti and Davies (2017), diabetes especially T2DM is a
global health concern. Numerous compelling evidences highlight that diabetes can be
prevented and health related quality of life can be improvement through modifications in
lifestyle habits. Lifestyle modifications mainly include physical exercise, diet management
and reduction in smoking and drinking. Venditti and Kramer (2012) are of the opinion the
effective lifestyle modification help to regulate the calories intake and burning of the extra

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calories which in turn helps to control the glycemic level of the body. Thus the main research
question is: How effective is life style management in reducing and complications associated
with type-2 diabetes and thereby promoting subsequent recovery?
Evaluation of the research
According to Gregg et al. (2012), the frequency of remission of T2DM through
lifestyle interventions is unclear. Thus, the principal objective of the research is to analyze the
long-term intensive weight loss intervention in relation to frequency of remission of T2DM
towards normoglycemia and prediabetes. Thus, the research aim of Gregg et al. (2012) was
novel as it specifically highlighted the research gap and structured the research question
accordingly. They conducted ancillary observational analysis under randomized control trial
with 4-year follow-up (April 2001 to April 2004). They randomly selected 4503 US adults
with BMI (body mass index) higher than 25 and have T2DM. The authors mainly
implemented intensive lifestyle intervention (ILI) with proper diabetes support and education
control condition (DSE). They authors randomly assigned one group of participants (n=
2241) to receive ILI and another group of participants (n=2262) to DSE which include
education in diet and management of physical activity. Therefore, the main strength of the
article is its high sample size. According to Charan and Biswas (2013) high sample size helps
to reduce the biased outcome. The analysis of the results highlighted that ILI is associated
with greater likelihood of T2DM remission among over-weight adults in comparison to
diabetes control and education. The research paradigm selected by the authors is positivism
research paradigm. According to Brannen (2017), positivism research paradigm is
appropriate for the quantitative research. Gregg et al. (2012) conducted quantitative research
as used statistical analysis in order to compare the primary outcome of the study (complete or
partial remission of T2DM) with ILI group and DSE group. One of the limitations of the

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study is, Gregg et al. (2012) used 4-year of follow-up in order to study the primary outcomes
and this lead to an overall decrease in the sample size, which might lead to biased outcome.
Research topic
According to the National Strategic Framework for Chronic Condition (2017), the
primary focus must be given on disease prevention in order to promote healthier Australia.
The health promotion strategies must be designed in such a way that it minimizes the adverse
effect associated with the disease outcome along with decrease in the progression of the
disease towards severity among the vulnerable population. The research topic highlighted in
the paper is mainly focused on how modification of the lifestyle helped in reducing the
severity of T2DM in comparison to simple disease education and awareness. The analysis of
the results highlighted that the physicians may provide proper disease education and hopeful
advice but such education and disease awareness is not suitable for the effective prevention of
the disease. Extensive lifestyle interventions like rigorous physical exercise along with
regulation of diet plan helps in decreasing the severity of diabetes via decrease the disease
status into prediabetic of nondiabetic glycemic level. The research undertaken by Gregg et al.
(2012) mainly elucidated that effective lifestyle intervention help in reducing the overall body
mass index (BMI) and this in turn helped to reduce the glycemic load of the body along with
decrease in the threats of developing cardiovascular complications. The overall effect of the
lifestyle interventions as highlighted by Gregg et al. (2012) in their study coincides with
National Strategic Framework for Chronic Condition (2017) as it lead to the promotion of
health, reduction of the associated health risk and with overall improvement of the critical life
stages.

