HEA542 Report: Dietary Intake and Type 2 Diabetes Management

This report critically reviews the impact of dietary intake on the prevention and management of Type 2 Diabetes. The study examines various aspects of nutrition, focusing on how diet influences the incidence and control of diabetes. It analyzes several research articles, including studies on the H...Read More

Running head: Type 2 Diabetes 1
Impact of Nutrition or Dietary Intake in the Management of Type 2 Diabetes
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Introduction
The incidences of diabetes have been on the rise in both developed and developing countries
with the highest mortality rates being attributed to chronic conditions such as diabetes (Shaw,
Sicree, & Zimmet, 2010). Larger shares of government budgets have been allocated for the
treatment of chronic diseases including diabetes. For instance, the annual expenditures of the
Australian government on diabetes is 14 million dollars per year (Lee et al., 2013) but still,
the prevalence of diabetes is ever on the rise. This has prompted doctors and nurses in
focusing on the most effective intervention to prevent or manage the incidence of diabetes
across the world. Diabetes is a combination of common metabolic disorders leading to
hyperglycemia. Several studies have examined the impact of diet on chronic illnesses in
addition to exploring the role of individual nutrients and foods in the deterrence and control
of chronic conditions such as diabetes. There is a common consensus across studies that diet
is a significant aspect in the prevention and management of diabetes.
Consequently, more emphasis has been placed on the role of self-management education and
diet therapy in controlling and preventing diabetes. Despite the increase in studies in focusing
on the treatment of diabetes, the prevalence of diabetes is still on the rise and is expected to
remain as the leading factor in deaths in the future (Shaw, Sicree, & Zimmet, 2010). This
essay will conduct a review of the current relevant literature on “Impact of dietary intake in
the prevention and management of type 2 diabetes.” Various aspects of nutrition regarding
the prevention and control of diabetes will comprehensively be addressed.
This critical review of the literature answers the question, “what is the impact of dietary
intake in the prevention and management of diabetes?” The study population consists of 200
type 2 diabetic patients aged between 35 to 70 years and attend the two public hospitals in
Melbourne, Victoria namely The Alfred Health and Austin health hospitals. The intervention

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would consist of dietary assessment (using a validated food frequency questionnaire) broadly
categorized into seven groups namely bread, fruits, vegetables, flesh including fish, animal
products, beverages, and snacks. The variable for the control group would be assessed using
the standard medical procedures for diabetes. The incidences of diabetes in both the control
and intervention groups will be compared after ten months of study.
The researcher used keywords in searching for current relevant articles for the critical review.
These include type 2 diabetes, management, prevention, diet, and nutrition alongside other
specific phrases on the nutritional pattern. Search engines such as Google Scholar, Elsevier,
NCBI, Springer, and PubMed were searched for primary research articles and secondary
sources such as meta-analysis. Further filtration was done on the articles published for the
last ten years and published in the English language. The reference lists of the selected
articles were searched as well, and some of them were included in the study as much as it was
deemed appropriate by the researcher. Five main articles derived from the above search
procedure, and included in this review include: the efficacy of dietary education on the
knowledge of diabetic patient using the HBM, prevention and control of type 2 diabetes:
nutritional aspects and approaches, the association between nutrient intake and the
advancement of type 2 diabetes, risk of type 2 diabetes in relation to the consumption of
vegetable and animal protein, and the relationship between the use of milk and milk products
and the prevalence of diabetes in Australia.
The empirical study by Sharifirad, Entezari, Kamran, and Azadbakht (2009) focused on the
usefulness of the Health Belief Model (HBM) on dietary education in patients diagnosed with
type 2 diabetic. The study focused on eighty-eight diabetic patients diagnosed with type 2
diabetes and were attendees of Iranian Diabetes Association sessions during the period of
study. The intervention comprised of two educational seminars teach lasting for one hour 20

