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
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References
- Projections of global mortality and burden of disease from 2002 to 2030.PLoS Med. 2006; 3e442
- Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.Diabetes Care. 2004; 27: 1047-1053
- 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
- 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
- Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis.Metab Clin Exp. 2015; 64: 338-347
- 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
- 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
- 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
- Diabetes and cardiovascular disease: focus on glucagon-like peptide-1 based therapies.Ther Adv Drug Saf. 2012; 3: 185-201
- Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus.Nutr Metab Cardiovasc Dis. 2004; 14: 373-394
- 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
- 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
- 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
- Case management for patients with poorly controlled diabetes: a randomized trial.Am J Med. 2004; 116: 732-739
- Effect of exercise on blood pressure in type 2 diabetes: a randomized controlled trial.J Gen Intern Med. 2012; 27: 1453-1459
- 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
- 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
- A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes.J Cardiovasc Pharmacol Ther. 2012; 17: 57-64
- 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
- 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
- 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
- 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
- Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial.Prim Care Diabetes. 2013; 7: 199-206
- Lifestyle intervention by group care prevents deterioration of type II diabetes: a 4-year randomized controlled clinical trial.Diabetologia. 2002; 45: 1231-1239
- Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study.Diabet Med. 2012; 29: e326-e333
- Biophysiologic outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) trial.J Acad Nutr Diet. 2012; 112: 1147-1157
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ. 2011; 343: d5928
- Empirical assessment of effect of publication bias on meta-analyses.BMJ. 2000; 320: 1574-1577
- The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus.Eur J Cardiovasc Prev Rehabil. 2007; 14: 837-843
- The maintenance of improved metabolic control after intensified diet therapy in recent type 2 diabetes.Diabetes Res Clin Pract. 1993; 19: 227-238
- Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: a review.Am J Prev Med. 2005; 28: 126-139
- Exercise and diabetes-related cardiovascular disease: systematic review of published evidence from observational studies and clinical trials.Curr Diab Rep. 2013; 13: 372-380
- 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
- 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
- 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
- Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials.Diabetes Res Clin Pract. 2011; 91: 1-12
Article info
Publication history
Published online: December 03, 2015
Accepted:
November 16,
2015
Received in revised form:
November 3,
2015
Received:
June 9,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