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Literature Review
Diabetes is considered as a progressive and incurable condition wherein the most
suitable scenario after the disease diagnosis is proper metabolic management and
management of the modifiable risk factor in order to reduce the associated complication that
might affect the neurovascular or cardiovascular system (Chatterjee, Khunti & Davies, 2017).
Gregg et al. (2012) conducted a quantitative observational randomized control trail and their
projected primary outcome was complete or partial remission of T2DM under the definition
of transition from meeting the criteria of diabetes to nondiabetic or prediabetic blood glucose
level. The results highlighted that group of participants who were assigned under the
extensive lifestyle interventions lost more body weight in comparison to the individuals who
only received disease education and awareness. The significant difference was 7.9% in 4-year
duration. The results also highlighted that ILI group has is 11.5% more likely to experience
partial or complete remission of diabetes during the first year. Thus overall statistical analysis
and the comparison of the data highlighted that ILI is associated with increased likelihood or
of partial remission of T2DM in comparison to the diabetes support or education. However,
Gregg et al. (2012) are of the opinion that absolute remission rate were more modest in
comparison to the partial remission rate.
Rejeski et al. (2012) are of the opinion that adults with T2DM have mobility
restrictions this increases with age. An intensive lifestyle intervention that helps to reduce
weight, promotes physical fitness and slows down the degenerative process of mobility
restriction among the T2DM individuals. They conducted randomized control with 5145
over-weight or obese individual between the age group of 45 to 75-year who are suffering
from T2DM. They randomly assigned one group to lifestyle intervention and another group
to diabetes support and education program. Thus, the approach of the study was identical
with the observational randomized control trial conducted by Gregg et al. (2012). The results

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highlighted that participants who were assigned under the lifestyle intervention showed
reduction in the mobility loss by 48% in comparison to the group who are assigned to
diabetes education and support. Rejeski et al. (2012) are of the opinion that physical exercise
as promoted by the lifestyle intervention helped to promote weight, which in turn increased
the physical fitness and thereby reducing mobility restriction. Reduction in the restriction in
mobility helped to improve the health-related quality of life of the individuals. However,
lifestyle interventions are associated with adverse events and this includes increase frequency
of musculoskeletal. Thus, it can be said that ILI is not comprehensive in improving overall
health-related quality of life of the individuals.
In relation to the effect of lifestyle modification and T2DM control the Look AHEAD
Research Group of Alpert Medical School of Brown University and Miriam Hospital
conducted a study in US. The aim of their study is to analyze whether an ILI used for
effective weight loss management is effective in decreasing the cardiovascular morbidity and
mortality among the individuals with T2DM. They randomly assigned 5145 obese and over-
weight individuals with T2DM under ILI. ILI promoted reduction in BMI along through
decrease intake of calories along with increase rate of physical activity. Another group
received diabetes support and education. The primary outcome measured in the study is
reduction in fatal outcomes among T2DM people arising from cardiovascular complications
like myocardial infarction. The results of the trial of 9.6 years of follow-up highlighted that
weight loss is greater in the intervention group (ILI) in comparison to the control group
(received only disease education and support). The results also highlighted that ILI is
effective in reducing glycemic index of the body however, failed to reduce the cardiovascular
completion. The authors are of the opinion that ILI has no significant effect on the blood
cholesterol and thus failed to cast significant impact of cardiovascular complications of
diabetes.

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Thus the research findings highlighted that ILI in comparison to disease education and
social support is effective in reducing weight and thus decreasing the severity of T2DM via
reducing the glycemic index. However, ILI has significant effect on cardiovascular
complication and rigorous physical exercise might promote musculoskeletal complications.
Thus implications to change in the nursing practice will mainly focus on implementation of
lifestyle modifications program other than solely relying on the disease education and social
support
Recommendation
According to Chawla, Chawla and Jaggi (2016), one of the adverse outcome of the
T2DM is development of marcovascular and microvascular complication. These are mainly
cardiac complications caused by high level of blood cholesterol and thereby leading to the
development of atherosclerosis. So recommendation for effective diabetes management must
be designed in such that way that it provides a comprehensive coverage to the macrovascular
and microvascular complications of diabetes. The study conducted by Sjöström et al. (2014)
highlighted effective amalgamation of invasive (bariatric surgery) and non-invasive
technique is effective in reducing the severity of T2DM via reducing the vulnerability of
developing macro and microvascular complications. Further research and comparative
analysis through observational randomized control trials are required to be undertaken in this
domain to provide a detailed overview.

