Role of lifestyle interventions in preventing diabetes: A literature review

This literature review critically evaluates the effectiveness of lifestyle interventions in preventing diabetes in adults above 18 years old. The review includes evidence from 10 articles retrieved from databases like CINAHL and MedLine. The review reveals that multi-component lifestyle interventions are more effective in glucose control and reducing the risk of complications compared to single component interventions. The study gives implications to incorporate motivational elements like motivational interviewing and peer support to achieve long-term success of the lifestyle modification intervention.

Running head: PREVENTING DIABETES
Preventing diabetes
Name of the student:
Name of the University:
Author’s note

1PREVENTING DIABETES
Role of lifestyle interventions like diet and physical activity in preventing obesity: A
literature review:
Significance of the study:
Diabetes is one of the major public health burden in Australia as it increases risk of other
chronic disease in people and increase the health care cost associated with management of the
condition. The significance of the issue is understood from the fact that about 1 million
hospitalization took place due to diabetes in 2015-2016 in Australia. The diabetes related
mortality was found to be higher in remote and very remote areas. Another vital element of the
Australians statistics is that the prevalence of diabetes increases up to the rate of 75 years
(AIHW, 2018). Hence, considering these statistics, it is necessary to identify the risk factor
behind such high rate of diabetes cases and hospitalization in Australia. Evidence suggest poor
lifestyle like unhealthy eating patterns and high involvement in sedentary behavior such as lack
of physical activity, prolonged screen time as one of the major risk factor of diabetes. Hence,
avoiding risk factors and lifestyle modification can play a significant role in preventing diabetes
in Australia. This paper aims to critically evaluate research evidence to understand how far
lifestyle modification is effective in preventing diabetes.
Research question:
How effective is lifestyle modification intervention in preventing diabetes in adults above
18 years old?

2PREVENTING DIABETES
Search strategy:
To get answer to the research questions, articles for the literature review were retrieved
from databases like CINAHL and MedLine. The main rationale behind using these databases for
the review is that they are globally recognized database known for publishing peer reviewed
journal articles from the field of health care, biomedical and nursing. Hence, the two chosen
database is likely to yield lot of evidence regarding for research work done for the prevention of
diabetes. The keywords that were used for the search process was extracted from the research
question and the main primary key terms included ‘lifestyle modification’, ‘lifestyle
intervention’ and ‘diabetes prevention’. These key terms were the primary search terms used for
the search process. However, the search process was widened by the use of Boolean operators
use of synonyms and thesaurus for the primary search terms and using advanced search filters in
CINAHL database. The use of thesaurus helped to identify synonyms for the primary search
terms. In this way, other additional key words like ‘physical activity intervention’, ‘dietary
intervention’, ‘exercise intervention’ and ‘lifestyle intervention was selected’. These search
terms were combined with ‘AND’ and ‘OR’ to get the desired research papers. For example,
some of the search phrases that were used conduct advanced searching included ‘dietary
intervention and diabetes prevention’, ‘lifestyle intervention and diabetes prevention’ and ‘
physical activity and diabetes prevention’.
The search process was also guided by set of inclusion and exclusion criteria. The main
eligibility criteria for the selection of research papers included inclusion of only those papers
which has been published within 2008 to 2018 and analysis of any type lifestyle modification as
the main intervention for the study. Qualitative research papers, cohort study, systematic review
and randomized control trial (RCT) were included for critical review.

3PREVENTING DIABETES
Summary of evidence:
Based on the review of the 10 articles selected for this research study, it has been found that
three types of intervention has been incorporated in health promotion program for the prevention
of diabetes. These interventions include the following:
1. Physical activity intervention:
Out of 10 articles, there were at least two papers which investigated about the efficacy of
physical activity intervention alone in preventing diabetes. Thomas et al. (2009) examined the
association between physical activity and glucose tolerance among adolescents. Physical activity
of participants was assessed using the acceloremtry over 8 days and study revealed that physical
activity was associated with improvement in glucose tolerance. The strength of the study is that
impact of both moderate and vigorous physical activity level was assessed. Hence, it gave
answer to the research question. However, the transferability of the work was affected by small
sample size. Another randomized controlled trial gave evidence regarding the use of physical
activity promotion for improving health of patients with pre and type 2 diabetes. The
significance of this paper is that it used randomized controlled trial as the study design which
comes under top heirarchy of research evidence. Physical activity intervention in this study was
provided to two groups. The first included the multi-component group who had to follow
physical activity prescription, motivational interviewing and group consultation. The second
group included people received pedometers to track their steps (Rossen et al., 2015). The
significance of this research is that it used motivation aspects in the physical activity intervention
too and helped to eliminate barriers such as discontinuation of physical activity intervention for

