Cardiovascular Effects Of Intensive Lifestyle Intervention For Type 2 Diabetes Management

Research question

According to the Australian Institute of Health and Welfare [AIHW] (2018) long lasting disease condition characterised by persistent symptoms are characterised as chronic diseases. The economic and social complications associated with chronic diseases disrupt the health-related quality of life of the affected individuals. AIHW highlights 8 major health conditions under chronic health diseases and these include asthma, cancer, arthritis, back-pain, chronic obstructive pulmonary disease, cardiovascular disease, diabetes and mental health conditions. The following assignment will highlight extensive literature review over type 2 diabetes management.

According to Chatterjee, Khunti and Davies (2017), diabetes especially T2DM is a global health concern. Numerous compelling evidences highlight that diabetes can be prevented and health related quality of life can be improvement through modifications in lifestyle habits. Lifestyle modifications mainly include physical exercise, diet management and reduction in smoking and drinking. Venditti and Kramer (2012) are of the opinion the effective lifestyle modification help to regulate the calories intake and burning of the extra calories which in turn helps to control the glycemic level of the body. Thus the main research question is: How effective is life style management in reducing and complications associated with type-2 diabetes and thereby promoting subsequent recovery?

According to Gregg et al. (2012), the frequency of remission of T2DM through lifestyle interventions is unclear. Thus, the principal objective of the research is to analyze the long-term intensive weight loss intervention in relation to frequency of remission of T2DM towards normoglycemia and prediabetes. Thus, the research aim of Gregg et al. (2012) was novel as it specifically highlighted the research gap and structured the research question accordingly. They conducted ancillary observational analysis under randomized control trial with 4-year follow-up (April 2001 to April 2004). They randomly selected 4503 US adults with BMI (body mass index) higher than 25 and have T2DM. The authors mainly implemented intensive lifestyle intervention (ILI) with proper diabetes support and education control condition (DSE). They authors randomly assigned one group of participants (n= 2241) to receive ILI and another group of participants (n=2262) to DSE which include education in diet and management of physical activity. Therefore, the main strength of the article is its high sample size. According to Charan and Biswas (2013) high sample size helps to reduce the biased outcome. The analysis of the results highlighted that ILI is associated with greater likelihood of T2DM remission among over-weight adults in comparison to diabetes control and education. The research paradigm selected by the authors is positivism research paradigm. According to Brannen (2017), positivism research paradigm is appropriate for the quantitative research. Gregg et al. (2012) conducted quantitative research as used statistical analysis in order to compare the primary outcome of the study (complete or partial remission of T2DM) with ILI group and DSE group. One of the limitations of the study is, Gregg et al. (2012) used 4-year of follow-up in order to study the primary outcomes and this lead to an overall decrease in the sample size, which might lead to biased outcome.

Research topic

According to the National Strategic Framework for Chronic Condition (2017), the primary focus must be given on disease prevention in order to promote healthier Australia. The health promotion strategies must be designed in such a way that it minimizes the adverse effect associated with the disease outcome along with decrease in the progression of the disease towards severity among the vulnerable population. The research topic highlighted in the paper is mainly focused on how modification of the lifestyle helped in reducing the severity of T2DM in comparison to simple disease education and awareness. The analysis of the results highlighted that the physicians may provide proper disease education and hopeful advice but such education and disease awareness is not suitable for the effective prevention of the disease. Extensive lifestyle interventions like rigorous physical exercise along with regulation of diet plan helps in decreasing the severity of diabetes via decrease the disease status into prediabetic of nondiabetic glycemic level. The research undertaken by Gregg et al. (2012) mainly elucidated that effective lifestyle intervention help in reducing the overall body mass index (BMI) and this in turn helped to reduce the glycemic load of the body along with decrease in the threats of developing cardiovascular complications. The overall effect of the lifestyle interventions as highlighted by Gregg et al. (2012) in their study coincides with National Strategic Framework for Chronic Condition (2017) as it lead to the promotion of health, reduction of the associated health risk and with overall improvement of the critical life stages.

Diabetes is considered as a progressive and incurable condition wherein the most suitable scenario after the disease diagnosis is proper metabolic management and management of the modifiable risk factor in order to reduce the associated complication that might affect the neurovascular or cardiovascular system (Chatterjee, Khunti & Davies, 2017). Gregg et al. (2012) conducted a quantitative observational randomized control trail and their projected primary outcome was complete or partial remission of T2DM under the definition of transition from meeting the criteria of diabetes to nondiabetic or prediabetic blood glucose level. The results highlighted that group of participants who were assigned under the extensive lifestyle interventions lost more body weight in comparison to the individuals who only received disease education and awareness. The significant difference was 7.9% in 4-year duration. The results also highlighted that ILI group has is 11.5% more likely to experience partial or complete remission of diabetes during the first year. Thus overall statistical analysis and the comparison of the data highlighted that ILI is associated with increased likelihood or of partial remission of T2DM in comparison to the diabetes support or education. However, Gregg et al. (2012) are of the opinion that absolute remission rate were more modest in comparison to the partial remission rate. 

