Advertisement

Efficacy of lifestyle interventions in patients with type 2 diabetes: A systematic review and meta-analysis

Published:December 03, 2015DOI:https://doi.org/10.1016/j.ejim.2015.11.016

      Highlights

      • Diet modification and physical activity are used for the evaluation of type 2 diabetes.
      • DIET intervention shows improvement in HbA1c, blood pressure, and the quality of life.
      • Nutrition had a significant impact on the QOL by reducing cardiovascular risk.

      Abstract

      Background

      The current meta-analysis evaluated the outcomes of various lifestyle interventions, including diet modifications (DIET), physical activity (PA), and patient education (EDU) in reducing the risk of cardiovascular disease in patients with type 2 diabetes.

      Methods

      Randomized clinical trials comparing lifestyle intervention with “usual care” (control) in type 2 diabetes patients were hand-searched from medical databases by two independent reviewers using the terms “diabetes, cardiovascular risk, lifestyle, health education, dietary, exercise/physical activities, and behavior intervention”.

      Results

      Of the 235 studies identified, 17 were chosen for the meta-analysis. The average age of patients ranged from 50–67.3 years. Results reveal no significant difference between the groups, with respect to BMI, while PA and DIET yielded a greater reduction in HbA1c. Significant reduction in both systolic and diastolic pressures in the DIET group, and diastolic pressure in the PA group, was observed. HDL-c in the DIET group was significantly higher than the control group, while no change in LDL-c levels, was seen in all three intervention subtypes. There was no difference between the EDU vs. the control group in terms of HbA1c, blood pressure or HDL-c and LDL-c.

