The Effect of a Comprehensive Lifestyle Modification Program on Glycemic Control and Body Composition in Patients with Type 2 Diabetes

The Prevalence of Sleep Disorders in People with Type 2 Diabetes and Obesity in Saudi Arabia: A Cross-Sectional Study

Purpose

Difficulty falling or staying asleep are considered sleep disorders, and these are common among people with type 2 diabetes mellitus (T2DM) and obesity. The presence of sleep disorders may cause poor glycemic control among this population. We therefore designed this study to assess sleep disorders among patients with T2DM and obesity.

Patients and Methods

This cross-sectional study examined the prevalence of sleep disorders in 148 patients with T2DM and obesity at a hospital in Taif, Saudi Arabia using a validated questionnaire.

Results

Among those patients who have been involved in this study, we found a moderate level of sleep disorders and disturbances. The average sleep disorder assessment score for the patients with T2DM and obesity was 2.8 ± 1.4. Additionally, the average score for the sleep pattern assessment was 2.7 ± 1.3 and 2.9 ± 1.5 for symptoms of lack of sleep. Our study also revealed that those patients also had suboptimal weight and glycemic control.

Conclusion

These findings demonstrate that patients with T2DM and obesity are at a higher risk of developing sleep disorders. Therefore, these patients need to be screened for sleep disorders to avoid further diabetes-related complications and to have an early lifestyle intervention.

Selenium supplementation effect on glycemic control: A GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials

Results from different studies on the effects of selenium supplementation on glycemic control are still debated. To fill this knowledge gap, we investigated the overall effects of selenium supplementation on some glycemic parameters such as fasting blood sugar (FBS), hemoglobinA1c (HbA1c), fasting insulin, quantitative insulin sensitivity check index (QUICKI), and homeostatic model assessment of insulin resistance (HOMA-IR). A comprehensive literature search was conducted from inception to April 2023 on Scopus, Web of Science, PubMed, Google Scholar, and Cochrane databases. All randomized controlled trials (RCTs) which reported an effect of selenium supplementation on glycemic parameters were included. A random-effects model was used to estimate the weighted mean difference (WMD) and 95% CI for each outcome. Between-studies heterogeneity was assessed by the I2 and Cochran's Q test. 20 trials were included in the meta-analysis. Pooled analysis showed that selenium intake significantly reduced fasting insulin (WMD: -3.02 µIu/mL, 95% CI; -5.13, -0.90, P = 0.005) and increased QUICKI levels (WMD: 0.01, 95% CI: 0.01, 0.02, P = 0.005). However, selenium supplementation did not change FBS (WMD: -1.32 mg/dL, 95% CI; -4.02, 1.37, P = 0.332), HbA1c (WMD = 0.05%, 95% CI: -0.19, 0.28, p = 0.701), and HOMA-IR (WMD: -0.82, 95% CI; -2.14, 0.50, P = 0.223). Moreover, we found that there is a non-linear association between selenium supplementation dosage and FBS (P-nonlinearity = 0.008). In conclusion, our study findings indicate some benefits of selenium on fasting insulin, and QUICKI compared with placebo, but elicits no effect on HbA1c, HOMA-IR, and FBS. Further well-designed RCTs with larger samples are necessary to ascertain the effects of selenium supplementation on glycemic control.

A randomized trial of comparing video telecare education vs. in-person education on dietary regimen compliance in patients with type 2 diabetes mellitus: a support for clinical telehealth Providers

BACKGROUND

Compliance to dietary recommendations by patients is the most difficult part of diabetes management. The nature of any educational method is to increase patients' awareness. But the question is, what is the effect of each method and for this purpose a comparative method should be considered. Therefore, this study was conducted to compare the effects of in-person education versus video tele-education on dietary regimen compliance in patients with T2DM.

METHODS

In this trial, 378 patients with type 2 diabetes mellitus (T2DM) were random allocated into video tele-education, in-person education and control groups. The patients' weight and biochemical parameters were measured before educational programs and three-month later.

RESULTS

The mean changes of patients' weight, glycemic parameters, and Lipid profiles decreased more in the two educational groups than the control group in a three-month period. There were no significant differences in the all study variables between the in-person and video education groups in post interventions except Total Cholesterol (TC). The pre- and post-intervention changes in the weight, TC, hemoglobin A1c, Triglyceride, and Very Low-density Lipoprotein Cholesterol were significant in both in-person group and video group. None of the educational programs had a significant impact on the Fasting blood sugar, Low-Density Lipoprotein Cholesterol, and High-Density Lipoprotein Cholesterol.

DISCUSSION

Video tele-education was just as effective as in-person educational method on dietary regimen compliance among patients with T2DM in a three-month period. Therefore, it is recommended to use video tele-education in combination with or as an alternative to the in-person education method. This study provides support for diabetes educator.

TRIAL REGISTRATION

This investigation was registered in the Iranian Registry of Clinical Trials Center ( IRCT20150302021307N4 ).

Replicating group-based education interventions for the management of type 2 diabetes: a review of intervention reporting

AIMS

To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes.

METHODS

A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors.

RESULTS

Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any individual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%).

CONCLUSIONS

Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.

Reported Benefits of Insulin Therapy for Better Glycemic Control in Type 2 Diabetic Patients-Is This Applicable in Saudi Patients?

AIM

To compare the effect of different treatment regimens (oral hypoglycemic agents [OHGs], insulin therapy, and combination of both) on glycemic control and other cardiometabolic risk factors in type 2 diabetes mellitus (T2DM) patients in Saudi.

