Effectiveness of Lifestyle Modifications on Type 2 Diabetes Mellitus in Smoking Individuals Aged 45-60 Years

This systematic review analyzes the effectiveness of lifestyle modifications on treating Type 2 Diabetes Mellitus in smoking individuals aged 45-60 years. It explores the impact of physical activity and dietary changes on diabetes treatment and the challenges faced by smokers with diabetes. The study suggests that a healthy lifestyle can reduce the risks associated with type 2 diabetes.

Effectiveness of lifestyle modifications on the treatment of type 2 diabetes mellitus among smoking individuals ageing 45-60
years

Abstract
The main objective of the systematic review is to determine the challenges faced with type 2 diabetes. The study analyses the
effectiveness of lifestyle modification in response to diagnosis and maintaining behavior change for a healthy life. The changes in
lifestyle behavior have been discussed and investigated to understand the impact of type 2 diabetes. People with smoking habits
between the age of 45 to 60 years face severe effects due to type 2 diabetics.
In the review studies using qualitative methods have been used to better understand the effectiveness of change in the lifestyle. It is
vital that the changes are made in the weight, proper exercise, and moderate to intense workout for at least 2hours a week. It is
advisable from data that diet is to be followed by including fruits and vegetables. However, it is identified that cigarette smoking
impacts health and leads to behavior change which is not suitable for treating type 2 diabetics.
As a part of the result, it is noted that improving nutrition and including vegetables helps to reduce weight. Quitting smoking is vital as
it will positively impact health behavior. It has also resulted that reducing stress, improving sleep, proper diagnosis, exercise, regular
monitoring of blood pressure, and limiting the smoking ability helps the type 2 diabetics patients.
It can thus be concluded that lifelong diseases with high risk can be reduced through leading a proper lifestyle. Controlling the glucose
level by following a healthy diet, weight loss, performing exercises will positively influence healthy blood glucose levels and reduce
the risks associated with type 2 diabetics.

Table of Contents
Abstract........................................................................................................................................................................................................2
Chapter 1: Introduction................................................................................................................................................................................5
Background of the study..........................................................................................................................................................................5
Aim and Objectives.................................................................................................................................................................................8
Problem of this Study..............................................................................................................................................................................8
Rationale of this Study.............................................................................................................................................................................9
Chapter 2: Research methodology.........................................................................................................................................................15
Introduction............................................................................................................................................................................................15
Step of Undertaking Systematic Review...........................................................................................................................................21
Limitations.............................................................................................................................................................................................22
Research Process...................................................................................................................................................................................23

Search Terms.........................................................................................................................................................................................23
Inclusion and Exclusion Criteria...........................................................................................................................................................24
Search Strategy......................................................................................................................................................................................25
Study selection.......................................................................................................................................................................................25
Data Extraction......................................................................................................................................................................................26
Findings from Secondary Data..............................................................................................................................................................40
Impact of Smoking on Diabetes........................................................................................................................................................40
Impact of Diet on Diabetes................................................................................................................................................................40
Impact of Physical Activity on Diabetes...........................................................................................................................................41
Chapter 5 Discussion.................................................................................................................................................................................43
Chapter 6: Conclusion...............................................................................................................................................................................49
Policy implications................................................................................................................................................................................54
References..................................................................................................................................................................................................55

Chapter 1: Introduction
Background of the study
The occurrence of diabetes is increasing globally, resulting in diabetes-related complications and even an impact on healthcare costs.
It is acknowledged that the number of people who have diabetes has risen from 108 million in 1980 to 422 million in 2014. Between
2000 to 2016, there was a 5% increase in premature mortality rate from diabetes (Wang & et. Al., 2018). It is even analyzed that
adults over 18 years are increasingly suffering from these diseases, which enhanced from 4.7% in 1980 to 8.5% in 2014(WHO, 2021).
In 2019, diabetes had led to the death of 1.5 million people, wherein 2.2 million death took place due to higher blood glucose levels in
2012. WHO has also estimated that diabetes was the 4th leading reason for the death of people in 2016? It is acknowledged that more
than 4.8 million people have diabetes, whereby more than 700 people prematurely die with diabetes every week (WHO, 2021). Type 2
diabetes is more commonly found among older individuals as compared to younger ones.
Type 2 Diabetes is a lifelong disease that has increased the mortality rate. An unhealthy lifestyle like drinking alcohol is harmful to
this disease, where a moderate amount of alcohol enhances insulin sensitivity and HDL cholesterol level. The heavy intake of alcohol
improves triglyceride levels and even impair the metabolism of glucose and carbohydrate (Figueira & et al.,2017). Smoking is also
linked with an increased risk of diabetes mellitus, where frequent smokers who intake 20 cigarettes per day possess a maximum
chance to attain diabetes. On the other hand, Occasional smokers are relatively at lesser risk of type-2 diabetes ( Figueira & et
al.,2017).

Apart from smoking and drinking alcohol. Weight gain has also acted as a significant issue for people with type 2 diabetes. As per the
Third National Health and Nutrition Examination Survey, most people with diabetes are obese or overweight. Type 2 diabetes with
overweight and obese patients can significantly improve glycemic control and plasma lipid when they decline the weight (Public
Health Agency of Canada Diabetes in Canada, 2016). It is underlined that body weight enhances with age and oral hypoglycemic
drugs lead to weight gain, thus, encouraging the patients to attain and maintain healthy weights should be of prime priority for every
diabetes care programmed.
Diabetes mellitus is a significant issue faced by modern civilization that has led to various complications and it can be seen in various
walks of the society as a common health issue (Rinaldi et al., 2016). Medical treatment alone cannot, however, lead to the cure of
diseases, but changes in lifestyle factors help in preventing diabetes. When an individual controls the glucose strictly, then it can avoid
the progression of issues associated with diabetes (Rinaldi et al., 2016). There is evidence that a healthy lifestyle following a healthy
diet and achievement of modest weight loss and regular physical activities helps in maintaining blood glucose levels and decline the
risk of type 2 diabetes (Rinaldi et al., 2016).
Lifestyle modification can reduce energy intake whereby control in diet and performing of physical exercise are the principal therapy
for overweight and obese patients who have Type-2 Diabetes. Research states that there are protective mechanisms which include
physical activities, anti-inflammatory strategy, reduction of weight via intake of low-calorie diets, and also a healthy eating pattern

that should be followed. The prevention of type 2 diabetes can be possible through modification of lifestyle and medication along with
dietary supplements, exercise, and also herbal medicines (Meier & Bonadonna, 2013).
Long-term diabetes management includes health behaviors like physical activities, weight management, smoking cessation, healthy
eating, etc. Regular physical activities assist in preventing type 2 diabetes, enhances blood pressure control, and also reduce the
complication risk (Fadare, Olamoyegun & Gbadegesin., 2015). Moderate to vigorous physical activities decline the risk of
cardiovascular mortality, blood pressure, smoking status and also control cholesterol level. Weight management and modification of
diet like the adoption of Mediterranean or low-glycemic index eating pattern is seen to be effective in decline cardiovascular disease
risk (Thamer & et.al., 2017). Smoking is a well-established and significant risk for cardiovascular disease, and people who have type
2 diabetes should quit smoking.
There are various developing and under-developed countries where diabetic patients are not aware of the benefits of lifestyle change
in glycemic control. There is a higher need to educate people regarding disease and various management options (Forouhi et al 2016).
Government should also focus upon educating students from the earlier stage about negative impacts of diabetes through upgrading
education system. Educating campaigns can also be effective to spread awareness regarding healthy lifestyle. Apart from this,
receiving the diagnosis of diabetes from the health professionals even enhances people’s awareness for the need to change lifestyle
and could act as motivating factors. A study has reported that more than 60% of the people who are of age 45-65 years and are

suffering from Type-2 diabetes are not attaining performing recommended and desired number of physical activities (Asaadet al.,
2016).
Aim and Objectives
The proposed study aims to analyze the effectiveness of lifestyle modifications on treating Type 2 Diabetes Mellitus in individuals
who smoke of age 45-65 years in India.
To support this aim, the proposed research study further attempts to achieve the following objectives. These objectives are:
 To acknowledge the impact of Type 2 Diabetes Mellitus in smokers aged 45-65 years in India.
 To explore the relationship between Type 2 Diabetes Mellitus treatment with smoking habits in an individual of age 45-65
years in India.
 To examine the impact of physical activity and changing dietary habits on the treatment of Type 2 Diabetes Mellitus in
smokers aged 45-65years in India.
Problem of this Study
Several studies have indicated that most people are facing type 2 diabetes complications due to a lack of proper knowledge and its
management. These people suffer from higher BMI, poor glycemic control, use of pharmacological treatments, and also co
morbidities. It is encountered that there is significantly less research in this subject considering the impact of analysis upon the