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minutes. The population was equally divided into two groups namely the intervention group
(that received the two educational sessions) and the control group which did not receive any
dietary education. A validated and reliable questionnaire was used to gather data on
nutritional knowledge, demographic information, elements of the HBM, and dietary practice.
The outcomes of the two groups were compared using the values of the variables under study.
The variables of comparison consisted of the elements of the HBM namely strictness,
vulnerability, susceptible, advantages and obstacles.
The authors found out that there was a significant increase in the values of the study variables
in the experimental group as well as substantial variations when compared to the placebo
group after the intervention. However, there was no significant variation between the study
groups concerning the elements of the HBM. There was a substantial increase in the
supposed vulnerability in the experimental group against the control group with mean
variations of 29 and -2.6 respectively. Similarly, supposed strictness had a significant mean
difference of 27.5 against 17.2 respectively, supposed susceptible had 28.5 against 0.6,
supposed advantages had mean variations of 21.1 against -3.1 respectively. There was a
substantial reduction in the perceived obstacles after the intervention in the experimental
group compared to the placebo group. Regarding the dietary knowledge and practice in type
2 diabetes after and before the intervention, the results indicated a higher significant
difference after the intervention in the case group. The authors concluded that dietary
education increased patient’s knowledge and minimized their fasting blood glucose, thus
confirming the effectiveness of the HBM in nutritional education.
Similar findings have also been arrived at by Shah, Kamdar, and Shah (2009) and Bains and
Egede (2011) who reported a significant increase in nutritional knowledge after an
educational intervention and a corresponding decline in type 2 diabetes risk. Chlebowy,

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Hood, and LaJoie, (2010) observed that the absence of health food and healthy recipes in
restaurants were the main obstacles to adherence to the diet. A study by Malathy, Narmadha,
Ramesh, Alvin, and Dinesh (2011) also found out that there was an increase in nutritional
practice after an intervention of educational program.
The study by Sharifirad et al. (2009) minimized common biases that are characteristic of such
studies by matching the experimental and control groups. Limited bias in a study makes the
inferences more credible and increases generalizability (Ihantola & Kihn, 2011). However,
most of the respondents were female, thus limiting the application to female population and
yet studies have clearly shown that type 2 diabetes is much more common in men than in
women (Siddiqui, Khan, & Carline, 2013). Therefore, the outcomes of this study impact the
nursing profession and practice because it proves that nutritional knowledge is more effective
in the prevention and treatment of diabetes than the usual treatment procedures. This,
therefore, requires the medical providers to be knowledgeable on this approach to be effective
in healthcare delivery.
Ley, Hamdy, Mohan, and Hu (2014) conducted a review of published articles on the function
of nutrition in the prevention and management of diabetes. The authors searched using search
engines such as Google Scholar and PubMed for primary and secondary publications
published within the last five years of the time of research. However, the old publications that
are usually referenced and book chapters were also cited to provide the audience with an in-
depth understanding of the study topic. The researchers analyzed their findings into various
themes that comprehensively addressed multiple aspects associated with diet and the
prevention and management of diabetes. These themes include diet transition and worldwide
nutritional trends, nutritional factors for the prevention of diabetes, and nutritional factors for
the management of diabetes.

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Concerning diet transition and worldwide nutritional trends, Ley et al. (2014) found out the
high incidence rates of type 2 diabetes are as a result of urbanization and changes in the
environment, in addition to transitions in work patterns from intensive manual work to
sedentary jobs, advanced transportation, and mechanization. Popkin, Adair, and Ng (2012)
note that economic development and changes in the environment has caused the rapid
transitions in food production, processing, and transportation of unhealthy foods.
Epidemiological transitions have also been experienced in the livestock industry which has
led to the increased supply of processed meat (Popkin et al., 2012).
The authors also found out that the nutritional factors that lead to the prevention of diabetes
include quantity and quality of dietary fat, positive energy balance and excess deposition,
vitamins and minerals, quality and quantity of carbohydrates, specific foods and food
categories, beverages, dietary patterns and general condition of the diet (Malik et al., 2010).
The nutritional factors for the control of diabetes as found by Ley et al. (2014) include
interventions on body loss, quality of carbohydrates, protein, macronutrients, fats, dietary
pattern, supplementation of minerals and vitamins, and alcohol.
The study has provided a detailed procedure of its search strategy and the criteria for
inclusion. The comprehensive details make the research to be replicable in different settings
and increase the credibility of the studies since any possible doubt of bias is exposed. The
selection criteria used makes sure that the reviewed articles are relevant, and therefore the
conclusions arrived at are valid. However, there is no statistical verification of the findings
thus making it difficult for the researcher to verify the findings of the review objectively.
Furthermore, the absence of statistical analysis makes it hard to examine causality especially
in cases where there are inconsistent outcomes.