SUBJECTS AND METHODS

Patients with T2DM, but no serious diabetic complications, were randomly recruited from the diabetes clinics at two large hospitals in Jeddah, Saudi Arabia, during June 2013 to July 2014. Only those without change in treatment modality for the last 18 months were included. Blood pressure and anthropometric measurements were measured. Treatment plan was recorded from the patients’ files. Fasting blood sample was obtained to measure glucose, HbA1c, and lipid profile.

RESULTS

A total of 197 patients were recruited; 41.1% were men and 58.9% were women. The mean (±SD) age was 58.5 ± 10.5 years. Most patients (60.7%) were on OHGs, 11.5% on insulin therapy, and 27.7% were using a combination of insulin and OHGs. The mean HbA1c was lower in patients using OHGs only, compared with means in those using insulin, or combined therapy in patients with disease duration of ≤10 years (P = 0.001) and also in those with a longer duration of the disease (P < 0.001). A lower mean diastolic and systolic blood pressure was found among patients on insulin alone (P < 0.01). No significant differences were found in lipid profiles among the groups.

CONCLUSION

Insulin therapy, without adequate diabetes education, fails to control hyperglycemia adequately in Saudi T2DM patients. There is a challenge to find out reasons for poor control and the ways as to how to improve glycemic control in T2DM.

Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran

OBJECTIVE

To identify barriers to recommended dietary adherence in patients with type 2 diabetes.

DESIGN

Observational cross-sectional study.

SAMPLE

One hundred-forty six overweight/obese volunteers with type 2 diabetes, who had previously received dietary advice for at least one year, were recruited from two diabetes clinics in Tabriz, north-west of Iran.

MEASUREMENTS

A 24-item questionnaire was designed to assess dietary barriers. The validity and reliability of the questionnaire were assessed by Content Validity Index, Content Validity Ratio and Cronbach's alpha, respectively. An exploratory factor analysis with principal component analysis extraction and varimax rotation was utilized in order to extract the underlying factors of dietary nonadherence.

RESULTS

Factor analysis yielded seven barrier factors including: situational barriers/difficulty resisting temptation [percent variance=11.64%], stress-related eating disorder/cost [percent variance=9.11%], difficulty with meal and snack plans [percent variance=8.76%], confusion [percent variance=8.45%], work-related issues [percent variance=7.72%], small portion size [percent variance=6.87%] and lack of palatability/family support [percent variance=6.78%]. These factors explained about 59.4% of the total variance.

CONCLUSIONS

Overall, patients with type 2 diabetes perceived some barriers to recommended dietary adherence. In dietary counseling, considering and addressing these barriers will likely be effective in increasing the dietary adherence for patients with type 2 diabetes in Iran.

Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis

BACKGROUND

Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs.

PURPOSE

To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes.

DATA SOURCES

6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists.

STUDY SELECTION

Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs.

DATA EXTRACTION

One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias.

DATA SYNTHESIS

Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants).

LIMITATIONS

All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions.

CONCLUSION

Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).

[Effects of a coaching program on comprehensive lifestyle modification for women with gestational diabetes mellitus]

PURPOSE

The purpose of this study was to investigate the effects of using a Coaching Program on Comprehensive Lifestyle Modification with pregnant women who have gestational diabetes.

METHODS

The research design for this study was a non-equivalent control group quasi-experimental study. Pregnant women with gestational diabetes were recruited from D women's hospital located in Gyeonggi Province from April to October, 2013. Participants in this study were 34 for the control group and 34 for the experimental group. The experimental group participated in the Coaching Program on Comprehensive Lifestyle Modification. The program consisted of education, small group coaching and telephone coaching over 4weeks. Statistical analysis was performed using the SPSS 21.0 program.

RESULTS

There were significant improvements in self-care behavior, and decreases in depression, fasting blood sugar and HbA1C in the experimental group compared to the control group. However, no significant differences were found between the two groups for knowledge of gestational diabetes mellitus.

CONCLUSION

The Coaching Program on Comprehensive Lifestyle Modification used in this study was found to be effective in improving self-care behavior and reducing depression, fasting blood sugar and HbA1C, and is recommended for use in clinical practice as an effective nursing intervention for pregnant women with gestational diabetes.

Effect of a continuous diabetes lifestyle intervention program on male workers in Korea

AIMS

This study was conducted to compare the effects of two years of lifestyle intervention to no intervention or one year of intervention on diabetes risk factors in male workers with impaired fasting glucose (IFG) or diabetes.

METHODS

We conducted a randomized lifestyle intervention trial designed to alter personal lifestyles among 123 industrial male workers (CG; control group, n=75; OIG; one-year intervention group, n=23; TIG; two-year intervention group, n=25). The intervention consisted of two parts, the main program (face-to-face counseling five times/12 weeks) and a follow-up program (e-mail counseling ten times/30 weeks). Assessments included biochemical characteristics, anthropometry and nutrient intake at baseline and after two years.

RESULTS

After two years, systolic blood pressure, HOMA-IR, HDL cholesterol and total energy intake (p<0.05) were reduced in the OIG group, while weight, body mass index, waist circumference, blood pressure, fasting plasma glucose (FPG), HbA1c and nutrient intake (total energy, carbohydrate, protein and sodium) were significantly decreased (p<0.05, respectively) in the TIG group. When compared to the CG, subjects in OIG and TIG showed significant improvements in the level of FPG and HbA1c (p<0.05).

CONCLUSIONS

Continuous lifestyle intervention for two years is more effective at improving diabetes risk factors than OIG.