Provision of nutritional/lifestyle counseling on diabetes self-management: A chance to improve metabolic control in new cases of type 2 diabetes
Abstract
Background: Type 2 diabetes (T2D) is an increasing public health problem primarily because of increase in the prevalence of a sedentary lifestyle and obesity. The aim of this study was to evaluate the efficacy of self-management education on metabolic control in adults with T2D.
Methods: In a quasi-experimental study, 300 patients with T2D recruited from the Diabetes Society of Natanz, Isfahan, Iran, from October 2012 to January 2013. The patients participated in a 16-week educational program held by trained dietician. At baseline, the intervention group attended a 20 minutes lifestyle and nutritional oral education program. Participants were assessed at baseline, 2 and 4 months follow-up for changes in body mass index, glycemic status, and lipid profile. Non-parametric and parametric descriptive and group × time (pre-post) repeated measure analysis of variance was done.
Results: The mean (± standard deviation) amount of weight lost between baseline and the end of 16 weeks was 0.66 ± 1.62 kg in compared to baseline (p < 0.0010). Significant time × treatment interaction effects were found for triglycerides (p < 0.0001), high density lipoprotein-cholesterol (p = 0.0010), fasting blood sugar (FBS) (p < 0.0001), 2-hour postprandial glucose (p < 0.0001), systolic blood pressure (BP) (p < 0.0001), diastolic BP (p < 0.0001), and hemoglobin A1c (HbA1c) (p = 0.0010). Mean FBS concentrations decreased by 30 mg/dl at week16. There was a non-significant increase in the HbA1c.
Conclusion: Nutritional/lifestyle counseling may improve metabolic control in T2D patients. Hence, it is possible to improve T2D control by means of non- pharmacologic interventions.
Chen L, Magliano DJ, Zimmet PZ. Theworldwide epidemiology of type 2 diabetes mellitus-present and future perspectives. Nat Rev Endocrinol. 2012; 8(4): 228-36.
Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine. 2010; 38(11): 602-6.
Haghdoost AA, Rezazadeh-Kermani M, Sadghirad B, Baradaran HR. Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. East Mediterr Health J. 2009; 15(3): 591-9.
Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009; 360(2): 129-39.
Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358(24):2560-72.
Standards of medical care for patients with diabetes mellitus. Diabetes Care. 2003; 26(Suppl 1): S33-S50.
Health Quality Ontario. Behavioural interventions for type 2 diabetes: an evidence-based analysis. Ont Health Technol Assess Ser. 2009; 9(21):1-45.
Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al. Effectiveness of the diabetes education and self-management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008; 336(7642): 491-5.
Erlich DR, Slawson DC, Shaughnessy A.Diabetes update: population management. FP Essent. 2013; 408: 25-33.
Holmen H, Torbjornsen A, Wahl AK, Jenum AK,Smastuen MC, Arsand E, et al. A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH. JMIR Mhealth Uhealth. 2014;2(4): e57.
Yuan C, Lai CW, Chan LW, Chow M, Law HK, Ying M. The effect of diabetes self-management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus. J Diabetes Res. 2014; 2014:789761.
Chen L, Pei JH, Kuang J, Chen HM, Chen Z, Li ZW, et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015; 64(2): 338-47.
Hidvegi T, Kovacs G. The effect of patient education on glycemic status and self-monitoring activity in type 2 diabetic patients recently switched to basal insulin analogue treatment. Orv Hetil. 2014; 155(43): 1713-21.
Staimez LR, Weber MB, Narayan KM, Oza-Frank R. A systematic review of overweight, obesity, and type 2 diabetes among Asian American subgroups. Curr Diabetes Rev. 2013; 9(4):
-31.
Mandal A. Study of prevalence of type 2 diabetes mellitus and hypertension in overweight and obese people. J Family Med Prim Care. 2014;3(1): 25-8.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6): 393-403.
Kriska AM, Saremi A, Hanson RL, Bennett PH, Kobes S, Williams DE, et al. Physical activity, obesity, and the incidence of type 2 diabetes in a high-risk population. Am J Epidemiol. 2003;158(7): 669-75.
Hu G, Lindstrom J, Valle TT, Eriksson JG, Jousilahti P, Silventoinen K, et al. Physical activity, body mass index, and risk of type 2 diabetes in patients with normal or impaired glucose regulation. Arch Intern Med. 2004;164(8): 892-6.
Beyazit E, Mollaoglu M. Investigation of effect on glycosylated hemoglobin, blood pressure, and body mass index of diabetes intensive education program in patients with type 2 diabetes mellitus. Am J Mens Health. 2011; 5(4): 351-7.
Luzio S, Piehlmeier W, Tovar C, Eberl S, Latzsch G, Fallbohmer E, et al. Results of the pilot study of DIADEM: a comprehensive disease management programme for type 2 diabetes. Diabetes Res Clin Pract. 2007; 76(3): 410-7.
