Role of lifestyle interventions in preventing diabetes: A literature review

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

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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?

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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.

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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

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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

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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

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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

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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