Healthy lifestyle practices have been shown by various studies to be effective in the improvement of health outcomes among patients with diabetes. Evidence suggests that interventions focusing on healthy lifestyles demonstrate their benefits by way of directly addressing biochemical indicators which, when uncontrolled, could lead to the worsening of diabetes. For instance, a essay writer study by Sarmento et al (2018) was conductedto assessthe relationship between patients’ eating patterns with its efficacy in achieving therapeutic targets among patients with type 2 diabetes. A cross-sectional study with 197 participants was conducted wherein participants were evaluated to have had “unhealthy” and “healthy” eating patterns. Participants whose diet was composed of refined carbohydrates, ultra-processed foods, sweets, and desserts were classified as patients with “unhealthy” eating patterns, whereas patients with “healthy” eating patterns were characterized to have high consumption of whole carbohydrates, dairy, white meat, fish, fruits and vegetables. These eating patterns were evaluated using a food frequency questionnaire in Southern Brazil. Meanwhile, the health outcomes indicative of improving or worsening conditions among diabetic patients were compared across these two groups. These indicators included their blood pressure, waist circumference, fasting plasma glucose, HbA1c, triglycerides, HDL-cholesterol levels, and LDL-cholesterol levels.
Sarmento et al (2018) found that the patient group with healthy eating patterns were more likely to achieve the therapeutic targets set among these indicators, and in fact regression analysis showed that there is a strong association between these habits and the health outcomes that result from them. Even when adjusting for sex, age, economic status, smoking habits, and their diabetes duration, patients with healthy eating habits were shown to have been more likely to achieve therapeutic targets as compared to their counterparts in the unhealthy eating group. Furthermore, the study also found that patients in the healthy eating patterns group are more able to achieve LDL cholesterol targets as compared to those in the unhealthy group, and that this achievement is not influenced by lipid-lowering drugs because there is no difference found in the frequency of drug users between the two groups.
Mackey et al (2018) studied the effects of diet on a much younger cohort – adolescents with type 1 diabetes through a randomized controlled trial. The study examined the intake of macronutrient and fiber in these 257 adolescents (mean age: 12 years old) who had diabetes for at least one year without any severe complications (e.g. retinopathy) and other diagnosed diseases. The randomized controlled trial was conducted by way of asking participants to complete four sessions on behavioral interventions and diabetes education, together with quarterly clinic visits. Dietary intake was documented over two interviews during a two-week period, where parents and their adolescent children were asked to log in a diary separately the completion of diabetes self-care tasks and nutritional intake from the previous day. The study found that for adolescents with a higher percentage of daily energy intake from fats, HbA1c levels were reported to be poorer in contrast with their peers who obtain their daily energy from proteins and carbohydrates.
While these studies suggest properly calibrated diets can greatly impact several indicators that signal improvements in diabetes management, some aspects of these studies may not be directly applicable in this research. For instance, the diets described in studies conducted by Sarmento et al (2018) and Mackey et al (2018) may not be applicable because diet is largely dependent on a patient’s medical history and environment. It is possible, for example, that there are diets that would also yield the same positive health benefits but were not included in the studies mentioned.
Interventions promoting healthy lifestyles have also been found to enable patients to achieve reduced admission rates and reduced consumption of medication because they postpone or decelerate the progression of diabetes over long periods of time.
For example, Botha et al (2018) conducted a study to examine the effectiveness of lifestyle interventions particularly aimed at weight management for type 2 diabetes in a span of three years. The study followed 1,500 patients between 2005 and 2014 who attended sessions that sought to educate patients on lifestyle weight management interventions. The study then correlated the attendance of participants in the sessions with health outcomes such as weight, HbA1c levels, and their use of diabetes medications. The study showed that among this cohort, patients who complete seven to nine sessions (termed “successful completers” by the authors) showed greater weight loss over three years as compared to patients who dropped off earlier. Successful completers were also able to avoid increasing their diabetes medication over three years compared to those who dropped off, and they were also able to experience significant reduction in HbA1c after three years compared to those who did not complete the program.
The evidence from Botha et al (2018)’s study shows that the benefits patients enjoy from lifestyle interventions have the potential to increase patient satisfaction by way of cost savings. However, while the concept may be applicable to this research, the methodology of implementing the lifestyle intervention may not – the authors cited that a constraint they faced was the low participation rate among eligible patients in lifestyle programs that necessitated multiple sessions. According to Botha et al (2018), there were a total of 23,000 patients with type 2 diabetes in Glasgow, United Kingdom between 2005 to 2014 but only 1,500 actually attended these sessions. This research then can incorporate this insight by creating lifestyle programs that can be easily integrated into the lives of patients in order to target more patients.
In addition, lifestyle programs have been seen to positively impact visible symptoms. Evert et al (2019) outline evidence-based guidelines for medical practitioners in implementing nutrition therapy for adults with diabetes.