4PREVENTING DIABETES
people with diabetes. The benefits of this approach is also understood from the fact that multi-
compont approach using motivational interviewing was more effective in improving physical
activity and promoting health of diabetes patients. Evidence supports the fact that motivational
aspect is important in promoting physical activity in people at risk of diabetes (Mori et al., 2011).
The importance of physical activity as a lifestyle modification intervention was also
shown by Mui et al. (2018) which also considered cultural aspect to promote physical activity
among people living in China. A telephone counselor was used to promote physical activity in
research participants and the system was used for six-month period. The significance of this
intervention is that it focused on behavioral informatics to change mindset of people and increase
their interest in physical activity. Hence, the research article can be applied in health promotion
initiatives to understand strategies that can be used to encourage people to become physically
active. This approach would enhance the success of any lifestyle intervention initiative in
Australia too. A systematic review also proved the efficacy of structured physical activity on
glycaemic control thus guiding implementation of more number of evidence based prevention
programmes in target setting (Edwards & Hosseinzadeh, 2017).
2. Lifestyle intervention using multiple approach:
Another significant finding of this critical review is that the critical appraisal of the papers
revealed that multi-component lifestyle intervention is more beneficial in preventing diabetes
and risk of complication compared to single intervention. There were at least four papers that
reported about the effectiveness of multi-component lifestyle intervention. For example, the
follow-up study used lifestyle intervention such as weight reduction program such as healthy diet
and moderate level of physical activity, room with treadmills and indoor physical activity

5PREVENTING DIABETES
facilities to promote behavioral change in research participant (Fianu et al., 2016). Another study
used web-based system to implement lifestyle intervention for individuals at risk of diabetes and
the main significance of this intervention was it considered all risk factors that lead to diabetes.
For example, weight loss, increase in physical activity, healthy eating, cessation of smoking and
stress management was incorporated in the web-based program to promote health of research
participants. The significance of this research paper is that it guides regarding the necessary
component that can be included in screening program for the successful prevention of diabetes
(Cha et al., 2017). The delivery of the intervention using web-based system has the advantage of
being cost-effective and reachable too. The paper by Thankappan et al. (2018) also revealed that
peer support group can play an important role in successful delivery of the lifestyle intervention
for patients at risk of diabetes.
Dietary intervention:
There was only one paper that used dietary intervention alone to prevent. This included the
paper by Du et al. (2017) which revealed that fresh fruit consumption is associated with lower
risk of diabetes and lower risk of death. However, the gap in the paper was that as it used
observation study design, it could not eliminate the effect of residual confounding factors.
Critical review of evidence:
The significance of this critical review is that maximum of the research papers included
RCT as the main research design. Although Thomas et al. (2009) was a poor quality paper as it
used only single component and small sample size to confirm the efficacy of physical activity
intervention, however many high quality research papers were also retrieved. The paper by
Thomas et al. (2009) had limitations as it had little benefit in application of the evidence in real

6PREVENTING DIABETES
practice. However, there were some papers which were very explicit and revealed the pros and
cons of both multi-component lifestyle modification intervention as well as single component
lifestyle modification intervention. The overall critical appraisal revealed the superiority of
multi-component intervention compared to single intervention in preventing diabetes. For
example, the multi-component intervention considered multiple risk factors that lead to diabetes
and focused on using different strategies to encourage people to avoid those risk behavior. In
addition, the study not only gave idea about innovative resources such as web-based tool and
telecounselling to motivate individuals to change their behavior; instead papers also gave idea
regarding important stakeholders who can play a role in enhancing the efficacy of the
intervention. For example, Thankappan et al. (2018) revealed the potential of peer support group
in preventing diabetes. However, one rationale behind the lack of generalizability of this study
was that the author did not adjust for multiple comparison and biases that could affect the study
result.
Despite limitations of some papers in having small sample size and little research rigour,
maximum papers were RCT trial and they used multi-component to enhance the efficacy of the
program. For example, the review of the paper by Cha et al. (2017) and Block et al. (2016)
suggested the importance of online mode as a cost effective strategy to prevent diabetes. For
example, Block et al. (2016) revealed the efficacy of online diabetes program in promoting
improvement in weight and gylcemic markers by considering eating habits, physical activity and
wellness factors for target group.
Gaps and implications of the findings