physical activities, weight loss, dietary change, and other factors in those aged 45-65 years who are smokers. Moreover, many
diabetes patients who are smokers aged 45-65 years are still unaware of the issues, as significantly less research has been performed in
this field. This has resulted in a significant issue that needs to be addressed.
Rationale of this Study
It is clear from the evidence Schellenberg & et.al. (2013) that when people take lifestyle intervention programs and attain adequate
knowledge regarding the diseases, then it can show a significant improvement in glycemic control and physiological health. This
study aims to analyze different lifestyle interventions important for those aged 45-65 who are smokers. This study is deemed as
necessary as it will help smokers of age 45-65 to get awareness regarding the impact of Type 2 Diabetes Mellitus. It will further help
them to develop linkage of Type 2 diabetes mellitus treatments with regard to the changes in their dietary and physical activity habits.
This study will assist smoker in getting awareness regarding the proper diet habits which they can apply in their daily life. It will
explain to individuals the importance of physical activities and a good diet to treat the problem. This research’s findings and results
will contribute to diabetes patients having greater control of their situation and stay healthy. It will also help the diabetes patients to
control their situation wherein help healthy people to keep good life. This study is also crucial explores the type of food, physical
activities, mental health, etc. are required for the lifestyle change. This can help build self-confidence among the patients to improve
their lifestyle and stop smoking, drinking alcohol, and eating more unhealthy foods.
Literature review

Diabetes and its types
Saito et.al. (2011) have stated that diabetes is a disease which occurs when the blood glucose is very high. Blood glucose is the main
source of energy that is derived from the food consumed by the individual. Most of the food that are eaten break down into sugar
termed as glucose which are released in the bloodstream. When the blood sugar rises, it gives signals to the pancreas to release insulin,
The insulin acts as key to let the blood sugar pass in the cells of body for usage as energy. However, when pancreas which is
responsible for hormonal secretion of insulin is absent that glucose stays at the blood itself and are not able go inside the cells
(Cochran & et.al. (2013).
Diabetes Australia (2021) stated that there are different types of diabetes that includes Type 1, type 2 and also gestational diabetes.
Type 1 diabetes is the type of diabetes which is autoimmune wherein the body attacks itself. In this, the cell which produce insulin in
the pancreas are ruined. Type 1 diabetes is common which is found in majority of people suffering from diabetes. This type 1 diabetes
is found in young adults and children but can also develop in any of the age. Type 1 diabetes can be termed Juvenile diabetes wherein
people with this type have to take the intake of insulin every day. More than 5-10% of the people possess Type 1 diabetes and often
develop quickly. Thus, this diabetes type is termed as Insulin-dependent diabetes.
Type 2 Diabetes mellitus
Bassler & et. al. (2010) has revealed that Type 2 Diabetes Mellitus is a chronic disease which is characterized by high sugar level in
the blood. This diabetes is also called adult-onset diabetes as it gets started in middle- and late-adulthood. There are larger number of

children and teens who are developing this conditions, Type 2 diabetes is more common than type 1 diabetes and is a different disease.
Type 2 diabetes is an impairment of how the body regulates and make the usage of sugar(glucose) as a major fuel. This long-term
chronic condition leads to too much sugar circulation in the blood stream. The excess blood sugar declines the elasticity of blood
vessels and leads to narrow done the blood flow. This decline supply of blood and oxygen and enhance the risks of higher blood
pressure which also damage blood vessels (Thamar & et.al., 2017). The decline in blood affects the different systems of body. The
higher levels of blood sugar have resulted in disorder of nervous, immunity and circulatory systems (Cho & et.al., 2013). In type 2
diabetes, pancreas does not make the production of enough insulin which is a hormone that makes the regulation of sugar movement
in the cells as well as cells does not respond in an effective manner to insulin and thus takes in lesser amount of sugar. Bell & et.al.
(2015) have mentioned that at the time of digestion, the food is broken down in various components wherein carbohydrates are broken
in simple sugars mainly glucose.
Works on Lifestyle Modifications and Diabetes
Diabetes can be controlled through development in patient’s dietary understanding, attitude and activities. These aspects are regarded
integral portion of inclusive diabetes care. Lifestyle management is a key aspect of diabetes care and comprises select management
education, self-management support, nutrition treatment, physical function, smoking cessation therapy and psychosocial care. Patients
and healthcare providers require to concentrate cooperatively on enhancing lifestyle from time to time of initial broad medical
assessment, during every succeeding assessment and follow up and throughout evaluation of problems and management of comorbid

situations for enhancing diabetes treatment (Williams & et. al., 2013). According to (Cho & et. al., 2013), obesity and inactive lifestyle
support to the threat of and development of type of 2 diabetes. Obesity is also an aspect of insulin resistance, which is a key reason of
increased glucose levels. Weight minimization and a growth in physical function enhances glycemic control through minimizing
insulin resistance and dropping abstaining blood glucose. Diabetes treatments in general minimize hepatic glucose production,
improve insulin discharge, progress insulin sensitivity and prolong the effect of glucagon like peptide. Interventional studies
demonstrated that high carbohydrate and high monounsaturated fat diets enhance insulin sensitivity, where glucose discarding dietary
activities include the first line interference for regulating dyslipidemia in diabetic patients. Various dietary studies suggested nutrition
therapy and changes in lifestyle as preliminary treatment for dyslipidemia. Metabolic control is regarded as the keystone in managing
diabetes (Lindstrom & et al., 2013; Heesch & et.al. 2011 and Forouhi & et. al., 2016)).
Lifestyle change for the prevention of diabetes
Esposito & et.al. (2015) stated that in the type 2 diabetes, the functioning of pancreas takes place but not in an effective manner. The
body build insulin resistance but is not able to convert the glucose in an effective manner into energy that results into presence of
larger amount of glucose in the blood. The type 2 diabetes could be managed by the means of means of lifestyle modifications that
includes regular exercise, healthy diet and also monitoring of the level of blood glucose.
Brand-Miller, Hayne, Petocz & Colagiuri(2013) have revealed that weight loss is termed as the main line of treatment for the Type 2
Diabetes and hypertension linked with obesity as obesity is the main reason for the metabolic syndrome, type 2 diabetes and also

insulin resistance. However, a lifestyle modification possesses a lower caloric diet, deduction in the sedentary behavior and also
exercise which leads to foundation for all therapy. It is analyzed that those people who are subjected to severe obesity and who does
not undertake exercise program are recommended to undertake bariatric surgery (Malin & et.al. (2012).
It is stated by Bell & et.al. (2015) that weight loss is a first-line treatment for the obesity linked type 2 diabetes and also hypertension.
The main objective of the decline in obesity is to decline the higher risks of cardiovascular events and even percent the complication
that arise from type 2 diabetes. The lifestyle interventions along with diet and exercise results into loss of weights which prevents and
delays type 2 diabetes as well as intolerance of glucose. The loss of weight even safeguards cardiovascular and renal complications
which affects the obese individuals with hypertension and metabolic syndrome. The weight loss linked with life-style modification
leads to the treatment for diabetes mellitus and also assist in antihypertensive pharmacological treatments.
Apart from above, it is also analyzed by Atkinson, et al (2015) that intake of calorie restricted diet along with aerobic exercise is
equally essential to maintain healthy weights so as to prevent and control the diabetes. It is stated that an individual should perform 2.5
hours of exercise per week and should have a modest intake of fat which is approximately 30% of the energy supply. When an
individual perform exercise and restrict its calorie diet that it results into loss of weight which proves to be effective in controlling or
preventing Type 2 Diabetes. It is analyzed that exercise intervention alone is not effective in the loss of weight, but mild calorie
restriction is also highly needed which results into controlling or preventing Type 2 Diabetes. It is recognized that a long term follows

up with relative higher protein, moderate lower calorie, lower glycemic index diets and also daily physical exercise leads to be
successful in declining long term rebound by maintaining fat-free-mass and attainment of higher loss of fat (Lindstrom & et al., 2013).