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The study has proved that the management and prevention of diabetes can effectively be
handled through dietary intake. This affects nursing profession in healthcare delivery because
it requires the health care providers to be much aware of how the diet works in the deterrence
and control of type 2 diabetes to be able to utilize the intervention in diabetic patients.
Yu et al. (2011) used the Chinese adults to examine the association between dietary intake
and the development of type 2 diabetes. The study took place at the Queen Mary Hospital in
Hong Kong. The researchers adopted a prospective cohort study and used a validated Food
Frequency Questionnaire (FFQ) (Esfahani, Asghari, Mirmiran, & Azizi, 2010). The dietary
patterns were identified using principal component analysis in which dietary glycaemic load
and several snacks were determined. The population under study were aged 25 to 74 years
and had been involved in the 1995-1996 nation-wide prevalence survey of dietary and
cardiovascular risk. The researcher followed up these individuals to find out any possible
development of diabetes for 9-14 years. Seventy-four diabetic incidences were found and
dietary patterns categorized into four main groups namely additional snacks and drinks,
additional animal and animal products, additionally processed grains, and additional fruits
and vegetables. There was a 14% lower risk of diabetes in those who had a high intake of
fish, fruits, and vegetables, while those with high consumption of animal and animal products
had 39% greater risk of diabetes. There was a dependent relationship between rice
consumption, dietary glycaemic load, and the consumption of snacks and in different forms
with diabetes. Therefore, this study shows that the risk of diabetes is directly associated with
diet, and plant-based foods have a much lower risk of developing diabetes compared to
animal and animal products. Similar findings were also arrived at by (Erber et al., 2009).
The study was approved by the ethics committee from two institutions, and it adhered to the
principles provided in the Declaration of Helsinki regarding experiments on human subjects.

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This is important because it shows that the research was beneficial and had a low risk of harm
to the participants. Furthermore, the obtained consent from the participants is an indication of
their willful participation in the research. The use of Student's t-test and chi-square test
provided the validity of the quantitative instruments used in the study. This is important
because it ensures that the responses of the participants upon which the inferences are made
are unbiased.
A validated FFQ was used in dietary assessment thus increasing the validity of the findings.
The use of the glycaemic index values and the Dietary Quality Index-International (DCQI-I)
that are internationally recognized (Atkinson, Foster-Powell, & Brand-Miller, 2008) further
increased the accuracy of the findings. This shows that the results can not only be reliable but
can be replicated in different geographical settings. However, the study reported very few
cases of diabetes, an indication that some of the predisposing factors might not have been
statistically substantial. Additionally, the single use of FFQ may fail to be representative of
long-term dietary intake. The findings by Yu et al. (2011) provide enough evidence of the
expectations of the healthcare providers. These findings demonstrate that the health
profession should focus more on the alternative methods of preventing and controlling type 2
diabetes. This requires that they focus on the individual dietary components of each food and
their benefit in treating type 2 diabetes.
Huxley et al. (2009) conducted a systematic review with meta-analysis on the relationship
between decaffeinated coffee, coffee, and the intake of tea with the risk of diabetes. The
author's used search engines to locate relevant studies by employing a combination of
keywords and specific dietary terms. The search range included articles published between
1966 and 2009 on the relationship between tea, coffee, and coffee without caffeine. The
authors ended up including 18 articles in their study out of the 120 full articles that were