7PREVENTING DIABETES
The study gives implication to incorporate motivational elements like motivational
interviewing and peer support to achieve long-term success of the lifestyle modification
intervention. However, some gaps left behind in the research is that certain confounding factors
like influence of self-report and lack of residual bias has not been considered. This needs to
considered in future research.
Conclusion:
From the critical review of research papers, it can be said that lifestyle modification is an
effective step to control and prevent health care cost associated with diabetes. The critical
review of the 10 papers revealed that multi-component lifestyle intervention are more effective
in glucose control and reducing risk of complications compared to single component
intervention. The research paper can have implications in adding elements that can enhance the
success of the preventive program

8PREVENTING DIABETES
Australian Institute of Health and Welfare (AIHW) (2018). Diabetes snapshot. Retrieved from:
https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-
australians-have-diabetes
Block, G., Azar, K. M. J., Romanelli, R. J., Block, T. J., Palaniappan, L. P., Dolginsky, M., &
Block, C. H. (2016). Improving diet, activity and wellness in adults at risk of diabetes:
randomized controlled trial. Nutrition & diabetes, 6(9), e231.
Cha, S. A., Lim, S. Y., Kim, K. R., Lee, E. Y., Kang, B., Choi, Y. H., ... & Ko, S. H. (2017).
Community-based randomized controlled trial of diabetes prevention study for high-risk
individuals of type 2 diabetes: lifestyle intervention using web-based system. BMC public
health, 17(1), 387.
Du, H., Li, L., Bennett, D., Guo, Y., Turnbull, I., Yang, L., ... & Millwood, I. Y. (2017). Fresh
fruit consumption in relation to incident diabetes and diabetic vascular complications: a
7-y prospective study of 0.5 million Chinese adults. PLoS medicine, 14(4), e1002279.
Duijzer, G., Haveman-Nies, A., Jansen, S. C., Ter Beek, J., van Bruggen, R., Willink, M. G.
J., ... & Feskens, E. J. M. (2017). Effect and maintenance of the SLIMMER diabetes
prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled
trial. Nutrition & diabetes, 7(5), e268.
Edwards, J., & Hosseinzadeh, H. (2017). The impact of structured physical activity on glycaemic
control in diabetes prevention programmes: A systematic review. Proceedings of
Singapore Healthcare, 2010105817739924.

9PREVENTING DIABETES
Fianu, A., Bourse, L., Naty, N., Le Moullec, N., Lepage, B., Lang, T., & Favier, F. (2016). Long-
Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2
Diabetes in a Low Socio-Economic Community–An Intervention Follow-Up Study on
Reunion Island. PloS one, 11(1), e0146095.
Mori, D. L., Silberbogen, A. K., Collins, A. E., Ulloa, E. W., Brown, K. L., & Niles, B. L.
(2011). Promoting physical activity in individuals with diabetes: telehealth
approaches. Diabetes Spectrum, 24(3), 127-135.
Mui, L. W., Friedman, R. H., Lau, J. T., Peng, J., & Abdullah, A. S. (2018). A RCT to evaluate a
totally automated, culturally-adapted telephone counselor for increasing physical activity
among physically inactive individuals in China. BMC public health, 18(1), 785.
Rossen, J., Yngve, A., Hagströmer, M., Brismar, K., Ainsworth, B. E., Iskull, C., ... &
Johansson, U. B. (2015). Physical activity promotion in the primary care setting in pre-
and type 2 diabetes-the Sophia step study, an RCT. BMC public health, 15(1), 647.
Thankappan, K. R., Sathish, T., Tapp, R. J., Shaw, J. E., Lotfaliany, M., Wolfe, R., ... & Fisher,
E. B. (2018). A peer-support lifestyle intervention for preventing type 2 diabetes in India:
A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program. PLoS
medicine, 15(6), e1002575.
Thomas, A. S., Greene, L. F., Ard, J. D., Oster, R. A., Darnell, B. E., & Gower, B. A. (2009).
Physical activity may facilitate diabetes prevention in adolescents. Diabetes Care, 32(1),
9-13.