Chapter 2: Research methodology
Introduction
The research study aims to determine the effectiveness of lifestyle modification to treat type 2 diabetes mellitus. For proper analysis of
the research, the appropriate methodology is to be selected so that research objectives are met in an organized manner. In general,
research methodology is a process along with the procedure that is being applied by the researchers to collect data so that the analysis
process is systematic along with efficient. The method of selecting the research methodology is based upon intuition so that the aims
and objectives are met, which is about lifestyle modification for the treatment of diabetes.
Research Philosophy
In any research work, there is a need for philosophical views based on which the entire research has been conducted and completed as
per the provided schedule. The research philosophy helps in better analysis of the project as it underpins the selection of the methods
and tools for analysis. In general, research philosophy can be of three forms, including positivism, constructivism, along
interpretivism. Positivism is structured and deals with scientific inquiry by focusing upon facts. Constructivism can be termed as an
anti-positivism technique where reality is merely seen as an individual experience with the complex, continuously changing
environment (Brown & Suter, 2012). On the other hand, interpretivism philosophy argues about developing in-depth knowledge by
focusing upon multiple realities and issues that are to be investigated (Flowers, 2009). Then again post positivism critiques and

amends positivism. According to post positivism philosophy every observation is fallible and has error and that every theory is
revisable.
This research is based on post positivism philosophy. According to this philosophy, a research subject should be observed from
subjective perspective. In this research also individual perspective is used for understanding the reality of the subject. In this research
it is considered that there is no absolute reality regarding effectiveness of lifestyle modification and treatment of type 2 diabetes. It is
considered that every realism has certain flaws and that absolute reality cannot be established. Therefore, the research will consider
viewpoints and findings of various authors as there is no single explanation of reality, and there can be multiple realities about the
subject
Research method
The research method is of relevance to attaining data by considering upon the process and procedures which follows guide that is
related with a direct research study to meet the aims and objectives. For the effectiveness of the research study and to elaborate upon
the practical lifestyle and treatment of type 2 diabetics, research methods are being applied. Quantitative and qualitative are the two
main types of research methods applied by the researchers to increase the efficiency of the study. The mixed research method is the
third method used by the researchers, and it is a mix of both qualitative and quantitative methods. It is important to note that the
quantitative research method is about dealing with numbers, contextual data so that the researcher is able to draw proper interferences
(Hox&Boeije, 2005). The quantitative approach is used for data collection, and it uses statistical tools to analyse the data gathered.

This method uses a questionnaire and follows experiment so that the findings are done in the most effective manner through the use of
statistical tools. It is further argued by the researcher that as quantitative methods use numbers, it is unable to develop an in-depth
analysis of the topic. The researchers using the quantitative method cannot attain detailed insights along with understanding to ensure
better results. This method is not very flexible as it tends to follow the specific structure and requirement (Hox&Boeije, 2005).
On the other hand, the other method of qualitative research is about attaining information and analysing concepts, symbols to meet the
objectives of the study. The qualitative research study is about acquiring knowledge through the use of necessary instruments so that
the problems framed can be analysed. This research method is about collecting data through proper observation, interviews based
upon the focus group. The qualitative approach is descriptive helps the researcher gain much data on the subject so that the aims and
objectives are met (Hox & Boeije, 2005). This method usually has low generalizability; it helps attain a holistic understanding of the
topic and research. The third approach of research is a mixed approach which is the combination of both quantitative and qualitative
methods. The use of the hybrid system is becoming common because it considers the strengths of every course to meet the research
objectives. In this mixed approach, the data collection along with analysis is the fusion of both methods. Contextually, the use of an
eclectic approach is helpful in this research study to meet complex situations.
However, it can be argued that in this research study qualitative approach is being used to elaborate the significance of lifestyle
modification for the treatment of type 2 diabetes. This qualitative method is effective. It is one of the ideal selections for this study
because it helps to attain a vital insight into the lifestyle modification impact on health and safety. This method is effective in

analyzing the findings and gain proper knowledge about the changing factors affecting human life dealing with type 2 diabetes. This
research helps to gain experiences from patients about the challenges faced due to type 2 diabetes. The challenges of living with
diabetics and patients’ voices are attained in this research.
Research approach
For the success of the research, it is essential that the researcher selects a proper approach to determine the type of data required to
meet the aims and objectives along with analysis. The research approach is divided into two factors as deductive and inductive
research approaches. The reasoned research approach is used with the quantitative method. In this approach, the hypothesis is created
so that the data attained can be managed through the help of statistical tools. On the other hand, the inductive research approach is
used for qualitative methods so that data collection is effective. The inductive approach tends to use multiple resources so that the
research objectives are met in accordance (Kothari, 2004).
In this research study, the Inductive research approach is being used as this approach helps to elaborate the significance of a healthy
lifestyle over others for treating diabetics. However, it is being determined that few studies have been done on the importance of
modification of lifestyle for the treatment of type 2 diabetes mellitus. Due to the lack of specific literature, it is becoming challenging
to frame the hypothesis which is required for the deductive approach; hence this approach is not applied in this study. The researcher
in the study focuses upon the use of the inductive research approach so that the data collection method is better and viable to elaborate
upon the effectiveness of modified lifestyle for the treatment of type 2diabete. The collection of data is reliable and feasible due to the

use of this approach. Hence, an inductive approach is being used as data for the research topic is attained from various reliable sources
that help to increase the authenticity.
Data Collection Procedure
Data collection is one of the most essential elements of the research study to analyze the objectives. The data collection method is
divided into two parts the primary data collection and secondary data collection. Data collection is essential for the research study to
be effective as without proper data the credibility is lost. Therefore, data collection is one of the most critical aspects for the research
to be effective and efficient. The primary data collection method is about collecting information using interviews and questionnaire
surveys. The primary data collection method is the data that are raw and are collected from the sources directly.
Moreover, it requires a statistical method for interpretation as the data are collected from respondents directly (Kothari, 2004). It is
noted that primary data is about an investigation in a direct manner through the help of varied sources, which includes questionnaires.
However, the issue that is faced is regarding the selection of data which is to be ethical through maintaining high standards. On the
other hand, the secondary data collection method is about attaining raw data in a refined manner by other authors of the articles.
Secondary data is being collected through the use of various articles and case studies to gain proper in-depth knowledge along with
understanding about the lifestyle modification which impacts the life of the people.
In this research study, secondary data has been gathered from articles, journals, and books. For the research to be compelling and
authentic, data has been collected from various sources such as articles, peer-reviewed journals, books, and online websites.

Furthermore, the data collected helped develop a solid theoretical understanding of the concept of lifestyle modification for the
treatment of type 2 diabetes. To gain a better experience and meet the research objectives, various works of varied authors have been
used to investigate the problem and understand the essential aspect of lifestyle modification for better health and treatment of diabetes.
The secondary data 3qw3collection is based upon literature review in a systematic manner so that the relevant articles and journals
along with websites are used so that pertinent information is attained based upon relevant journals (Kothari, 2004).
Data Analysis
It is an integral part of conducting and completing any particular research study on a selected subject. In this research study, secondary
data is being determined based on inclusion and exclusion criteria. For better evaluation of the gathered information, the PICO tool is
being used, which is effectively used for the systematic reviews. It is being used for the analysis of the qualitative data, which is about
population or problem, Interest, and Context (Brown& Suter, 2012). This method is used as a search strategy for the systematic search
to gain a good idea and investigation about lifestyle modification for the treatment of type 2 diabetes. For appropriate data analysis,
the PICO tools are used by pointing upon the components for proper identification of the information. It is usually used to support
evidence-based clinical practice so that the aims and objectives are met. PICO is being used to attain the knowledge to the well-built
question about type 2 diabetics. It is helpful to evaluate the systematic reviews and determine the clinical evidence about the research
type 2 diabetics.

Step of Undertaking Systematic Review
 Formulation of objectives: As a part of systematic review, at first the research objectives are formulated. The research
objectives are based on the research problem identified.
 Development of protocol: Protocol is vital for systematic review. It defines the methods i.e., to be used in the review with the
objective of reducing biasness. The protocol comprises the aspects searching strategy, selection criteria, inclusion and
exclusion criteria and evaluation of study quality.
 Conduct search: Searching is conducted in order to find relevant articles for systematic review. Various keywords and search
engines are used for searching different articles on the basis of the subject.
 Data Extraction: Data extraction is crucial as the process needs to be systematic as the specification is based upon themes.
 Data analysis: The data analysis is subject to the kind of data extracted. To ensure flexibility in data analysis, PICO is used so
that relevant data is extracted for the synthesis of data to meet the objectives.
Interpretation of results: The final step is interpretation of results obtained through PICO method. The results are interpreted in the
discussion chapter by deliberating the findings of the review and evaluating to literature review
Strengths and Weaknesses of Systematic review

