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ABSTRACTBackground: Lifestyle modification is associated with glycemic control. It is often a less concentrated area in practice due to various reasons. This study was done to assess the outcome of Lifestyle Interventions in the management of diabetes.Design: Observational study in an outpatient set-up in a Mission Hospital, KeralaStudy population: Type II diabetic patients enrolled in the weekly Diabetic clinic during a time-frame of 2 months.Materials and methods: Of all the enrolled patients, Thirty-five of them showed willingness and compliance to Lifestyle Interventions and were followed up over 3 months. Data analyzed using Chi-square test, Paired test, Percentages and WHO-5 well-being index. Diabetes Educator and the Family Physician were involved in patient interaction and continuous follow-up.Variables: Body weight (BMI), Blood pressure, HbA1c, lipid profile, fasting blood sugar, postprandial blood sugar and subjective level of well-being were assessed before and after the study.Results: Majority of the individuals were in age group of 51-60 years (40%). 74.3% were non-smokers. 82.9% were non-alcoholics. There was statistically significant difference in Body weight (p 0.00), BMI (p 0.00), fasting and postprandial sugars (p 0.00), HBA1C (p=0.00), lipid profile (p = 0.00), subjective level of well-being between initial and final visit. There was statistically significant difference in systolic blood pressure but not in Diastolic blood pressure.Conclusion: Prompt and timely lifestyle interventions have an indispensable role in improving the glycemic status and quality of life of an individual. Patient education and continuous motivation from the health-care provider has huge impact on the final outcome of diabetes.Keywords: Lifestyle modifications, Diabetes management, Well-being.

INTRODUCTIONDiabetes is a global health burden affecting around 415 million people which is expected to reach 642 million by 2040 (IDF). South Indian cities show higher prevalence and Kochi has a prevalence as high as 19.5% (ADEPS).1

Patient education, counselling, and rapport building are gifted tools to enable better treatment outcomes. Studies that reported a positive effect on patient outcomes often included patient education.2

The World Health Day theme for 2016 was ‘’Beat Dia-betes’’ reminding us about its exponential progression. This study was done to assess the outcome of Lifestyle Interventions in the management of patients with T2DM

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Lifestyle Interventions to Improve Diabetes Management1Waseem Ahmed N, 2Manjunath S, 3Shobha P1Consultant Physician, 2Associate Professor, 3Specialist1Department of Family Medicine, Wellness and Diabetes, CRAFT Hospital and Research Centre, Kodungallur, Kerala, India2Department of Community Medicine, KIMS, Hubli, Karnataka, India3Department of Family Medicine, VPS Lakeshore Hospital, Kerala, India

Original Article

To cite: Ahmed WN,Nekar MS, Shobha P. Lifestyle Interventions to Improve Diabetes Management. Int J Diab 2019;3-6

Received on: 06/09/2019

Accepted on: 13/09/2019

Address for CorrespondenceWaseem Ahmed NConsultant Physician Department of Family Medicine Wellness and Diabetes, CRAFT Hospital and Research Centre Kodungallur, Kerala, Indiadrwaseemahmedn@gmail.com

which would pave the way for further detailed studies in Kerala.

MATERIALS AND METHODSThis observational study was carried out at Assumption Hospital (Mission Hospital), Kerala on thirty five Type II diabetic patients in the age group of 30 to

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Waseem Ahmed N et al.

70 years enrolled in the weekly Diabetic clinic during November to December 2016 and they were followed up over 3 months. They were advised lifestyle modifications in the form of medical nutrition therapy, exercise, smoking/alcohol restriction. Their pharmacological treatment was unchanged from a month before initiation of the study until its completion. Body weight (BMI), Blood pressure, HbA1c, lipid profile, fasting blood sugar, postprandial blood sugar and subjective level of well-being were assessed before and after the study. Data collected was entered in a predesigned proforma and analyzed using Chi-square test, Paired test, Percentages and WHO-5 well-being index.

RESULTSIn the study subjects, majority of them were in age group of 51-60 years (40%). Majority (74.3%) of them were non smokers. Of the 9 smokers, 3 stopped smoking (Figs 1 and 2). Majority (82.9%)of them were non alcoholics. Of the 6 alcohol consumers, 2 stopped drinking. There was statistically significant difference in Body weight (p 0.00), BMI (p 0.00), fasting and postprandial sugars (p 0.00), HBA1C (p = 0.00), lipid profile (p = 0.00) between initial and final visit. There was statistically significant difference in systolic blood pressure (p 0.003) but not in Diastolic blood pressure (p 0.483) (Table 1).

Fig. 1: Frequency of study subjects according to age Fig. 2: Comparison of parameters—Initial and final visit

In 34.28% of the study subject there was a significant improvement(10% score increase) in the level of well being assessed using WHO-5 Well Being Index.

Lifestyle Interventions to Improve Diabetes Management

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Table 1Significance of lifestyle interventions on various parameters

Variables CI lower limit CI upper limit P value

BMI 1.551 2.449 <0.001

FBS 15.926 21.560 <0.001

PPBS 21.829 33.314 <0.001

HbA1C 0.350 0.735 <0.001

S. Cholesterol 6.091 14.081 <0.001

LDL 3.886 9.999 <0.001

TGL 8.661 25.396 <0.001

HDL –1.784 –0.502 0.001

Systolic BP 1.090 4.967 0.003

Diastolic BP –1.246 2.580 0.483

Fig. 3: “Decrease in HbA1C

DISCUSSIONLifestyle changes, diet and physical activity produced weight loss of 5-7%.3

In LOOK AHEAD study, when patients with lifestyle intervention were followed up in 4 years, they found that SBP decreased by 5.33 mm Hg, DBP by 2.92 mm Hg which was significant. The results of this study (HbA1c, SBP, HDL, TGL, LDL) was in agreement with the LOOK AHEAD Trial4 (Fig. 3).

Sanz et al in a study showed that LSM decreased blood glucose by mean HbA1c of 0.6% which was in agreement with our study.5

Diabetes Prevention Program (DPP) study found that lifestyle interventions and physical activity of 150 min/week improved cardio vascular risk factors, dyslipidemia, hypertension and inflammatory markers.6

FBS, PPBS, BMI reduction also correlated with the study conducted by Kim et al.7

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Various studies like Diabetes Prevention Programme Outcome Study (DPPOS), Diabetes Prevention Program (DPP), Indian Diabetes Prevention Program (IDPP-1), Finnish Diabetes Prevention Study [DPS], Da QING IGT and Diabetes Study have demonstrated reduction in incidence of diabetes through lifestyle modifications (LSM).

CONCLUSIONThus from this study it can be concluded that prompt and timely lifestyle interventions have an indispensable role in the management of Diabetes. Significant reduction in BMI, HbA1C, sugars, lipids, systolic pressures and the level of well-being can be achieved with proper lifestyle adjustments. The results of this study demonstrate that if LSM is introduced in day to day practice it will have a huge impact on the society. Patient education and continuous motivation/follow up by the health care provider improves the glycemic status and quality of life in diabetics. Diet, Exercise and education form the three corner stones in DM management. ‘’In Kerala where coconut oil, tapioca and rice-based foods form the bulk of regular diet, replacing it with alternative less glycemic diets has shown to be beneficial.’’

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