Abdelgadir M, Elbagir M, Eltom M, Berne C. The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan. Diabetes Res Clin Pract. 2006; 74(1): 90-4.
Wild S, Roglic G, Green A, Sicree R, King H.Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004; 27(5): 1047-53.
Gillies CL, Abrams KR, Lambert PC, Cooper NJ, Sutton AJ, Hsu RT, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ. 2007; 334(7588): 299.
Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta- analysis of randomized controlled trials. Diabetes Care. 2005; 28(11): 2780-6.
Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002; 25(7):1159-71.
Kopp HP, Kopp CW, Festa A, Krzyzanowska K, Kriwanek S, Minar E, et al. Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol.2003; 23(6): 1042-7.
Wein P, Beischer N, Harris C, Permezel M. A trial of simple versus intensified dietary modification for prevention of progression to diabetes mellitus in women with impaired glucose tolerance. Aust N Z J Obstet Gynaecol. 1999;39(2): 162-6.
Oldroyd JC, Unwin NC, White M, Imrie K, Mathers JC, Alberti KG. Randomised controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months. Diabetes Res Clin Pract. 2001; 52(1): 29-43.
Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30(6): 1374-83.
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient- centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35(6): 1364-79.
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258): 405-12.
Peterson RM, Beeson L, Shulz E, Firek A, De LM, Balcazar H, et al. Impacting obesity and glycemic control using a culturally-sensitive diabetes education program in Hispanic patients with type 2 diabetes. Int J Body Compos Res.2010; 8(3): 85-94.
Watanabe M, Yamaoka K, Yokotsuka M, Tango T. Randomized controlled trial of a new dietary education program to prevent type 2 diabetes in a high-risk group of Japanese male workers. Diabetes Care. 2003; 26(12): 3209-14.
Li X, Zhou Q, Zou F, Wu L, Chen H, Liu Z.Effectiveness of systematic self-management education on blood sugar level of patients in the community with type 2 diabetes. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012; 37(4): 355-8.
Pimentel GD, Portero-McLellan KC, Oliveira EP, Spada AP, Oshiiwa M, Zemdegs JC, et al. Long- term nutrition education reduces several risk factors for type 2 diabetes mellitus in Brazilians with impaired glucose tolerance. Nutr Res. 2010;30(3): 186-90.
Swinburn BA, Metcalf PA, Ley SJ. Long-term (5- year) effects of a reduced-fat diet intervention in individuals with glucose intolerance. Diabetes Care. 2001; 24(4): 619-24.
Ricci-Cabello I, Ruiz-Perez I, Rojas-Garcia A,Pastor G, Rodriguez-Barranco M, Goncalves DC. Characteristics and effectiveness of diabetes self- management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression. BMC Endocr Disord. 2014; 14: 60.
Brownlee M, Hirsch IB. Glycemic variability: a hemoglobin A1c-independent risk factor for diabetic complications. JAMA. 2006; 295(14):1707-8.
Sone H, Katagiri A, Ishibashi S, Abe R, Saito Y, Murase T, et al. Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Horm Metab Res. 2002; 34(9): 509-15.
Scain SF, Friedman R, Gross JL. A structured educational program improves metabolic control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Educ. 2009; 35(4): 603-11.
Harmel AP, Berra K. Impact of the new National Cholesterol Education Program (NCEP) guidelines on patient management. J Am Acad Nurse Pract. 2003; 15(8): 350-60.
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: aqualitative study. Patient Prefer Adherence. 2014;8: 237-46.
Dorland K, Liddy C. A pragmatic comparison of two diabetes education programs in improving type 2 diabetes mellitus outcomes. BMC Res Notes. 2014; 7: 186
Sigurdardottir AK, Jonsdottir H, Benediktsson R.Outcomes of educational interventions in type 2 diabetes: WEKA data-mining analysis. Patient Educ Couns. 2007; 67(1-2): 21-31.
Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA. 2004;291(3): 335-42.
Mollaoglu M, Beyazit E. Influence of diabetic education on patient metabolic control. Appl Nurs Res. 2009; 22(3): 183-90.
Harmel AP, Berra K. Impact of the new National Cholesterol Education Program (NCEP) guidelines on patient management. J Am Acad Nurse Pract. 2003; 15(8): 350-60.
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: aqualitative study. Patient Prefer Adherence. 2014;8: 237-46.
Dorland K, Liddy C. A pragmatic comparison of two diabetes education programs in improving type 2 diabetes mellitus outcomes. BMC Res Notes. 2014; 7: 186.
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| Issue | Vol 1, No 2 (spring 2015) | |
| Section | Original Article(s) | |
| Keywords | ||
| Lifestyle modification Education program Type 2 diabetes Self-management | ||
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