The key strengths of systematic review are that it addresses certain question and hypothesis. It is explicit in nature and is reliable and
provide precise results. This method gives comprehensive review of every accessible data. Properly conducted systematic review is an
effective method to become acquainted with best accessible research evidence. It permits to consider the complete range of relevant
findings from research on specific subject. The procedure can also establish whether the scientific findings are reliable and
generalizable across population and whether findings differ considerably by specific subgroups. Furthermore, the possible strength of
systematic review deceits in clearness of every stage of the synthesis procedure, permitting to concentrate on the qualities of every
decision made in amassing the information.
The weakness of systematic review is that controversies can appear around the clarification of summarized outcomes, specifically
when the results of researches are shared in meta evaluation. The systematic review procedure unavoidably recognizes studies that are
diverse in design, methodology, specific intervention utilized and kinds of respondents studied. There is frequently certain subjectivity
while choosing how similar researches must be before pooling is appropriate. Combining studies of weak quality with rigorous studies
can result in worse estimates of fundamental reality or false logic of accuracy throughout reality. False logic of accuracy can also
appear when several subgroups described by characteristics differ in their experiential reaction.
Limitations
The limitation that the research study faced is the lack of a quantitative method. The study is limited to the explored secondary data
gathered from various sources. Moreover, as it is a broad topic, it is difficult to cover every aspect of lifestyle modification for type 2

diabetes. Time is another constraint that acted as a limitation for the research study. The end can be that the research is based on the
perception of various researchers who have worked on this research subject. Use of secondary sources can be deemed that several
articles were outdated and old for evaluating the research subject. Thus, it might not represent the proper understanding of the present
day’s situation.
Research Process
The research process depends upon several activities, and it involves understanding information from the literature review through the
help of various journals, articles, books, and online websites. Analyzing the research design and collecting information from reliable,
authentic sources is part of determining the objectives about the changing lifestyle modification. The philosophical understanding and
data collection is one vital phase that helps to elaborate the project research. The last aspect is the analysis of the data gathered to
ensure better output.
Search Terms
In order to conduct the systematic review various search terms are used, for example, ‘impact of lifestyle modification on type 2
diabetes’, ‘impact of exercise on type 2 diabetes’, and ‘lifestyle intervention on type 2 diabetes’ among others.

Inclusion and Exclusion Criteria
Furthermore, for the effectiveness of the research study, both inclusion and exclusion criteria are being used. Concerning the
requirements, it is noted that inclusion criteria have:
i. Studies that included adult subjects aged between 45-65-year-olds
ii. Studies published between January 2015 and December 2020
iii. Studies that were published in English
iv. RCT is required
v. Basic essence of English language is taken which is associated with the article.
Exclusion criteria include:
i. Studies including a pregnant woman
ii. Studies including subjects that are below 17year old
iii. Studies that exclude type T2DM
iv. RCT is not required.
v. Other than the English language is no applicable.

Search Strategy
In order to search the studies for conducting systematic review, search engine and online library databases are used. During
research, there are different website that provided some limited extent of knowledge for acquiring related information about the type 2
diabetes which includes springer.link, NCPI, PubMed and others. Springer.link has provided the information that can help to support
research procedure along with evaluation of finding. This is critically evaluated that NCPI has also provided some information that has
been collected for effective evaluation and involvement of information that help to acquire related information and provide critical
analysis regarding type 2 diabetes. PubMed has also provided information which can be highly effective and allow to interpret the
reason of type 2 diabetes between age of 45 to 60 years. There are also different extent of reason which includes the smoking habit
that create health degradation and causes type 2 diabetes. Sprinkle.link has provided information to use about the improved nutrition
and vegetable that can help to reduce the weight. With the help of quitting smoking vital negative impact in behaviour can be reduced
and help to to decrease the stress and improve sleep. Through search strategy, various information has been collected with some
limited extent through using different websites that provide enough information that help in the research and provide enough
information related with cause of the type 2 diabetes along with related extent. This can help to reduce the impact of type 2 diabetes.
There is also information provided on the website throw using Springer.link and NCPI, PubMed that have a improved information
regarding improved health through quitting smoking. There is also information about the benefit of quitting smoking and provide
various health improvement information.

Study selection
The following PRISMA flow chart demonstrates the study selection procedure for systematic review.
Articles identified through search
engines (number = 94)
No additional articles are found
through online databases and search
engine
Number of articles after
removing duplicates = 59
Articles are screened for
inclusion = 54 Some irrelevant articles
are excluded = 41
Full text articles are evaluated for
eligibility = 25 Some irrelevant full text
articles are removed = 16
Articles included in PICO
model =12
IdentificationScreeningEligibilityInclusion

The research has been provided the enough information about the type 2 diabetes and there is some of the description about the reason
for this study selection. Reason for the selection of this group and various reason of health concern about type 2 diabetes as a health
condition. Type 2 diabetes is a major concern within India which can be observed easily from data. It has provided that type 2 diabetes
is increasing health concern within India that can affect one in 100 people with negative health impact. It has been also evaluated that
type 2 diabetes is highly effective and health concern for the raising population. In this, one of the most affected group is 45 to 60 year
that are having type 2 diabetes. This group is highly associated with getting high frequency of type 2 diabetes and have negative health
impact on them. This study has been selected because type 2 diabetes is raising health concern within India and across the globe that
are highly affecting the individual health and create a negative health impact about the quality of life. This also includes various health
issues which countries. Due to various reason including smoking behavior adult like to smoke more due other reason which includes
reducing their stress. Due to this, they get cause to various negative health impact and also lead to type 2 diabetes which is associated
with major health concern and create negative health impact on their health and reduce their quality of life
Data Extraction
The data is extracted from the various source which may include various strategies such as experiments, survey, case study and more.
This all aspect is well associated with selected topic which help to emphasis the understandable factor of research which is conducted
for the selected population. The major of data is real and follow the core diabolical truth of research topic. In this, the primary source

and the secondary source is taken under consideration which may create knowledge regards with selected topic of diabetes 2 mellitus
and their effectiveness which is associated with the modification of lifestyle.
PICO framework/Model
The PICO method has been used in order to conduct the research findings. For obtaining relevant articles for PICO, at first the
relevant articles are identified, afterwards these articles are screened, then it is evaluated for eligibility and afterwards it has been
included in the research.
Population Intervention Comparison Outcome
In this research, population are
the respondents of New South
Wales. The respondents
comprise people with smoking
activities (Chong & et. Al.,
2017)
A self-reported information is
used and follows up study is
conducted. Smoking status and
number of cigarettes smoked is
utilized as a measure of
changes in behavior.
These variables are compared
between respondents in type of
2 diabetes and no type of
diabetes.
The results revealed that new
type 2 diabetes are more
possibly to quit smoking in
comparison with no type 2
diabetes.
The population in this research
was 224 type 2 diabetes
The intervention was
undertaken in two phases. The
There was control group who
comprise respondents in
Significant development in
blood sugar fasting and blood

mellitus patients in Delhi of
India. The respondents belong
to the age group of 35 to 70
years with fasting blood sugar
above 120 mg/dl and
postprandial blood sugar above
180 mg/dl (Kumari & et. Al.,
2018).
first six months period was
active period, where
counseling was given once per
month. The second stage was
maintenance period, where
respondents were followed up
for additional xi months. A
board LMC program
comprising Lifestyle
Intervention Holistic Model is
utilized as an instrument for
counseling of participants in
order to regulate type 2
diabetes. An expert dietician,
diabetes instructor and
physical trainer provided the
lifestyle change therapy. The
typical care group, who
obtained standard care,
comprising pharmacological
and provision of pamphlets
and booklets regarding several
health subjects. The treatment
group comprise people who
are provided lifestyle change
treatment by using lifestyle
intervention holistic
framework. The key
intervention activities
comprise balanced diet,
physical functions, tobacco
and alcohol cessation, stress
management and obedience to
routine examination and
sugar PP has been found in
treatment group from baseline
to one year follow up.
Considerable changes are
observed in body fat
percentage and diastolic blood
pressure from third and twelfth
moth follow up between
treatment and control group.
Considerable changes are
observed in blood pressure and
pulse rate between two groups
during the follow up. There is
significant variation being
observed in cholesterol
between treatment and control
group from third to twelfth

therapy session was repeated at
each month for about six
months and followed up for
measurement of the
respondents was done at
baseline of third, sixth and
twelfth month. All lifestyle
intervention elements were
elucidated by counseling in
local language, using images,
videos, direct interviews and
conversation with group of
people. Every session of
lifestyle changes counseling
required 10 to 15 minutes.
treatment. month. There was also
significant development in diet
chart, minimization of
consumption of sugar rich
products, minimization of
consumption of junk foods,
walking attitudes, consumption
of tobacco, leaving tobacco,
drinking alcohol, leaving
alcohol, having appropriate
sleep, feeling relaxed and
symptoms of diabetes
complications.
The population of the research
comprises 7735 respondents,
The respondents are
categorized into eight groups
The percentage variation in
body weight between
From the result about 290
incident cases of diabetes over