10PREVENTING DIABETES
Appendix :
Description Research
design
outcomes Your
judg
ment
s
Reference
details
Researc
h Aims/
objectiv
es
Nat
ure
of
inter
vent
ion
Stud
y
popu
latio
n
Rese
arch
desig
n
type
Data
coll
ecti
on
Findin
gs/
results
Concl
usion
s
As
su
mp
t
ion
s
Limitatitio
ns
Usef
ulnes
s as
infor
matio
n
sourc
e for
your
topic
1st
articl
e:
Phys
ical
Acti
vity
May
Facil
itate
Diab
etes
Prev
Author
names :
Amy S.
Thomas,
Lori F.
Greene,
Jamy D.
Ard,
Robert A.
Oster,Bett
The
aim of
this
study
was to
examin
e the
associa
tion of
Tota
l
popu
latio
n of
32
male
and
fema
le.
long
itudi
nal
pare
nt
stud
y,
Pri
mar
y
All of
the
data
were
colle
cted
durin
g one
inpati
In the
study
,
physi
cal
activi
ty
was
assoc
iated
The study
only
includes
the
adolescenc
e
population
. They did
not
consider
Usef
ul for
under
stand
ing
that
physi
cal
activi
ty

11PREVENTING DIABETES
entio
n in
Adol
esce
nts
Jour
nal
name
:
Diab
etes
care.
vol.
32(1)
y E.
Darnell,
and
Barbara
A.
Gower.
Year of
publicatio
n : 2009
Country :
Number
of
participan
ts : 32
physic
al
activit
y with
glucos
e
toleran
ce and
resting
energy
expend
iture
(REE)
among
adoles
cents.
ent
visit
to the
Gene
ral
Clini
cal
Rese
arch
Cente
r
with
carbo
hydra
te
meta
bolis
m. It
sugge
sted
that
physi
cal
activi
ty
reduc
es the
risk
of
obesit
y,
gluco
se
intole
rance
of the
popul
the effect
in older
population
reduc
es
the
risk
of
obesi
ty

12PREVENTING DIABETES
ation
Critic
al
appra
isal
tool
Q1.
yes
Q2.
yes
Q3.
yes
Q4.
yes
Q5.
yes
Q6.
Unc
lear
Q7.
Uncle
ar
Q8.
Yes
Q9
.
yes
Q. 10
2nd
articl
e:
Long
-
Term
Effec
tiven
ess of
a
Lifest
yle
Inter
venti
on
for
the
Prim
ary
Preve
Name of
the
authors:
Adrian
Fianu ,
Léa
Bourse,
Nadège
Naty,
Nathalie
Le
Moullec,
Benoît
Lepage,
Thierry
Lang,
François
Favier;
Volume :
11(1) ,
the aim
of
combine
d
lifestyle
interven
tion was
the prim
ary
preventi
on of
T2D by
risk
factor
reductio
n
RED
IA-
prev
1
coho
rt
stud
y of
445
adul
ts
livin
g in
depr
ived
area
s,
aged
18–
cohor
t
study
is
a qua
si-
exper
iment
with
multi
ple
grou
ps
Data
was
coll
ecte
d
first
by
skill
ed
nurs
es
and
seco
nd
dieti
cian
coll
ecti
ng
data
The
data
was
measu
red
Anthr
opom
etric
measu
remen
t,
dietiti
an
measu
remen
ts and
statist
ical
In the
conte
xt on
Reuni
on
Islan
d is
obeso
genic
, with
a
high
level
of
envir
onme
ntal
expos
ure
(in
the
attrition of
the cohort
(42%) is
high, but
similar to
the
attrition of
a cluster-
controlled
trial
conducted
in a district
in Tehran
for T2D
primary
prevention
using
communit
y-based
It is
usefu
l to
under
stand
how
lifest
yle
differ
ence
leads
to
type
2
diabe
tes