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References
Australian Health Ministers’ Advisory Council (2017).National Strategic Framework for
Chronic Conditions. Access date: 4th October 2018. Retrieved from:
http://www.health.gov.au/internet/main/publishing.nsf/content/A0F1B6D61796CF3D
CA257E4D001AD4C4/$File/National%20Strategic%20Framework%20for
%20Chronic%20Conditions.pdf
Australian Institute of Health and Welfare.(2018). Chronic Disease Overview. Access date:
4th October 2018. Retrieved from: https://www.aihw.gov.au/reports-statistics/health-
conditions-disability-deaths/chronic-disease/overview
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in
medical research?. Indian journal of psychological medicine, 35(2), 121.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085),
2239-2251.
Chawla, A., Chawla, R., & Jaggi, S. (2016). Microvasular and macrovascular complications
in diabetes mellitus: distinct or continuum?. Indian journal of endocrinology and
metabolism, 20(4), 546.
Gregg, E. W., Chen, H., Wagenknecht, L. E., Clark, J. M., Delahanty, L. M., Bantle, J., ... &
Pi-Sunyer, F. X. (2012). Association of an intensive lifestyle intervention with
remission of type 2 diabetes. Jama, 308(23), 2489-2496.
Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle
intervention in type 2 diabetes. New England journal of medicine, 369(2), 145-154.

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Rejeski, W. J., Ip, E. H., Bertoni, A. G., Bray, G. A., Evans, G., Gregg, E. W., & Zhang, Q.
(2012). Lifestyle change and mobility in obese adults with type 2 diabetes. New
England Journal of Medicine, 366(13), 1209-1217.
Sjöström, L., Peltonen, M., Jacobson, P., Ahlin, S., Andersson-Assarsson, J., Anveden, Å., ...
& Näslund, I. (2014). Association of bariatric surgery with long-term remission of
type 2 diabetes and with microvascular and macrovascular
complications. Jama, 311(22), 2297-2304.
Venditti, E. M., & Kramer, M. K. (2012). Necessary components for lifestyle modification
interventions to reduce diabetes risk. Current diabetes reports, 12(2), 138-146.

Running head: EVIDENCE BASED NURSING
Appendix
Annotated Bibliography
Name and year of publication Aim of the study Study Design Results
Gregg, E. W., Chen, H.,
Wagenknecht, L. E., Clark, J.
M., Delahanty, L. M., Bantle,
J., ... & Pi-Sunyer, F. X.
(2012)
The principal objective of the research
is to analyze the long-term intensive
weight loss intervention in relation to
frequency of remission of T2DM
towards normoglycemia and
prediabetes.
They conducted ancillary
observational analysis
under randomized control
trial with 4-year follow-up
The analysis of the results
highlighted that ILI is associated
with greater likelihood of T2DM
remission among over-weight adults
in comparison to diabetes control
and education.
Rejeski, W. J., Ip, E. H.,
Bertoni, A. G., Bray, G. A.,
Evans, G., Gregg, E. W., &
Zhang, Q. (2012)
The aim of the study was to elucidate
tha an intensive lifestyle intervention
that helps to reduce weight, promotes
physical fitness and slows down the
degenerative process of mobility
restriction among the T2DM
individuals.
They conducted
randomized control with
5145 over-weight or obese
individual between the age
group of 45 to 75-year who
are suffering from T2DM.
Physical exercise as promoted by the
lifestyle intervention helped to
promote weight, which in turn
increased the physical fitness and
thereby reducing mobility
restriction. Reduction in the
restriction in mobility helped to

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EVIDENCE BASED NURSING
improve the health-related quality of
life of the individuals. However,
lifestyle interventions are associated
with adverse events and this includes
increase frequency of
musculoskeletal.
Look AHEAD Research
Group. (2013)
The aim of their study is to analyze
whether an ILI used for effective weight
loss management is effective in
decreasing the cardiovascular morbidity
and mortality among the individuals
with T2DM.
Randomised control trial The results of the trial of 9.6 years of
follow-up highlighted that weight
loss is greater in the intervention
group (ILI) in comparison to the
control group (received only disease
education and support). The results
also highlighted that ILI is effective
in reducing glycemic index of the
body however, failed to reduce the
cardiovascular completion.

Running head: EVIDENCE BASED NURSING