who are male with age group
of 40 to 59 years from the UK.
The respondents are taken
from people of general
practices from 24 cities in the
UK comprising England,
Wales and Scotland
(Wenatchee & et. Al., 2015).
on the basis of smoking status
at screening, which are never
smokers, primary smokers, ex
cigarette smokers, secondary
smokers, and current smokers
at four level, which are
smokers of 1 to 19 cigarettes,
20 cigarettes, 21 to 39
cigarettes and 40 cigarettes or
more in a day. Five years after
screening, a questionnaire
similar to administered at
screening was delivered to
every surviving respondent and
comprehensive information
was obtained on changes in
smoking behavior and other
screening and fifth year
questionnaire was determined
for every respondent. Every
respondent was followed for
each reason of death,
cardiovascular illness, and
development of diabetes from
screening. New cases of
diabetes were determined by
questionnaire completed by
respondents at fifth and twelfth
year after screening by
methodical periodic
examinations for any
references of diabetes.
the average follow up period of
16.8 years in 7124 respondents
have been observed. Every
current smoker combined had
considerable high relative risk
of diabetes in comparison with
never smokers. When the
current smokers are divided by
number of cigarettes smokes,
there is insignificant difference
in risks between light with 1 to
19 cigarettes in a day and
heavy smokers of more than 20
cigarettes in a day. Smoking
status is strong associated with
BMI. Weight was higher in ex
cigarettes smokers and lowest

risk aspects. in cigarettes smokers.
Enhanced risk of diabetes
related with smoking and
secondary smoking was
observed. Risk of diabetes
reduced with enhanced years
since quitting cigarettes.
Advantages of giving up
smoking were clear in those
respondents who had given up
smoking for more than 5 years
before screening. Risk reverted
to never smokers in those who
provided minimum 20 years
before screening. Respondents
who given up in 5 years before
screening demonstrated

slightly high risk in
comparison with current
smokers.
The respondents in the study
are 2312 male respondents of
electric organization in Japan
(Kawakami & et. Al., 2017).
No intervention has been done
in the research. The research
aims to evaluate impact of
smoking on non-insulin
dependent diabetes mellitus.
There is no control or
treatment group in the
research.
From the research, it can be
observed that those who smoke
16 to 25 cigarettes in a day has
3.27 times higher risk of
developing non-insulin
dependent diabetes mellitus
throughout follow up period in
comparison with nonsmokers.
In this research 69 respondents
are involved in nine months
motivational program
concentrated on the principles
of diet, sessions on nutrients,
The intervention lasted for
nine months. The nutritional
program was structured in
quarterly group discussion
undertaken by skilled
In this research control group
are those who have not joined
the nutritional training
program and treatment group
are those who have been
From the findings, it can be
observed that the 9 months
nutritional motivational
intervention program has
enhanced the dietary habits

distribution of meals through a
day and dietary choices. The
study is conducted in Italy.
The population are between
age group of 50 and 70 years,
staying in community and
diagnosed with type 2 diabetes
at a minimum one year before
(Onofrio & et. Al., 2018).
nutritionist, who deliberated
with patients regarding the role
of diet in diabetes control, diet
advantages, healthy food
selections and the way to
manage individual nutrition by
adequate regular distribution of
meals.
intervened with the nutritional
motivational program.
Throughout the periodic
meeting, questionnaire on
dietary behaviors after the
program and behaviors
previously authenticated in
other intervention was
compared in order to
understand the effect of
intervention.
and activities among the
middle age and old people with
type of diabetes in comparison
with control diabetes subjects,
who undergoes only training
regarding healthy style
controlled by physicians. A
considerable minimization in
regular caloric consumption
was discovered with a total
50% minimization in level of
cholesterol and fatty acids,
with notable outcomes, similar
to those associated with
carbohydrates, on the
progression of diabetes and
appearance of complications

among the treatment group.
Throughout the nine months,
the mean BMI passed from
level one obesity to overweight
values among respondents.
The research comprises 88
prospective studies with
296446 incident cases of type
2 diabetes (Pan & et. Al.,
2015).
In the study, there is no
intervention conducted.
Significant connection has
been observed between
smoking and type 2 diabetes
risk by evaluating the studies.
There is apparent with
cumulative exposure to
smoking.
In this research, systematic
review is conducted by
evaluating randomized
controlled trials. Respondents
In the study, percentage of
respondents with beginning of
type-2 diabetes throughout the
end of study. 47 interventions
In the research, the odds ratio
with beginning of type 2
diabetes at one year in
intervention group, i.e., group
From the result, it can be
observed that odds ratio and
lifestyle modifications were
about 0.46 times lower in

in the inspected studies are
adult who are diagnosed with
type 2 diabetes (Yamaoka &
et. Al., 2019).
and 12 treatment groups are
used for analysis. Among
them, total 10 interventions
were treated at independent
interventions. Control
interventions were standard
conventional education or
usual treatment or placebo.
with lifestyle modification in
terms of dietary, exercise or
medication is compared with
control group, which comprise
group receiving standard
treatment or placebo.
comparison with standard
intervention by Bayesian
strategy. The odds ratio with
beginning of type-2 diabetes in
lifestyle alteration intervention
group was found to be 0.60
times lower in comparison
with standard intervention
group by random effect model.
The impact of lifestyle
alteration in comparison with
other treatments by indirect
comparisons is not significant.
The percentage of respondents
with beginning of type 2
diabetes in intervention group
was about two times great in

comparison with control
group.

The population in the research
is 552 adults with type 2
diabetes in Finland. They are
evaluated in order to
understand the effectiveness of
intensive diet exercise program
in prevention of type 2
diabetes among the subjects
(Tuomilehto & et. Al., 2015)
In the research, overweight
samples are randomized either
to intervention group or to
control group. The intervention
group obtained individual
counseling regarding diet,
weight loss and physical
exercise, while the control
group has not obtained any of
these. The counseling was
intended at minimizing the
weight, consumption of fatty
foods and saturated fat and
growing consumption of fiber
and physical functions.
In order to conduct research
comparison has been made
among the intervention group
and control group. An oral
glucose tolerance examination
was conducted yearly to
measure any kind of changes
among the groups. The
diagnosis of diabetes was
confirmed through second
evaluation.
From the outcome, it can be
observed that there is
considerable difference
between weight loss between
the two groups after one year
and after two years of
intervention. The cumulative
occurrence of diabetes was
found to be 11% in the
intervention group and 23% in
control group. Throughout the
examination, the threat of
diabetes was minimized by
58% in the intervention group.
In this research, there was
large population of 3000
The participants of the
research are randomly
The research compares if there
is any development with
From the findings, it has been
found that treatment group has

overweight adults with IGT in
the US. The respondents are
representative of several
national group residents in the
country. The objective of the
research was to understand if
diet and exercise can delay
type 2 diabetes among the
population studied (NIH,
2015).
allocated to intensive lifestyle
intervention. The diabetes
prevention program included
extra arm whereby certain
respondents were randomized
to the medicine metformin. On
average the treatment group
maintained their physical
function and training for about
30 minutes every day, typically
through walking and other
mode aim intensity training.
respect to weight and
metformin which is a key risk
factor for generating type 2
diabetes.
lost five to seven percent of
their body weight throughout
exercise. Apart from that
treatment group has also
reduced their metformin.
About 29% of control group
participants have developed
diabetes throughout the follow
up procedure of three years. In
comparison 22% of metformin
arm and 14% of treatment
group has developed diabetes.
The population in the research
article is the old age people
with age group of 60 to 65
years (Chentli, Azzoug &
Mahgoun, 2015).
Diabetes is most frequent in
older people. Growing life
expectation alongside growing
rate of obesity and inactive
lifestyle results in high

occurrence of diabetes within
old people. Diabetes is
frequently unobserved in old
patients as it is either
asymptomatic or signs are non-
specific.
The population in the research
are 243 elderly people with the
age group of more than 60
years in various districts in
India (Saini, 2018).
The face-to-face interview
method is used in order to
collect data from samples so as
to understand impact of
lifestyle modifications on
physical functions, health
learning, blood glucose level
and diabetes.
The outcome of the study
revealed that physical
inactivity is vital risk aspect
for type 2 diabetes. Lifestyle
modification within elderly
people with diabetes living in
rural areas are reducing and
they are subject to diabetes
mellitus complications and
overweight. Elderly people
following good lifestyle