13PREVENTING DIABETES
ntion
of
Type
2
Diab
etes
in a
Low
Socio
-
Econ
omic
Com
munit
y –
An
Inter
venti
on
Follo
w-Up
Study
on
Reun
ion
Islan
year of
publicatio
n : 2016
40 h
avin
g
type
2
diab
etes
on
phys
ical
acti
vity
seco
nd
analys
is
partic
ular
low
socio
-
econo
mic
condi
tions)
and
preva
lent
unhea
lthy
lifest
yle
behav
ior
whic
h
give
rise
to the
diabe
tes
type
lifestyle
interventio
n

14PREVENTING DIABETES
d
Journ
al
name
:
PloS
one,
2.
Diabe
tes
interv
entio
n
progr
am
has
better
effect
on
the
interv
entio
n
group
than
other
group
Appr
aisal
tool
Q1.
yes
Q2.
yes
Q3.
yes
Q4.
yes
Q5.
yes
Q6.
yes
Q7.
yes
Q8.
no
Q9
.
no
Q10.
3rd
articl
e :
Name of
the
authors :
The
purpose
of this
Aim
of
the
420
partic
ipant
a
rand
omi
Primar
y data
collect
Data
collec
ted
even a
perfect
diabetes

15PREVENTING DIABETES
Com
munit
y-
based
rando
mize
d
contr
olled
trial
of
diabe
tes
preve
ntion
study
for
highr
isk
indivi
duals
of
type
2
diabe
tes:
Seon-Ah
Cha ,
Sun-
Young
Lim ,
Koo-Rye
Kim ,
Eun-
Young
Lee ,
Borami
Kang,
Yoon-Hee
Choi1,Ku
n-Ho
Yoon1,Y
u-Bae
Ahn1 ,
Jin-Hee
Lee2 and
Seung-
Hyun Ko
Year of
publiactio
n : 2017
manuscr
ipt is to
provide
a
detailed
descripti
on of
the web-
based
LSI
program
used in
a
commun
ity
setting
in the
Korean
Diabetes
preventi
on
program
stud
y is
to
eval
uate
the
effec
tiven
ess
of a
peer-
supp
ort
lifest
yle
inter
venti
on in
prev
entin
g
type
2
diab
etes
amo
s are
being
recru
ited
for 6
mont
h and
follo
w up
for
22
mont
hs
zed
cont
rolle
d
clini
cal
trial
ion direct
ly
from
the
interv
entio
n
progr
am
and
statist
ical
analy
sis
prevention
program is
of no use
if the high-
risk
individuals
are not
screened
or are
inappropri
ately
selected.
Communit
y-based
screening
of type 2
diabetes
across the
country is
realisticall
y
impossible
without
sufficient
budget.

16PREVENTING DIABETES
lifest
yle
interv
entio
n
using
web-
based
syste
m.
Volu
me :
17
Num
ber 1
ng
high
-risk
indiv
idual
s
ident
ified
on
the
basis
of a
simp
le
diab
etes
risk
scor
e.
Appr
aisal
Critic
al :
Q1.
yes
Q2.
yes
Q3.
yes
Q4.
yes
Q5.
yes
Q6.
yes
Q7.
yes
Q8.
yes
Q9
.
yes
Q10.
Unclear
4th Name of o A Rand Pri Statisti In They did Usful

