Comorbidities and Ethnocultural Factors Limit the Physical Activity of Rural Sri Lankan Patients with Diabetes Mellitus

Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis

Background

The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia.

Methods

Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM.

Results

The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%).

Conclusions

Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.

Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries-A Qualitative Systematic Review with Meta-Synthesis

Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.

Modeling the participation in physical exercises by university academic community in Sri Lanka

Purpose

The World Health Organization issued its global action plan on physical activities 2018–2030, emphasizing the importance of context-specific evidence on the subject. Accordingly, this study aims to provide unique and important policy insights on trends and drivers of participation in physical exercises by academic community in Sri Lankan universities.

Design/methodology/approach

For this purpose, we collected cross-sectional data (n = 456) in 2020 using a survey, and first, estimated a double-hurdle model to uncover covariates influencing likelihood and intensity of physical exercises overall. Second, count-data models are estimated to capture regularity of key exercises.

Findings

The results reveal that about 50% of members do not participate in any general physical exercise. Older members (marginal effect (ME) = 3.764, p < 0.01), non-Buddhists (ME = 54.889, p < 0.01) and alcohol consumers (ME = 32.178, p < 0.05) exhibit a higher intensity of participating in exercises overall. The intensity is lower for rural members (ME = −63.807, p < 0.01) and those with health insurance covers (ME = −31.447, p < 0.05). Individuals diagnosed for chronic illnesses show a higher likelihood of exercising but, their time devotion is limited. The number of children the academic staff members have as parents reduces the likelihood, but for those who choose to exercise have higher time devotion with increased number of children. The covariates play a similar role in determining regularity of key exercises: walking, jogging and exercising on workout machines.

Research limitations/implications

The results imply a need to promote exercising in general and particularly among younger, healthy, insured and female individuals living in rural sector.

Originality/value

The study covers an under-researched professional sub-group in an under-researched developing context, examining both the likelihood and regularity of exercising as both dimensions are equally important for individuals to maintain healthy lives.

Effects of different aerobic exercise training on glycemia in patients with type 2 diabetes: A protocol for systematic review and meta analysis

BACKGROUND

Type 2 diabetes is an emergent worldwide health crisis, and rates are growing globally. Aerobic exercise is an essential measure for patients with diabetes, which has the advantages of flexible time and low cost. Aerobic exercise is a popular method to reduce blood glucose. Due to the lack of randomized trials to compare the effects of various aerobic exercises, it is difficult to judge the relative efficacy. Therefore, we intend to conduct a network meta-analysis to evaluate these aerobic exercises.

METHODS

According to the retrieval strategies, randomized controlled trials on different aerobic exercise training will be obtained from China National Knowledge Infrastructure, WanFang, SinoMed, PubMed, Web of Science, EMBASE, and Cochrane Library, regardless of publication date or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed in Markov Chain Monte Carlo method and carried out with Stata14 and OpenBUGS software. Ultimately, the evidentiary grade for the results will be evaluated.

RESULTS

Eighteen literatures with a total of 1134 patients were included for the meta-analysis. In glycemia assessment, Tennis (standard mean difference = 3.59, credible interval 1.52, 5.65), had significantly better effects than the named control group. Tennis (standard mean difference = 3.50, credible interval 1.05, 5.59), had significantly better effects than the named Taiji group.

CONCLUSION

All together, these results suggest that tennis may be the best way to improve blood glucose in patients with type 2 diabetes. This study may provide an excellent resource for future control glycemia and may also serve as a springboard for creative undertakings as yet unknown.

Correlates of Self-Care Behaviors in Adults With Type 2 Diabetes and Comorbid Heart Failure

PURPOSE

The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF).

METHOD

Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors.

RESULT

Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care.

CONCLUSION

Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.