modifications demonstrates
better control on quick and
random blood glucose levels.
The study is based on 9528 no
diabetic male and 88613 no
diabetic female with age group
of 40 to 79 years in Japan
(Sairenchi, 2017).
Intervention is conducted on
middle age group people with
age of 40 to 59 years and aged
people with age group of 60 to
79 years regarding level of
smoking and its connection
with diabetes.
In this research, risk ratios of
diabetes are compared between
never smokers and current
smokers.
Excess risk is much
pronounced within male with
parental history of diabetes in
comparison with male without
one. Furthermore, excess risk
within current smokers is
observed in both subgroups of
40 to 59 years people and 60 to
79 years people. Furthermore,
it was found that smoking was
independently related with
enhanced risk of type 2
diabetes within middle age

group and aged group people

Findings from Secondary Data
From the research, it has been found that there is a large number of populations who are
affected from the type 2 diabetes in which smoking is the one of the one reason that impact on
type 2 diabetes patient negatively. It has been identified that type 2 diabetes patient have the
lower quality of life which need to be improve and with the impact of smoking leads to reduce
their influence sensitivity and creative degradation within health. It has been also identified that
diet plan has an important role and providing better management to the type 2 diabetes and
improving their health condition. Improving nutrition along with vegetable can help to reduce
weight and help in quitting smoking. With quitting smoking people can allow to provide better
health impact and reduce the negative burden on health. Type 2 diabetes is a lifelong disease
which needs to be reduce by improving quality of life and according some negative aspect which
can cause negative health impact. With modification in lifestyle negative impact of type 2
diabetes can be reduced and managed for live longer. It has been found that there is various
reason of getting Type 2 diabetes which leads to negative impact on the individual health. There
is also various reason which includes the smoking, nutritional diet and others. There is also
various problem which are associated with smoking which have high impact on the individual
and leads to creates negative impact on the people with type 2 diabetes.
Impact of Smoking on Diabetes
Various investigational and medical studies recommend that smoking reduces the insulin
sensitivity and accordingly lead to disorders of glucose and lipid metabolism, for example,
hyperglycemia and dyslipidemia. Specific in people with diabetes, it is apparent that smoking
deteriorates the metabolic control. A bigger insulin dose is required in order to accomplish
similar metabolic control in smokers. There are strong effects of nicotine on insulin, secretion

and improvement of diabetes. Nicotine contact can encourage a minimization of insulin
discharge, and adversely influence insulin activity, recommending nicotine can be a cause for
growth of insulin within diabetes patients. Mitochondrial dysfunction, oxidative burden and
irritation are involved as fundamental instruments of nicotine induced pancreatic loss of β cells
(Xie & et. Al., 2019).
Impact of Diet on Diabetes
The advantageous result of dietary arrangement on diabetes mellitus and glucose metabolism is
related with considerable minimization in the threat of developing type 2 diabetes. The dietary
form focuses on the consumption of fat basically from foods, which have high unsaturated fatty
acids, and inspires regular eating of fruits, vegetables, low fat products, whole grains, low eating
of fish, poultry and red meat. The arrangement of diet is one of the ideal forms for its
advantageous outcomes on health of people, which is helpful against the development of type 2
diabetes, comprising minimized oxidative stress and insulin resistance. Diets are featured by low
level of energy density, which stop weight increase and apply a defensive impact on
improvement of type-2 diabetes, a situation i.e., partially mediated by maintaining weight.
Increased obedience to diet in combination with physical activity is related with lower possibility
of having diabetes after adjustment for several aspects (Asif, 2015).
Interventional research demonstrated that high carbohydrate and high monounsaturated fat
enhance insulin sensitivity, whereas glucose clearance dietary procedures include the first line
intervention for regulating dyslipidemia in people with diabetes. Various research suggested
nutrition treatment and variation in lifestyle as initial treatment for diabetes. Metabolic control is
regarded as the keystone in controlling diabetes and its problems. Carbohydrate consumption has
direct impact on postprandial glucose level in individuals with diabetes and is the principal

macronutrient of concern in glycemic control. Furthermore, a person’s selection of food and
energy balance has certain influence on weight, blood pressure and lipid level. Therefore, diets
from health experts can assist people with diabetes in accomplishing the health objectives
through customizing the diet interventions and ongoing support for changes (Sami & et. Al.,
2017). Dietary habits are critical components of individual cardiovascular and metabolic threats.
Impact of Physical Activity on Diabetes
Regular physical activity assists the body cells to digest glucose and hence reduce the blood
glucose level. Physical activity also supports with reduction of weight along with managing
blood cholesterol. Significant advantages of exercise in controlling diabetes comprise reduced
requirement for insulin, reduced threat of obesity and reduced threat of heart illness. Physical
activity minimizes the level of cholesterol, enhances the ratio of low-density lipoprotein to high
density lipoprotein and minimizes blood triglycerides. It can also minimize blood pressure and
lead to low stress level. Walking is one of simplest physical activities, which can be done
lifetime without any particular tool and with little threat of injury. Physical activity results in
metabolism, glucose production and muscle contraction. Contracting muscle enhances
acceptance of blood glucose. Any physical activity generates a change from major dependence
on free fatty acid at rest to a combination of fat, glucose and muscle glycogen with small
influence from amino acids. With the reduction of glycogen stocks, muscle enhances their
acceptance and utilization of circulating blood glucose, along with free fatty acid, discharge from
adipose tissue. Insulin stimulated blood glucose acceptance into skeletal muscle predominates at
rest and is reduced in type 2 diabetes, while muscle contraction encourages blood glucose
transport through distinct preservative device not reduced by type 2 diabetes (Colberg & et. Al.,
2015).

Chapter 5 Discussion
The objective of the research is to determine the efficiency of lifestyle modification on type 2
diabetes. The systematic review evaluated the possibility of lifestyle modification in minimizing
the progression of diabetes. Lifestyle modification in terms of changes in dietary habits, physical
exercise and prevention of smoking can reduce the occurrence of diabetes. These studies give
evidence that threat of developing type 2 diabetes can be minimized through changes in lifestyle
by adults who are at high threat of diabetes. In most of the studies, the difference between
intervention group and control group is substantial. The findings focus on significance of
lifestyle changes and resulting weight loss in combination with growth in physical function in
prevention of diabetes. Furthermore, certain studies demonstrated advantages of lifestyle
modifications with respect to cardiovascular risk aspects along with enhanced glucose and
insulin tolerance. The promising finding is that lifestyle intervention has long run carry over
effect on type 2 diabetes occurrence.
There are several challenges that are being faced by people suffering from people with type 2
diabetes; therefore, to ensure effectiveness in the lifestyle, national standards for diabetes self-
management education and support are taking measures to educate people and facilitate them
with proper understanding. Lifestyle management is linked with self-management and sustaining
skills about managing behavior so that the effectiveness is more in terms of clinical outcomes
(Bansal & et al., 2017). People with type 2 diabetes are familiar, as noted from the study and
findings that it affects about 90% of patients. From the analysis of the data, it has been revealed
that lifestyle. The intervention has a substantial role in improving the health of patients suffering
from type 2 diabetics. The main aim of lifestyle changes regard weight loss which is more than
5%, and it is vital the people suffering from diabetics need to reduce fat intake by about 30% of

the total energy. This helps to maintain a healthy lifestyle by improving food habits. It is a
challenge that patients need to take not only proper medication but also improve the style of
living by exercising correctly and balance the calorie intake. It is advisable to analyze the various
interventions and outcomes that increasing physical activity and improving the quality of living
helps to influence people with diabetes. The risk is reduced by a considerable extent when the
lifestyle is managed as good living is beneficial for a long time (Bansal & et al., 2017).
Contextually, it is vital to state from the information and findings that lifestyle change has a
strong impact and reduces the risk for people diagnosed with type 2 diabetics. Several
challenges are faced by people who are smokers; therefore, the challenge is to improve lifestyle
so that diabetics can be managed in the most effective way.
As per the discussion is concerned from the data gathered and review of literature, it is noted that
several interventions in the lifestyle improve the health. Individuals must take two and half hours
each week of intense physical activity so that the body is healthy and have the strength to fight as
stated that due to this disease, weight is increased considerably, therefore negatively influencing
health, making people tired and lazy. The main idea is to ensure weight loss and attain a healthy
body mass index by improving eating habits (Lindstrom & et al., 2013). The practice is to
replace carbohydrates with wholegrain foods so that the energy is improved. Individuals across
the globe need to improve eating habits by reducing junk and focus on having healthy vegetables
and high dietary fiber. Another aspect, as determined from the data, is that patients need to
reduce saturated fats and improve the diet.
Moreover, for the treatment of type 2 diabetics, it is essential to improve the challenges that are
faced by people, which is mainly a lack of understanding about the diseases. It is necessary to
improve the physical activates on a regular basis, and it is recommended to do physical activity