17PREVENTING DIABETES
paper
:
A
peer-
supp
ort
lifest
yle
interv
entio
n for
preve
nting
type
2
diabe
tes in
India:
A
cluste
r-
rando
mize
d
contr
olled
the
authors :
Kavumpu
rathu R.
Thankapp
an ,
Thirunavu
kkarasu
Sathish ,
Robyn J.
Tapp,
Jonathan
E.
Shaw,Moj
taba
Lotfaliany
,Rory
Wolfe,
Pilvikki
Absetz,
Elezebeth
Mathews,
Zahra
Aziz
Emily D.
examin
e
whether
the
interven
tion
could
reduce
diabete
s
incidenc
e at 24
months
among
high-
risk
individu
als
identifie
d on the
basis of
a
diabete
s risk
score.
total
of
1,00
7
parti
cipa
nts
(47.2
%
fema
le)
were
enrol
led
omiz
ed
trial
contr
ol
mar
y
acal
analys
is and
eva;ua
tion
this
low-
and
middl
e-
inco
me
settin
g, a
low-
cost
peer-
suppo
rt
lifest
yle
interv
entio
n
result
ed in
a
nonsi
gnific
ant
reduc
not
conside
other
study
groups
for
under
stand
ing
the
demo
graph
ic
point
of
view
of
the
diabe
tes

18PREVENTING DIABETES
trial
of the
Keral
a
Diab
etes
Preve
ntion
Progr
am.
Journ
al
name
: plos
one
Volu
me :
15
Num
ber: 6
Williams,
Edwin B.
Fisher,
Paul Z.
Zimmet,
Ajay
Mahal,
Sajitha
Balachan
dran,
Fabrizio
D'Esposit
o,
Priyanka
Sajeev,
Emma
Thomas,
Brian
Oldenbur
g.
Published
year:
2018
tion
in
diabe
tes
incid
ence
at 24
mont
hs in
a
high-
risk
popul
ation
identi
fied
on
the
basis
of a
risk
score.
Critic
al
Q1. Q2. Q3 Q4. Q5 Q6 Q7. Q8. Q9 10. Q10.

19PREVENTING DIABETES
appra
isal
tool
yes yes yes yes yes yes yes yes .
yes
Unclear yes
5th
Articl
e :
Physi
cal
activi
ty
prom
otion
in the
prima
ry
care
settin
g in
pre-
and
type
2
diabe
tes -
the
Sophi
Jenny
Rossen1,2
, Agneta
Yngve1,3,
Maria
Hagström
er4 ,
Kerstin
Brismar5
, Barbara
E.
Ainswort
h6 ,
Christina
Iskull7 ,
Peter
Möller7
and Unn-
Britt
Johansso
The aim
of
Sophia
Step
Study is
to
evaluate
the
impact
of a
multi-
compon
ent and
a single
compon
ent
physical
activity
interven
tion
aiming
at
improvi
, 310
patie
nts
will
be
inclu
ded
and
follo
wed
for
24
mont
hs
a
rando
mize
d
contr
olled
trial
a
Pri
mar
y
Accele
romete
r and
statisti
cs,
questi
oner
Direc
tly
from
the
prima
ry
care
settin
g
With an
ageing
population
and
increasing
incidence
of pre-
diabetes
and
diabetes, it
is of high
importance
to
construct,
implement
and
evaluate
cost-
effective
preventive
methods
adjusted
Usef
ul for
under
stand
ing
the
demo
graph
ic
effect

20PREVENTING DIABETES
a step
study
, an
RCT
Jenny
Ross
en1,
ng
HbA1
for the
health care
system
Critic
al
appra
isal
tool
Q1.
yes
Q2.
yes
Q3.
yes
Q4.
yes
Q5.
yes
Q6.
yes
Q7.
yes
Q8
yes
Q9
.
un
cle
ar
Q10.
yes
6th
articl
e
A
RCT
to
evalu
ate a
totall
y
auto
mate
d,
cultu

ancelot W
. H. Mui,

Robert H.
Friedman
Email
author,

Joseph T.
F. LauEm
ail author,

Ji Peng an
t
evaluati
ng the
efficacy
of an
automat
ed
telephon
e
counsel
or
(TLC-
PA-
China)
Stud
y
popu
latio
n :
211
Rand
omiz
d
trail
contr
ol
Pri
mar
y
Statisti
cal
analys
is and
sampli
zation
Direc
tly
from
the
interv
entio
n
group
s and
secon
dary
data
The
monetary
and time
costs to
participant
s are
minimal
because
the
automated
system
uses the
existing
telephone
Usef
ul for
under
stand
ing
the
diabe
tes

21PREVENTING DIABETES
rally-
adap
ted
telep
hone
coun
selor
for
incre
asing
physi
cal
activi
ty
amo
ng
physi
cally
inact
ive
indiv
idual
s in
Chin
a
Jour
d

Abu S. A
bdullah
Year
Volume
number :
18
number 1
for
promoti
ng
physical
activity
to the
WHO-
recomm
ended
level
among
physical
ly
inactive
family
member
s of
diabetes
patients.
network to
deliver the
interventio
n with
around-
the-clock
access.

