Lifestyle Modifications & Type 2 Diabetes Mellitus Treatment

This systematic review investigates the effectiveness of lifestyle modifications in treating type 2 diabetes mellitus, particularly among smoking individuals aged 45-60. It highlights the increasing global prevalence of diabetes and the importance of lifestyle changes such as diet, exercise, and smoking cessation in managing the disease. The review analyzes the impact of smoking, diet, and physical activity on diabetes, emphasizing the need for weight management, healthy eating habits, and regular physical activity to control blood glucose levels and reduce the risks associated with type 2 diabetes. The study also underscores the importance of educating individuals about the benefits of lifestyle changes and the need for government initiatives to promote awareness and early diagnosis. Ultimately, the review concludes that adopting a healthy lifestyle can significantly reduce the risks associated with type 2 diabetes and improve overall health outcomes.

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