Literature Review

Rejeski et al. (2012) are of the opinion that adults with T2DM have mobility restrictions this increases with age. An intensive lifestyle intervention that helps to reduce weight, promotes physical fitness and slows down the degenerative process of mobility restriction among the T2DM individuals. They conducted randomized control with 5145 over-weight or obese individual between the age group of 45 to 75-year who are suffering from T2DM. They randomly assigned one group to lifestyle intervention and another group to diabetes support and education program. Thus, the approach of the study was identical with the observational randomized control trial conducted by Gregg et al. (2012). The results highlighted that participants who were assigned under the lifestyle intervention showed reduction in the mobility loss by 48% in comparison to the group who are assigned to diabetes education and support. Rejeski et al. (2012) are of the opinion that physical exercise as promoted by the lifestyle intervention helped to promote weight, which in turn increased the physical fitness and thereby reducing mobility restriction. Reduction in the restriction in mobility helped to improve the health-related quality of life of the individuals. However, lifestyle interventions are associated with adverse events and this includes increase frequency of musculoskeletal. Thus, it can be said that ILI is not comprehensive in improving overall health-related quality of life of the individuals.

In relation to the effect of lifestyle modification and T2DM control the Look AHEAD Research Group of Alpert Medical School of Brown University and Miriam Hospital conducted a study in US. The aim of their study is to analyze whether an ILI used for effective weight loss management is effective in decreasing the cardiovascular morbidity and mortality among the individuals with T2DM. They randomly assigned 5145 obese and over-weight individuals with T2DM under ILI. ILI promoted reduction in BMI along through decrease intake of calories along with increase rate of physical activity. Another group received diabetes support and education. The primary outcome measured in the study is reduction in fatal outcomes among T2DM people arising from cardiovascular complications like myocardial infarction. The results of the trial of 9.6 years of follow-up highlighted that weight loss is greater in the intervention group (ILI) in comparison to the control group (received only disease education and support). The results also highlighted that ILI is effective in reducing glycemic index of the body however, failed to reduce the cardiovascular completion. The authors are of the opinion that ILI has no significant effect on the blood cholesterol and thus failed to cast significant impact of cardiovascular complications of diabetes.  

Thus the research findings highlighted that ILI in comparison to disease education and social support is effective in reducing weight and thus decreasing the severity of T2DM via reducing the glycemic index. However, ILI has significant effect on cardiovascular complication and rigorous physical exercise might promote musculoskeletal complications. Thus implications to change in the nursing practice will mainly focus on implementation of lifestyle modifications program other than solely relying on the disease education and social support

According to Chawla, Chawla and Jaggi (2016), one of the adverse outcome of the T2DM is development of marcovascular and microvascular complication. These are mainly cardiac complications caused by high level of blood cholesterol and thereby leading to the development of atherosclerosis. So recommendation for effective diabetes management must be designed in such that way that it provides a comprehensive coverage to the macrovascular and microvascular complications of diabetes. The study conducted by Sjöström et al. (2014) highlighted effective amalgamation of invasive (bariatric surgery) and non-invasive technique is effective in reducing the severity of T2DM via reducing the vulnerability of developing macro and microvascular complications. Further research and comparative analysis through observational randomized control trials are required to be undertaken in this domain to provide a detailed overview.

References

Australian Health Ministers’ Advisory Council (2017).National Strategic Framework for Chronic Conditions. Access date: 4^th October 2018. Retrieved from: https://www.health.gov.au/internet/main/publishing.nsf/content/A0F1B6D61796CF3DCA257E4D001AD4C4/$File/National%20Strategic%20Framework%20for%20Chronic%20Conditions.pdf

Australian Institute of Health and Welfare.(2018). Chronic Disease Overview. Access date: 4^th October 2018. Retrieved from: https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/chronic-disease/overview

Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.

Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research?. Indian journal of psychological medicine, 35(2), 121.

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.

Chawla, A., Chawla, R., & Jaggi, S. (2016). Microvasular and macrovascular complications in diabetes mellitus: distinct or continuum?. Indian journal of endocrinology and metabolism, 20(4), 546.

Gregg, E. W., Chen, H., Wagenknecht, L. E., Clark, J. M., Delahanty, L. M., Bantle, J., … & Pi-Sunyer, F. X. (2012). Association of an intensive lifestyle intervention with remission of type 2 diabetes. Jama, 308(23), 2489-2496.

Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England journal of medicine, 369(2), 145-154.

Rejeski, W. J., Ip, E. H., Bertoni, A. G., Bray, G. A., Evans, G., Gregg, E. W., & Zhang, Q. (2012). Lifestyle change and mobility in obese adults with type 2 diabetes. New England Journal of Medicine, 366(13), 1209-1217.

Sjöström, L., Peltonen, M., Jacobson, P., Ahlin, S., Andersson-Assarsson, J., Anveden, Å., … & Näslund, I. (2014). Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. Jama, 311(22), 2297-2304.

Venditti, E. M., & Kramer, M. K. (2012). Necessary components for lifestyle modification interventions to reduce diabetes risk. Current diabetes reports, 12(2), 138-146.

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