22PREVENTING DIABETES
nal
name
:
BMC
Publi
c
Healt
h
Critic
al
appra
isal
tool
Q1.
yes
Q2
yes
Q3.
yes
Q4
yes
Q5
yes
Q6
yes
Q7
yes
Q8
yes
Q9
yes
Q10
yes
7th
articl
e
the
impa
ct of
struc
tured
physi
cal
activi
Joseph
Edwar
ds,
Hassa
n
Hossei
nzadeh
Stud
y
popu
latio
n :
30
pape
r
Prim
ary
Systa
matic
revie
w
Pri
mar
y
Directl
y from
paper
Revie
w of
literat
ure
The
saliency of
SPA in
embattling
prediabete
s to avert
T2DM is
understate
d and
under-
explored.

23PREVENTING DIABETES
ty on
glyca
emic
contr
ol in
diabe
tes
prev
entio
n
prog
ram
mes:
A
syste
mati
c
revie
w
Physical
activity
traverses
the
morpholog
ical and
physiologi
cal aspects
of the
human
body and
has the
ability to
impact the
body at a
metabolic
level –
stimulating
changes
that either
delay the
onset of
T2DM or
reset the
body to
normal

24PREVENTING DIABETES
glucose
control, as
in Jenkins’
IDPT.32
Critic
al
appra
isal
Q1.
yes
Q2.
yes
Q3.
yes
Q4
yes
Q5
yes
Q6
yes
Q7
yes
Q8
yes
Q9
.
yes
Q10.
yes
8th
articl
e
mpro
ving
diet,
activi
ty
and
welln
ess in
adult
s at
risk
of
diabe
tes:
 G
B
lo
c
k
 ,
K
M
J
A
za
r
 ,
R
J
R
o
To
evaluate
in adults
at risk
of
diabetes
Stud
y
popu
latio
n :
30
pape
r
Prim
ary
rando
mize
d
contr
olled
trial
Pri
mar
y
Statisti
cal
analys
is
Direc
tly
from
the
interv
entio
n
group
s and
secon
dary
data
In
addition
to
promoti
ng
improve
ments in
weight
and
glycemi
c
markers,
the
Alive-

25PREVENTING DIABETES
rando
mize
d
contr
olled
trial
m
a
n
el
li
 ,
T
J
B
lo
c
k
 ,
L
P
P
al
a
ni
a
p
p
a
n
 ,
M
PD
program
appears
to
improve
eating
habits
and
physical
activity,
behavio
rs
importa
nt not
just for
diabetes
preventi
on but
for
those

26PREVENTING DIABETES
D
ol
gi
ns
k
y

&
C
H
B
lo
c
k
with
diagnos
ed
diabetes
or
obesity.
The
improve
ments in
wellness
/product
ivity
may
derive
from the
diet and
activity
improve
ments,
and

27PREVENTING DIABETES
from the
satisfact
ion and
self-
efficacy
of
achievin
g goals.
Critic
al
appri
sal
Q1.
yes
Q2
yes
Q3
yes
Q4
yes
Q5
yes
Q6
yes
Q7
yes
Q8
yes
Q9
yes
Q10
yes
9th
paper
Effec
t and
maint
enanc
e of
the
SLI
MM
ER

D
ui
jz
er
 ,
A
H
a
v
e
the
aim
is to
inve
stiga
te
Stud
y
popu
latio
n :
1000
Rand
omiz
ed
trail
contr
ol
Pri
mar
y
Statisti
cal
analys
is
this
study
has
show
n that
the
Dutc
h
SLIM
MER
lifest
Limitation:
The
rando
mised
desig
n,
comp