both intense and moderate. It can be determined as a part of the discussion that moderate-
intensity workouts are mainly brisk walking, cycling on flat terrain, hiking, aerobics, manual
lawnmower, along rollerblading. On the other hand, as a part of lifestyle management, vigorous
physical activities such as jogging, swimming, playing football, cycling, skipping along with
gymnastics (Lindstrom & et al., 2013). It is essential that proper activity is done so that the mind
is fresh and calm and can ensure a healthy life. Relaxing the body and keeping the body fit is
essential and is helpful along with medication.
It is a known fact that stress is regarded as one of the risk factors linked with type 2 diabetics.
Therefore, the idea is to reduce stress so that the treatment of complexities is reduced to a
considerable extent. In the current environment, the human body undergoes several changes due
to the external environment that impacts blood pressure. The blood pressure is mainly increased,
thus positively surging the blood glucose levels, hence affecting the immune system. The main
idea is to improve the immune system by changing the style of living. There are several non-
crucial bodily functions that impact the health because of the digestion issues; growth along with
repairs affects the energy level, thus influencing threat response (Petocz & Colagiuri, 2013).
Stress is impacting life; therefore, it is essential to improve the level of stress, so that blood
glucose is maintained. From the gathered data is has been evident if the body’s glucose level is
not controlled correctly, then the body might feel stressed, thus increasing anxiety. Stress
management is vital and requires proper technique so that the blood sugar changes do not impact
the body. The management of stress is also part of the management and requires the appropriate
mindfulness, which is a simple way to control stress thus positively influence the outcome.
Type 2 diabetics relate to several complications that affect the health, such as heart disease,
strokes, mental health, along hypertension which negatively affects the body. The impact of

stress also leads to depression along with anxiety that leads to type 2 diabetes. There are several
factors that lead to stress, thus impact blood pressure, such as work pressure. This can be
managed by improving living, staying positive, and ensure healthy lifestyle habits. Lifestyle
habits are linked with good habits, improving food habits, and avoid drinks along with smoking.
Smoking is one of the significant issues that are being faced by people within the age group of 45
to 60 years, thus impacting the health along with psychological stress (Bell & et al., 2015).
It is a fact that a high amount of work pressure and stress raise the risk of type 2 diabetics by
almost 45%. On the other hand, people having depression also develop type 2 diabetics. Lack of
sleep, lack of time management impacts the style of living. It is essential that people ensure a
healthy sleep so that the body is relaxed, helping to cope with the changing issues. There are
several ways of dealing with type 2 diabetics that are positively linked with lifestyle management
so that the challenges can be managed. Lifestyle management is about avoiding self-medication,
which is including too much coffee, alcohol for a better diet. It is advisable to avoid stress and
ensure regular physical activity so that the body is relaxed and calm. Lifestyle management is
about avoiding the challenges that are by taking rest and relaxing a bit so that the level of stress
is reduced (Lindstrom & et al., 2013). One of the most critical factors that have been determined
rim the study is that it is essential to manage time so that the task is completed within the
stipulated time. This helps to reduce anxiety, thus improve type 2 diabetics.
As a discussion, it is having been diagnosed that people suffering from type 2 diabetics need to
involve in education programs so that the knowledge is increased. As a method, it is vital that the
challenge to educate people is more and therefore increased the education and stating about
physical activity and quitting the habit of smoking might positively influence towards healthy
living. Moreover, another factor that is affecting the understanding is the sustainability of

lifestyle behavioral changes. Motivation is essential to lead a healthy life that helps balance life
and prevent diabetes (Gagnon & et al., 2011).
Considering the gathered data, it is evident and discussed that a balanced diet is to be followed
by people with type 2 diabetics and a proper diet chart. As a part of lifestyle management, it is
encouraged that food intake is to be in good proportion so that the level of glycemic is
controlled, weight is maintained, and blood pressure. It is noted that exercise impacts the health
of people as its impacts insulin sensitivity and also holds glycemic. It is further determined from
the study that obesity impacts diabetics and the sedentary behavior of people increases the risks.
It is further distinguished from the research that alcohol consumption if done moderately, will
have less chance on the type 2 diabetics. Exposure to people’s smoking increases the risk for the
patients; therefore, lifestyle improvement needs to be done. The trouble is significant for people
who are chain smokers and are at risk of pollution. From the literature review, it has been
determined that duration, along with the quality of sleep, matters as it helps to improve diabetics.
It is discussed that 7-8 hours per day sleep will lower the risk of type 2 diabetics. Lifestyle
management is also linked with healthy living along with a clean environment and house also
positively influences to reduce of people with type 2 diabetes (Chen & et al., 2013).
Contextually, it is essential to diagnose type 2 diabetics at an early stage so that the risk is less.
There are several symptoms that are part of the diagnosis methods, such as urination problems,
loss of weight, and thirst. Several other tests are done to improve the lifestyle so that based upon
the tests, and people can manage the style of living and consider upon medication. From the
analysis of the review, it is noted that weight loss is one of the methods of treatment and
hypertension linked with obesity because it impacts metabolic syndrome. Therefore, to meet the
objectives of the research study, it is evident that lifestyle modification is to be done by

managing a lower-calorie diet and the reduction in the sedentary lifestyle. It is vital that the body
is active and exercise; yoga helps to improve the therapy regarding the decrease in weight.
People’s eating habits have changed; thus, type 2 diabetics have increased as people are more
into junk foods, processed food and do not value green vegetables, fresh meats in their meals.
Thus it can be stated that the weight loss program is due to lifestyle modification positively
influencing treatment for diabetes mellitus, thus assisting in antihypertensive pharmacological
therapies. The main motive of the diabetics’ management is to keep the level of blood glucose to
reduce the complications that are faced by people both short term and long term (American
Diabetes Association, 2017). Regular monitoring of the glucose level is also vital so that people
are aware of their condition, which helps in improving the style of living.
The medical team responsible for monitoring the conditions includes doctors, specialists,
credential Diabetes educator, and also dietician helping people to lead a better life—regular
check-up and taking timely medicine another factor that leads to effectiveness and helps to
reduce complexities. The idea is to manage people and meet the challenges that are faced
through proper knowledge, understanding about the health, and following an appropriate lifestyle
(Tuomilehto&et.al., 2011). Designing nutritional therapy and regular monitoring is a positive
aspect controlling the treatment and diabetics’ management for healthy outcomes. The main
intention is to reduce the complexities and complications along with co-morbidities. Thus it can
be stated that lifestyle interventions and self-care behaviors have a substantial role to play in
managing type 2 diabetics.

Chapter 6: Conclusion
This study tries to enhance the research regarding the effectiveness of lifestyle changes in
treating Type 2 Diabetes Mellitus in smokers aged 45 to 65 years old. This study also examines
several treatments of the lifestyle in this research. Physical activities, anti-inflammatory
strategies, weight loss through low-calorie meals, and a balanced eating pattern should all be
used to avoid diabetes 2. Weight loss and dietary changes, such as switching to the
Mediterranean or low-glycemic-index diet, have been shown to reduce the risk of cardiovascular
disease in this case. The study shows that over 60 per cent of adults aged 45-65 with type 2
diabetes do not have the proper number of physical activities that they wish to do. According to
the findings, an energy-dense western-style diet combined with a sedentary lifestyle is the
leading cause of type 2 diabetes. On the other hand, people with T2D that are formed within a
normal weight or excess weight, display visceral obesity and fat deposition and reduce muscle
weight, which leads to normal BMI. Identifying the processes behind obesity-related type 2
diabetes may aid in weight reduction and maintenance, as well as improved control of type 2
diabetes, along with postponing or prevent the onset of type 2 diabetes and maybe even minimize
consequences. Diet is shown to be one of the main causes of diabetes type 2. Type 2 diabetes is
also caused by genetics, physical inactivity, lesser work, greater smoking rates, and greater
alcohol intake, according to the researchers. Increased television viewing has been shown to
raise the risk of diabetes development. This study has further explained that increased television
viewing has been shown to raise the risk of diabetes development. However, when more than
three cups of green tea drink, a flavor-packed green tea is proven to enhance glycemic
management.

