Diabetes mellitus is said to be one of the most medical conditions in many places around the world, affecting around 347 million adults in the year 2013 alone (Pal et al., 2013, p.2). Out of this number, as much as 90 percent of them have type 2 diabetes, which is a complex medical condition, as it can lead to heart attacks and heart strokes (Pal et al., 2013, p.2). In the year 2010 however, almost half of those who were diagnosed with diabetes mellitus are within the 20-60 age group that has a 2-to-4-fold increased risk of having cardiovascular disease (Paulweber et al., 2010, p.S4). With this, medical scientists produced evidence-based interventions for the prevention of type 2 diabetes mellitus, such as Naik et al. (2015), who insisted the effect of lifestyle intervention in preventing its occurrence. This paper is focused on the evidence-based intervention that Naik et al. (2015) developed for the treatment of diabetes in adults, specifically those who are from 20 years old and above.
Evidence-Based Intervention by Naik et al. (2015)
Overview
In the research article, Naik et al. (2015) identified diabetes mellitus as “one of the most costly and burdensome of chronic diseases” (p.1). It is a global epidemic that is expected to rise from 387 million in 2015 to about 592 million by 2035, not to mention a number of 175 million cases that are undiagnosed (Naik et al., 2015, p.1). It is a complex medical condition, as it increases the risk of developing cardiovascular disease, and may even lead to death. Above all, most of those undiagnosed or newly diagnosed with diabetes mellitus already has micro vascular disease, usually about 4-7 years before a clinical diagnosis of the said disease (Naik et al., 2015, p.1). For this, most of those diagnosed with diabetes have considerable financial and economic burden, both in the developing and developed countries. In fact, the overall treatment costs may reach to as much as $85,500 only for clinical diagnosis alone, which have led to further research on possible intervention tools that can be used for the prevention of type 2 diabetes mellitus (p.1).
Method
In this evidence-based research, Naik et al. (2015) used source articles identified in the PubMed Central, EMBASE, and Cochrane Central Register of Controlled Trials up to the month of May 2015. The research focused on large-scale outcome trials, which Naik et al. (2015) says are actually “the best to guide evidence-based decisions” (p.2). They also used research studies that had a follow-up time period of at least 2 years, which increases the durability of the treatment effect (p.2). Meanwhile, Naik et al. (2015) used two major approaches in the development of a prevention plan: first is a lifestyle intervention; and second is a pharmacological intervention (p.2). For lifestyle interventions, the target was on weight loss more than 5 percent that reduces the intake of fat to less than 30 percent of total energy intake, and reduces saturated fats to less than 10 percent of total energy intake. They also focused on studies with findings that increased the level of physical activity to about 150 minutes per week. As for the pharmacological intervention, they used therapies that were known to have been effective in the prevention or delay of type 2 diabetes mellitus. This is seen in the risk reduction of disease most evident with rosiglitazone, metformin, insulin glargine, acarbose, valsartan, and Nateglinide (p.3). They also used studies that were proven to reduce the possibility for cardiovascular disease, as shown in the Study to Prevent NIDDM study, as well as the Triglitazone in Prevention of Diabetes (TRIPOD) study.
Findings
The research study compares the prevention of type 2 diabetes mellitus using either lifestyle prevention or the use of medication. The findings show that both interventions reflect a short-term risk reduction in the incidence of the said disease. Also, none of the pharmacological interventions demonstrated continued reduction in diabetes risk after taking the drug medication. What was more successful was the use of lifestyle interventions in reducing the incidence of diabetes mellitus, even after a number of years without active intervention. Lifestyle interventions were also proven to have greatly reduced mortality related to cardiovascular disease, which were not seen in the use of pharmacological agents. With all these, it clearly shows that the lifestyle interventions produce much greater benefits, as compared to pharmacological interventions (Naik et al., 2015, p.5). Also, lifestyle interventions were known to be cost saving than that of using pharmacological agents, with “no untoward effects” (p.5) on the side of the patient. It also reduces the risk for cardiovascular disease, which proves how lifestyle interventions prove to be more effective in treating diabetes, especially for older adults and those who are known to be less overweight.
Conclusion
Pal et al. (2013) reiterated the words of Corbin & Strauss (1988) that there are three elements useful in coping with diabetes: (1) medical and behavioral management; (2) role management; and (3) emotional management (p.4). In these three elements, it is evident how they play a role in lifestyle intervention, in which the focus is on the patient’s behavior, emotion, and their role and relationship with others. In using lifestyle intervention, much has to do with the patient’s decision making and their ability to solve problems and use resources for action planning and behavior change. All of these require skills and knowledge, for they should know how to tailor their lifestyle according to the needs that they have concerning their health. Self-management is therefore, the key for a successful lifestyle intervention.
References:
Corbin, J.M., & Strauss, A. (1988). Unending work and care: managing chronic illness at home. San Francisco, CA: Jossey-Bass.
Naik, V., Dave, R., Stephens, J.W., & Davies, J.S. (2015). Evidence-based prevention of type 2 diabetes: Role of lifestyle intervention as compared to pharmacological agents. International Journal of Diabetes and Clinical Research, 2(5), 1-7. Retrieved August 17, 2016 from http://clinmedjournals.org/articles/ijdcr/international-journal-of-diabetes-and-clinical-research-ijdcr-2-049.pdf.
Pal, K., Eastwood, S.V., Michie, S., Farmer, A.J., Barnard, M.L., Peacock, R., Wood, B., Murray, E. (2013). Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, Issue 3, 1-48. Doi: 10.1002/14651858.CD008776.pub2
Paulweber, B., Valensi, P., Lindstrom, J., Lalic, N.M., Greaves, C.J., McKee, M., Kissimova-Skarbek, K.,, & Roden, M. (2010). A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res, 42(1), S3-S36.