      Conclusion

      DIET intervention showed an improvement in HbA1c, systolic/diastolic blood pressure and HDL-c, with an exception of LDL-c and BMI, suggesting that nutritional intervention had a significant impact on the quality of life by reducing the cardiovascular risk in type 2 diabetes patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mathers C.D.
        • Loncar D.
        Projections of global mortality and burden of disease from 2002 to 2030.
        PLoS Med. 2006; 3e442
        • 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: 1047-1053
        • Puavilai G.
        • Chanprasertyotin S.
        • Sriphrapradaeng A.
        Diagnostic criteria for diabetes mellitus and other categories of glucose intolerance: 1997 criteria by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (ADA), 1998 WHO consultation criteria, and 1985 WHO criteria.
        in: World Health Organization. Diabetes research and clinical practice. 44. 1999: 21-26
        • Hippisley-Cox J.
        • Coupland C.
        Development and validation of risk prediction equations to estimate future risk of heart failure in patients with diabetes: a prospective cohort study.
        BMJ Open. 2015; 5e008503
        • Chen L.
        • Pei J.H.
        • Kuang J.
        • Chen H.M.
        • Chen Z.
        • Li Z.W.
        • et al.
        Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis.
        Metab Clin Exp. 2015; 64: 338-347
        • Rock C.L.
        • Flatt S.W.
        • Pakiz B.
        • Taylor K.S.
        • Leone A.F.
        • Brelje K.
        • et al.
        Weight loss, glycemic control, and cardiovascular disease risk factors in response to differential diet composition in a weight loss program in type 2 diabetes: a randomized controlled trial.
        Diabetes Care. 2014; 37: 1573-1580
        • Florez H.
        • Temprosa M.G.
        • Orchard T.J.
        • Mather K.J.
        • Marcovina S.M.
        • Barrett-Connor E.
        • et al.
        Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.
        Diabetes Obes Metab. 2014; 16: 326-333
        • Yoo S.
        • Chin S.O.
        • Lee S.A.
        • Koh G.
        Factors associated with glycemic variability in patients with type 2 diabetes: focus on oral hypoglycemic agents and cardiovascular risk factors.
        Endocrinol Metab (Seoul, Korea). 2015; 30: 352-360
        • Stranges P.
        • Khanderia U.
        Diabetes and cardiovascular disease: focus on glucagon-like peptide-1 based therapies.
        Ther Adv Drug Saf. 2012; 3: 185-201
        • Mann J.I.
        • De Leeuw I.
        • Hermansen K.
        • Karamanos B.
        • Karlstrom B.
        • Katsilambros N.
        • et al.
        Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus.
        Nutr Metab Cardiovasc Dis. 2004; 14: 373-394
        • Look A.R.G.
        • Pi-Sunyer X.
        • Blackburn G.
        • Brancati F.L.
        • Bray G.A.
        • Bright R.
        • 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: 1374-1383
        • Look A.R.G.
        • Wing R.R.
        Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial.
        Arch Intern Med. 2010; 170: 1566-1575
        • Wisse W.
        • Boer Rookhuizen M.
        • de Kruif M.D.
        • van Rossum J.
        • Jordans I.
        • ten Cate H.
        • et al.
        Prescription of physical activity is not sufficient to change sedentary behavior and improve glycemic control in type 2 diabetes patients.
        Diabetes Res Clin Pract. 2010; 88: e10-e13
        • Krein S.L.
        • Klamerus M.L.
        • Vijan S.
        • Lee J.L.
        • Fitzgerald J.T.
        • Pawlow A.
        • et al.
        Case management for patients with poorly controlled diabetes: a randomized trial.
        Am J Med. 2004; 116: 732-739
        • Dobrosielski D.A.
        • Gibbs B.B.
        • Ouyang P.
        • Bonekamp S.
        • Clark J.M.
        • Wang N.Y.
        • et al.
        Effect of exercise on blood pressure in type 2 diabetes: a randomized controlled trial.
        J Gen Intern Med. 2012; 27: 1453-1459
        • Balducci S.
        • Zanuso S.
        • Nicolucci A.
        • De Feo P.
        • Cavallo S.
        • Cardelli P.
        • et al.
        Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES).
        Arch Intern Med. 2010; 170: 1794-1803
        • Kirk A.
        • Mutrie N.
        • MacIntyre P.
        • Fisher M.
        Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with type 2 diabetes.
        Diabetologia. 2004; 47: 821-832
        • Chan C.W.
        • Siu S.C.
        • Wong C.K.
        • Lee V.W.
        A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes.
        J Cardiovasc Pharmacol Ther. 2012; 17: 57-64
        • Ko G.T.
        • Li J.K.
        • Kan E.C.
        • Lo M.K.
        Effects of a structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese type 2 diabetic patients: a 1-year prospective randomized study.
        Diabet Med. 2004; 21: 1274-1279
        • Crasto W.
        • Jarvis J.
        • Khunti K.
        • Skinner T.C.
        • Gray L.J.
        • Brela J.
        • et al.
        Multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: the Microalbuminuria Education and Medication Optimisation (MEMO) study.
        Diabetes Res Clin Pract. 2011; 93: 328-336
        • Salinero-Fort M.A.
        • Carrillo-de Santa Pau E.
        • Arrieta-Blanco F.J.
        • Abanades-Herranz J.C.
        • Martin-Madrazo C.
        • Rodes-Soldevila B.
        • et al.
        Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus.
        BMC Public Health. 2011; 11: 267
        • Coppell K.J.
        • Kataoka M.
        • Williams S.M.
        • Chisholm A.W.
        • Vorgers S.M.
        • Mann J.I.
        Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment—Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial.
        BMJ. 2010; 341: c3337
        • Mohamed H.
        • Al-Lenjawi B.
        • Amuna P.
        • Zotor F.
        • Elmahdi H.
        Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial.
        Prim Care Diabetes. 2013; 7: 199-206
        • Trento M.
        • Passera P.
        • Bajardi M.
        • Tomalino M.
        • Grassi G.
        • Borgo E.
        • et al.
        Lifestyle intervention by group care prevents deterioration of type II diabetes: a 4-year randomized controlled clinical trial.
        Diabetologia. 2002; 45: 1231-1239
        • Ali M.
        • Schifano F.
        • Robinson P.
        • Phillips G.
        • Doherty L.
        • Melnick P.
        • et al.
        Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study.
        Diabet Med. 2012; 29: e326-e333
        • Sevick M.A.
        • Korytkowski M.
        • Stone R.A.
        • Piraino B.
        • Ren D.
        • Sereika S.
        • et al.
        Biophysiologic outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) trial.
        J Acad Nutr Diet. 2012; 112: 1147-1157
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • Juni P.
        • Moher D.
        • Oxman A.D.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Sutton A.J.
        • Duval S.J.
        • Tweedie R.L.
        • Abrams K.R.
        • Jones D.R.
        Empirical assessment of effect of publication bias on meta-analyses.
        BMJ. 2000; 320: 1574-1577
        • Kadoglou N.P.
        • Iliadis F.
        • Angelopoulou N.
        • Perrea D.
        • Ampatzidis G.
        • Liapis C.D.
        • et al.
        The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus.
        Eur J Cardiovasc Prev Rehabil. 2007; 14: 837-843
        • Uusitupa M.
        • Laitinen J.
        • Siitonen O.
        • Vanninen E.
        • Pyorala K.
        The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes.
        Diabetes Res Clin Pract. 1993; 19: 227-238
        • Norris S.L.
        • Zhang X.
        • Avenell A.
        • Gregg E.
        • Bowman B.
        • Schmid C.H.
        • et al.
        Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: a review.
        Am J Prev Med. 2005; 28: 126-139
        • Koivula R.W.
        • Tornberg A.B.
        • Franks P.W.
        Exercise and diabetes-related cardiovascular disease: systematic review of published evidence from observational studies and clinical trials.
        Curr Diab Rep. 2013; 13: 372-380
        • Schellenberg E.S.
        • Dryden D.M.
        • Vandermeer B.
        • Ha C.
        • Korownyk C.
        Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis.
        Ann Intern Med. 2013; 159: 543-551
        • Angermayr L.
        • Melchart D.
        • Linde K.
        Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus—a systematic review of randomized controlled trials.
        Ann Behav Med. 2010; 40: 49-64
        • Sone H.
        • Tanaka S.
        • Iimuro S.
        • Tanaka S.
        • Oida K.
        • Yamasaki Y.
        • et al.
        Long-term lifestyle intervention lowers the incidence of stroke in Japanese patients with type 2 diabetes: a nationwide multicentre randomised controlled trial (the Japan Diabetes Complications Study).
        Diabetologia. 2010; 53: 419-428
        • Baker M.K.
        • Simpson K.
        • Lloyd B.
        • Bauman A.E.
        • Singh M.A.
        Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials.
        Diabetes Res Clin Pract. 2011; 91: 1-12