When compared to non-smokers, exposure to cigarette smoking has been shown to increase the
risk of T2D both actively and passively. According to research, those who are exposed to a lot of
residential traffic, noise, and tiny airborne particles are more likely to develop T2D. Sleep
quality and sleep duration also contribute to diabetes as nocturnal light exposure and sound
effects leading to sleep disruption. It is also assessed that the risk of T2D also is higher for
shifting employees or persons who have less sleep due to prolonged working hours. When
someone is stressed, anxieties that are directly linked with diabetes are investigated in this study.
The report went on to say that smoking and a lack of physical activity are viewed as mediators of
diabetes among those who have a lower socioeconomic standing. The study found that type2
diabetes can be diagnosed with Mellitus when the rapid plasma glucose is greater than 7.0
mmol/L, whereas the symptoms including random plasma glucose levels are larger or equal to
11.1 mmol/L. It can be seen from the study that, oral glucose tolerance tests and other diagnostic
instruments aid in recognizing the glucose level. When it comes to diagnosis, the National
Institute of Diabetes and Digestive and Kidney Diseases has indicated that it is achievable if
HbA1c and plasma glucose levels are both within the normal range. This research study
postulated that glycated hemoglobin tests are commonly used to identify Type 2 Diabetes. The
study has also examined that, type 2 diabetes can be treated with lifestyle changes such as
regular exercise, a nutritious diet, and blood glucose monitoring. According to the study, weight
loss has been identified as the primary therapy for Type 2 Diabetes and hypertension associated
with obesity. The blood glucose levels, and blood pressure and cardiovascular hazards related to
weight reduction may be controlled by several methods and depends on the technique of weight
reduction.

However, it is stated that persons who suffer from extreme obesity and do not engage in an
activity programmed should consider bariatric surgery. Diabetes, particularly type 2 diabetes,
and hypertension is on the rise, owing in part to rising obesity rates. The two most popular
bariatric surgeries for the treatment of severe obesity or obesity that is unresponsive to dietary
changes such as a low-calorie diet and exercise are gastric bypass and adjustable gastric banding.
Bariatric intervention weight loss leads to an increase or standardization of glucose metabolism
via numerous processes such as the restriction of calories, change of the entero-insular axis,
stimulation of the neurological system, a significant change in the quality of living and many
more. In terms of treatment, it has been highlighted from this study that losing weight is just the
first treatment for obesity associated with type 2 diabetes as well as hypertension. Obese people
with hypertension and metabolic syndrome can be seen developing cardiovascular and renal
problems when they lose weight. The study has further explained that weight reduction along
with lifestyle changes aids in the management of diabetes mellitus and also aids in the
administration of antihypertensive medications. Compliance is the most important factor in
implementing lifestyle changes. It had been analyzed from the above study that, calorie intakes
and aerobic activity are also considered vital to maintain healthy weights in order to avoid
diabetes. Since exercise alone is ineffective in weight loss, a modest calorie restriction can also
be seen required in order to treat or prevent Type 2 Diabetes. In terms of maintaining fat-free
mass and attainment of a higher loss of fat, it is also observed that the long-term monitoring of
greater protein, moderately reduced calories, lower glycemic index diameters and daily physique
practices leading to a successful decline in long-term recovery.
According to the study, it had been also examined that, endurance training programs result from
a clear separation of cardiovascular fitness adaptation and improvements in metabolic risk

factors such as insulin resistance and sympathetic activation. Aerobic exercise of lower intensity
endurance was designed to improve lipid oxidation, insulin resistance and the body structure as
well. Saturated fat derived from animal food supplies is however found to elevate cholesterol and
is highly associated with heart disease, according to the research. It has been discovered that
coronary heart disease, atherosclerosis, ischemic heart disease, and stroke may all be exacerbated
by a larger concentration of saturated fats. On the other hand, the amount of high-density
lipoprotein and a drop in the density of lipoprotein and cholesterol in extremely low density have
also been shown to be increased by unsaturated fats. The study has found that someone should
have access to a healthcare team that includes doctors, specialists, a credentialed Diabetes
educator, and a nutritionist who can help with blood glucose monitoring, as well as good food
and physical activity. Medications have been provided to patients with this kind of type 2
diabetes to help the pancreases to create more insulin or to improve their physiological functions
so that patients can keep the blood glucose level within the range intended by the pancreases.
This study has further reviewed that, the injections and pills must be taken in conjunction with
good food and adequate physical activity, in order to treat type 2 diabetes. However, the study
findings suggest that smoking and medical studies, diminishes insulin sensitivity and, as a result,
leads to glucose and lipid metabolic problems. Nicotine has a significant impact on insulin
production, secretion, and diabetes management. The study further postulated that nicotine
contact can reduce insulin release and have a negative impact on insulin activity, hence
prescribing nicotine to diabetics can lead to an increase in insulin resistance.
However, the finding also showed, that there is a strong reduction in the risk of acquiring type 2
diabetes in the benefits of the diabetes mellitus and glucose method. Foods that have high in
saturated fatty acids can also be seen motivating frequent intake of fruits, veggies, low-fat goods,

whole grains, low fish-eating, poultry and red meat in their dietary shape. The study regarding
interventional study has shown that high carbohydrates and monounsaturated fat improve insulin
sensitivity, but the first line of treatment for managing dyslipidemia in diabetics includes the
clearance of glucose. It is also important to highlight from the study that, postprandial glucose
levels, carbon consumption affects people with diabetes directly and constitutes the main major
macronutrient of the glycemic control system. The study has even analyzed that, diets from
health specialists can help patients with diabetes achieve their health goals by tailoring diet
treatments and providing continuing support for improvements. Physical activity has also been
shown to help with weight loss and blood cholesterol management. To have a better
understanding of the effectiveness of a lifestyle modification, qualitative methodologies were
employed in the investigation. Changes in weight, adequate exercise, and moderate to vigorous
activity for at least 2 hours each week are all critical. According to the research, a diet rich in
fruits and vegetables should be followed. However, it has been established that cigarette smoking
has a negative influence on health and leads to behavioral changes that are detrimental to type 2
diabetes therapy. Individuals with Type 2 diabetes are more likely to have co-morbid conditions
such as cardiovascular disease, and death rates have gone up as more patients are infected with
the disease. Along with obtaining diabetes self-management education, self-management
support, and other activities, one of the most essential aspects of diabetes treatment is lifestyle
control.
This study has further explained that blood glucose activated by insulin are mostly rested and
lowered in type 2 diabetes whereas blood glucose transit by separate pathways not affected by
type 2 Diabetes which is supported by muscular contraction. Furthermore, while specific diets
such as a low-carbohydrate diet have been shown to aid weight reduction in the past, they may

raise heart risk. It has also been reported that, due to increased cardiovascular risk, a high-protein
or low-carbohydrate diet is not suggested. The period of time from diagnosis is another crucial
element that can influence the long-term success of lifestyle behavioral modifications. A
diagnosis of diabetes by a medical practitioner may raise awareness of the need for a lifestyle
change and motivate them. Structured diabetic patient education enhances patients' awareness
and awareness of their illness and has a favorable impact on improving dietary habits, according
to research. Education of patient can also boost physical exercise and enable patients to quit
smoking; however, this can only be a short-term consequence. Overall, it is uncertain if people
with type 2 diagnosis are changing their lifestyle and maintaining improvements in behavior.
Stress is recognized as one of the risk factors associated with type 2 diabetics, and thus the
objective is to lower the amount of stress in order to significantly minimize the treatment of
complexity. Based on the collected data, it is clear and stated that patients with type 2 diabetes
should have a balanced diet and follow a healthy diet plan. As a result, it may be concluded that
adopting a healthy lifestyle can minimize the chance of developing chronic illnesses.
Policy implementation
Promotion of Healthy lifestyle: In order to deal with type 2 diabetes, it is important to promote
healthy lifestyle by concentrating on aspects such as early treatment of overweight and obesity
within high-risk groups, consumption of nutrient products with low fat and sugar free, active
lifestyle comprising regular physical exercise and cessation of smoking
Formulation of well-being and resilience: It is recommended that there is need to
communicate with the physician and get the healthy nutrition plan that can be highly effective
for the people with type 2 diabetes. Through following the diet plan people with type 2 diabetes
can get able to live better quality of life. By improving in their health and due to getting quality

of food and nutrition diet. People with type 2 diabetes and regular smoker have the lower
nutritional diet can also decrease the health and reduce quality of life style. Through following
this recommendation individual can keep focus on their diet by taking nutritional food can be
helpful for their improved health. This can help to get better quality of life and achieve the well-
being and resilience.
Early recognition of people at risk: It is vital to recognize people who are at risk of developing
type 2 diabetes. They require to be provided with optimal nutrition and weight maintenance
solutions.
Healthy lifestyle program: Healthy lifestyle program or intervention must concentrate on life
course viewpoint and not on certain age group or developmental phase. Legislative action is
essential in order to encourage healthy lifestyle for population. Government employees in social,
health and nutritional among others fields require to move forward on incorporated strategy to
the prevention of diabetes, rather than only treating the symptoms.

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