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This study synthesizes evidence from a wide variety of sources, including collaboration with patient advocates and experts through teleconference calls and email, as well as a systematic review of literature in PubMed published between 2014 to 2018 with an emphasis on randomized controlled trials, systematic reviews, and meta-analyses of various RCTs. The guidelines recommend integrating nutrition education and physical activity in lifestyle programs because evidence suggests these programs help achieve 10% loss of body weight and are “more effective in decreasing diabetes incidence and improving cardiovascular disease risk factors” (Evert et al, 2019). Evert et al (2019) also cite that diabetes self-management education and support programs have been seen to improve the cardiometabolic and microvascular outcomes among patients, especially if such programs shared knowledge, skills, and abilities that help promote self-care among patients with diabetes.
The same is echoed by the clinical practice guidelines published by the Canadian Diabetes Association in 2018. According to the guidelines, studies have shown that nutrition therapy has the potential to improve glycemic control by reducing glycated HbA1c up to 2.0% (Sievenpiper et al, 2018). When nutritional therapy is combined with other diabetes care interventions, this can lead to reduced hospital rates as well. According to the guidelines, nutrition therapy should be tailor-fit to the patient and must integrate self-management education. The guidelines emphasize replacing food with high glycemic index with food that have low glycemic indices as systematic reviews and randomized trials have shown significant improvements in glycemic control over 2-week to 6-month periods when this intervention is implemented. The guidelines also recommend intensive lifestyle interventions that integrate modified diets and intensive physical activity, citing the China Da Qing Diabetes Prevention Study that demonstrated 47% reduction in severe retinopathy in the six years that an intensive lifestyle program is implemented among patients with diabetes (Sievenpiper et al, 2018).
Applying these findings to this research, lifestyle interventions can focus not only on addressing biochemical indicators through food intake, but also on improving overall wellbeing and decreasing risks of co-morbid disease and symptoms by integrating a holistic approach that includes physical activity and supplementary education to promote self-care.
Lastly, healthy lifestyle interventions have been shown to be more effective as first-line treatment options compared to pharmacotherapies because of their ability to bypass the limitations of pharmacotherapies.
In a study by Price et al (2018), Price et al (2018) conducted a systematic review evaluating lifestyle therapies and pharmacotherapies among patients diagnosed with prediabetes. In this systematic review, the study found that several published clinical guidelines and studies point to the effectiveness of lifestyle interventions as first-line options when treating diabetes and preventing the disease from worsening.
For instance, the study cites the Diabetes Prevention Program that compared the weight loss effects and incidence of diabetes among 3,200 patients with prediabetes and how these indicators were affected by three different independent variables: lifestyle modifications, pharmacotherapy in the form of metformin, and placebo. The study found that the incidence of progressing to type 2 diabetes among these patients was significantly reduced by 58% when it is driven by lifestyle interventions, whereas the same indicator is only reduced by 31% among patients treated with metformin. The incidence of worsening diabetes among these patients were also 39% lower in the group that was only treated with lifestyle interventions as opposed to those treated with metformin. In a ten-year follow-up, Price et al (2018) recount that the Diabetes Prevention Program study showed that the group treated with lifestyle modifications delayed the onset of diabetes (and, by extension, admission rate) by four years as compared to the two years provided by the metformin and placebo groups.
Price et al (2018) also conclude from their systematic review of literature that potentially, the Diabetes Prevention Program study showed promise for lifestyle-related interventions as compared to pharmacotherapies because the effects of medication has been limited by “low adherence, modest efficacy, adverse effects, and weight regain after cessation” (Price et al, 2018). The study of Price et al (2018) emphasize a key feature of therapy that tends to be overlooked in literature: the ease and convenience that the therapy espouses to ensure patient adherence and the continuing effectivity of therapy. Taking this into consideration, the research can implement healthy lifestyle interventions by ensuring that these interventions can still yield the same (if not better) benefits as their pharmacotherapy counterparts while minimizing the constraint of adherence and regression after cessation present with medication.
In summary, health lifestyle interventions have demonstrated positive effects on the management of diabetes, and in some studies, have shown so while postponing the need for medication.
References
Botha, S. et al. (2018). Effect of non-surgical weight management on weight and glycaemic control in people with type 2 diabetes: A comparison of interventional and non-interventional outcomes at 3 years. Diabetes, Obesity & Metabolism 20(4), pp. 879-888
Evert, A. et al. (2019). Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 42(5), pp. 731-754
Mackey, E. et al. (2018). Teens with Type 1 Diabetes: How Does Their Nutrition Measure Up? Journal of Diabetes Research 2018. doi.org/10.115/2018/5094569
Price, S. et al. (2018). Lifestyle and Pharmacotherapy for Weight Loss in Preventing or Delaying Diabetes. American Journal of Lifestyle Medicine 12(1), pp. 34-37
Sarmento, R. et al. (2018). Eating Patterns and Health Outcomes in Patients with Type 2 Diabetes. Journal of the Endocrine Society 2(1), pp. 42-52
Sievenpiper, J. et al. (2018). 2018 Clinical Practice Guidelines: Nutrition Therapy. Canadian Journal of Diabetes 42(2018), pp. 64-79