28PREVENTING DIABETES
diabe
tes
preve
ntion
lifest
yle
interv
entio
n in
Dutc
h
prima
ry
healt
hcare
: a
rando
mise
d
contr
olled
trial
m
a
n-
N
ie
s
 ,
S
C
Ja
ns
e
n
 , J
te
r
B
ee
k
 ,
R
v
a
n
B
ru
whet
her
effe
cts
sust
aine
d six
mon
ths
after
the
activ
e
inter
yle
interv
entio
n is
effect
ive in
the
short
and
long
term
in
impro
ving
clinic
al
and
meta
bolic
risk
factor
s,
dietar
y
intak
e,
rehen
sive
evalu
ation
appro
ach
(outc
omes
at
sever
al
levels
), and
valida

29PREVENTING DIABETES
g
g
e
n
 ,
M
G
J
W
ill
in
k
 ,
G
J
H
id
di
n
k

&
E
J
M
F
vent
ion
peri
od
ende
d.
physi
cal
activi
ty,
and
qualit
y of
life in
subje
cts at
high
risk
of
diabe
tes.
More
insig
ht
into
longe
r-
term
effect
s of
the
interv
ted
metho
ds to
meas
ure
dietar
y
intake
and
PA
allow
us to
draw
solid

30PREVENTING DIABETES
es
k
e
ns
entio
n on
maint
enanc
e and
cost-
effect
ivene
ss is
neede
d and
impor
tant
for
sustai
nable
diabe
tes
preve
ntion.
The
result
s
provi
de
valua
concl
usion
s on
the
SLIM
MER
interv
entio
n’s
effect
ivene
ss.

31PREVENTING DIABETES
ble
infor
matio
n for
prima
ry
healt
hcare
profe
ssion
als,
resear
chers
and
polic
ymak
ers.
Critic
al
appra
isal
Q1.
yes
Q2
yes
Q3
yes
Q4
yes
Q5
yes
Q6
yes
Q7
yes
Q7
yes
Q8
yes
Q9
yes
Q10
yes
10th
paper
:
Fresh
fruit
Huaidong
Du1,2*,
Liming
Li3,4*,
Derrick
To
evaluate
the
incident
s of the
Stud
y
popu
latio
Rand
omiz
ed
trail
contr
Pri
mar
y
Statisti
cal
analys
is
This
large
prosp
ective
study
Did not
consider
population
popul
at

32PREVENTING DIABETES
consu
mptio
n in
relati
on to
incid
ent
diabe
tes
and
diabe
tic
vascu
lar
comp
licati
ons:
A 7-y
prosp
ectiv
e
study
of 0.5
milli
on
Chin
Bennett2 ,
Yu
Guo4 ,
Iain
Turnbull2
, Ling
Yang1,2,
Fiona
Bragg2 ,
Zheng
Bian4 ,
Yiping
Chen1,2,
Junshi
Chen5 ,
Iona Y.
Millwood
1,2, Sam
Sansome2
, Liangcai
Ma6 ,
Ying
Huang7 ,
Ningmei
Zhang8 ,
Xiangyan
diabetes n:
512,
891
p
ol of
Chine
se
adults
with
and
witho
ut
diabe
tes
show
ed
that
highe
r
fresh
fruit
consu
mptio
n was
signif
icantl
y
assoc
iated
with

33PREVENTING DIABETES
ese
adult
s
g
Zheng9 ,
Qiang
Sun10,
Timothy
J. Key11,
Rory
Collins2 ,
Richard
Peto2 ,
Zhengmin
g Chen2 ,
China
Kadoorie
Biobank
study¶
a
lower
risk
of
devel
oping
diabe
tes,
and
also
with
a
lower
risk
of
dying
or
devel
oping
vascu
lar
comp
licati
ons
amon
g

34PREVENTING DIABETES
those
who
have
alrea
dy
devel
oped
diabe
tes.
These
assoc
iation
s
appea
red to
be
simil
ar in
both
men
and
wom
en, in
urban
and
rural

35PREVENTING DIABETES
reside
nts,
and
in
those
with
previ
ously
diagn
osed
and
scree
ndete
cted
diabe
tes
Critic
al
appra
isal
Q1.
yes
Q2
yes
Q3
yes
Q4
yes
Q5.
yes
Q6
yes
Q7
yes
Q8
yes
Q9
.
yes
Q10
yes