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reviewed. Thirteen studies showed estimate relationship between tea and decaffeinated coffee
and risk of diabetes. The authors also found a converse log-linear association between the
intake of coffee and consequent risk of diabetes in that for each extra cup of coffee taken a
day there was a corresponding 7% drop in the relative risk of excess diabetes. These findings
are contrary to those of Ding, Bhupathiraju, Chen, van Dam, and Hu (2014) who found out
that diabetes risk was inversely proportional to type 2 diabetic patients aged 60 years and
below. Otherwise, the risk increased by 40% in the patients older than 60 years. Furthermore,
other studies have associated increased levels of coffee and tea intake to risky behaviors that
contribute to developing diabetes, for example, inactivity and smoking of cigarettes (Hu,
2011).
The study provides a detailed procedure on how the review was conducted in addition to
providing a flow diagram for the same. This makes the outcomes more credible and
minimizes any possible bias that may be attributed to the process of analysis. Inter-rater
reliability was achieved through the use of two of the researchers in data extraction and the
involvement of over three of them in the literature review.
The authors were not able to carry out an analysis for intake of tea because the reviewed
articles relied only on the adjusted estimates. The generalizability of the study to other
settings is limited because only 20% of the non-white population was included making it
difficult to apply the findings to western populations. Furthermore, the small sample size over
a large area may lead to overestimation as a result of small-study bias. The findings by
Huxley et al. (2009) on the relationship between the consumption of coffee, tea and coffee
without caffeine with risk of developing type 2 diabetes is faced by a lot of limitations as
explained above and thus this shows that further studies should be conducted on the same
topic to provide additional and explicit knowledge of the same.

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McNaughton, Dunstan, Ball, Shaw, and Crawford (2009) investigated the relationship
between diet quality, diabetes and other chronic illnesses using a cross-sectional study by the
Australian Diabetes, Obesity and Lifestyle survey on adults aged 25 years and above. FFQ
data and dietary guideline index were used to examine diet quality. Linear regression adjusted
for age, education, activity, BMI, sedentary lifestyle, and smoking were used to assess the
relationship between diet quality and diabetes. The authors found out an inverse relationship
between diet quality and the incidence of type 2 diabetes in men and with pre-diabetes in
women. The findings also demonstrated that high-risk factors for type 2 diabetes were due to
the lack of adherence to the standardized dietary guidelines. The outcomes of the authors are
in agreement with those of Fung, McCullough, Van Dam, and Hu (2007) which demonstrated
a converse association between quality diet and the prevalence of type diabetes in women.
Similarly, Fogli-Cawley et al. (2007) found an inverse relationship with blood pressure and
size of the waist in adults of both genders.
The study has some strengths and limitations, and therefore impact the health profession. It
used an already established and proved dietary index to make recommendations for healthy
food consumption in Australia. The different methods of determining diseases used in the
study strengthen the validity of the findings. Furthermore, the reliability of the conclusions
was ascertained by using two tests (FFQ data and dietary guideline index) to arrive at the
same conclusion. The sample size for diabetes was small to warrant generalizability thus
decreasing its external validity. The study has also examined several confounders such as
demographic characteristics, lifestyle conduct, among other risk factors in its analysis. This
strengthens the credibility of the findings and the possibility of being replicated in different

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settings. Furthermore, the outcomes can be used in the nursing profession as a basis for
recommending treatments to diabetic patients and for as a basis for further research.
Conclusion
The continuing increase in the incidences of type 2 diabetes across the globe has led to much
focus on the alternative methods of preventing and controlling the chronic condition. Several
studies have been conducted on the various aspects of dietary intake, nutritional components,
and strategies and their association with type 2 diabetes. The objective of this study was to
ascertain the effectiveness of Nutrition or dietary intake in the management of type 2 diabetes
by conducting a critical review of the relevant and current literature. A review of five peers
reviewed journal articles addressing the various aspects of diet, and the risk of developing
type 2 diabetes was conducted in this study. The findings across the review point towards a
consensus on the significant positive effect of diet on the prevention and control of type 2
diabetes. These findings also indicate the health profession should also update their approach
towards dealing with chronic illnesses such as type 2 diabetes

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