# Exercise as it relates to Disease/A lifestyle change could prevent type 2 diabetes in high risk individuals!
## What is the background to this research?

Diabetes is a metabolic disease which occurs due to a problem with the way insulin works within an individuals body, and if long-term, can cause issues with the individuals organs. In particular, Diabetes Mellitus or Type 2 Diabetes is usually associated with obesity and results issues with insulin resistance. This type of diabetes usually has an increased risk associated with a lack of physical activity, obesity and also age and is becoming more prevalent due to the increase in sedentary lifestyles people are adapting. Type 2 Diabetes Mellitus is a major issue which is becoming increasingly more, and comes with risks including cardiovascular morbidity.

## Where is the research from?

This study included choosing 522 middle-aged, overweight subjects at random. The mean age of these participants were 55 and their mean BMI was 31, which is classified as obese. Jaakko Tuomilehto, one of the authors of this study, works within the Department for Clinical Neurosciences and Preventive Medicine and has past experience in this field as he has conducted many studies on different topics within diabetes such as the Determinant Factors of Glycemic Control Among type 2 Diabetes Saudi Patients Project, Screening for Type 2 Diabetes, and Guestational Diabetes Mellitus. Exercise is often thought to help with the management of obesity and glycemic control, although a meta-analysis of controlled clinical trials has noted that clinical trials on the effect of exercise on Type 2 diabetes is often using a small sample size and can often give conflicting results.. Although a positive of this study is that it is a randomised control trial, a meta-analysis which is a study of many studies, has proven limitations that may not have been noticed otherwise without comparing.

## What kind of research was this?

This study is a Random Controlled Trial on if Type 2 Diabetes can be prevented for high risk individuals with a lifestyle change intervention. A randomised controlled Trial is gold standard for this type of testing

## What did the research involve?

The participants were put into either an intervention group or a controlled group. The intervention group were given counselling to help in the process of losing weight. They were given a detailed and individualised diet and a goal to lose 5% of their body weight Each year. Each subject in the intervention group had seven sessions with a nutritionist during the first year of the study and one session every three months thereafter. These subjects also received individual guidance on increasing their level of physical activity. These participants undertook an oral glucose-tolerance test and to confirm a diabetes diagnosis, the participants undertook a second test. The mean duration of the participants follow ups was 3.2 years. The control group were given information about diet and exercise at their annual visits but they weren't given an individualised program. They were to complete a food diary at each visit, using a booklet to illustrate the portion sizes of their food.
The method was a good approach although there could have been things done to improve on the method used. Perhaps a personal training or such should have accompanied the intervention group to ensure they were following the directions given, following the exercise and diet plan. Also, allowing the participants from both groups to self report their food diary could cause some bias. Some participants may over or under record their food intake and types of food eaten. There may be limitations in the evidence of this study due to the limited catch ups with the participants, being only annual visits. Again, there also may be limitations in the way each individual self-reported both their physical activity and diet, although regardless of these limitations, the overall result was a decrease of the risk of Type 2 Diabetes in high risk individuals. The study does not specify the types of exercise which should be undertaken to reduce the risk of Type 2 Diabetes Mellitus, rather just states what was done in some training sessions in the study.

## What were the basic results?

The mean amount of weight loss at the end of year 1 was 4.2 +/-5.1kg in the intervention group and 0.8+/- in the control group. The net loss by the end of the second year was 3.5+/-5.5kg in the intervention group and 0.8+/-4.4kg in the control group. The incidence of diabetes after four years was 11% in the intervention group and 23% in the control group. The risk of diabetes overall was reduced by 58% due to the changes in lifestyle The conclusion made by the researchers from these results is that Type 2 Diabetes Mellitus can be prevented by changes in lifestyle in high risk patients, both males and females. The reason for the overall reduction, according to the researchers is due to some participants in the intervention group not following recommendations, and also due to all participants in the control group also receiving general health advice which may have benefited them.

## What conclusions can we take from this research?

An overall conclusion taken from this study is that a full change in lifestyle was needed to reduce the overall risk of Type 2 Diabetes Mellitus in high risk individuals, not just diet or just physical activity. This needs to be considered when putting in place interventions to reduce the risk of Type 2 Diabetes. Many other studies have reiterated the importance of physical activity for people at risk of Type 2 Diabetes. A particular study which looks at the importance of exercise in creating a metabolic response affecting fuel utilisation in the body which is influenced by intensity and duration of the exercise. A study done on women suggested that the main cause for Type 2 Diabetes is excess body fat and therefore the most successful intervention would be weight control. Both diet and exercise could be of the most importance in reducing the risk of getting this metabolic disease.

## Practical advice

Some practical advice which should be taken from this study is that a change in overall lifestyle should be undertaken if wanting to reduce the overall risk of Type 2 Diabetes Mellitus. With a change in lifestyle, comes a change in adiposity and therefore body weight which is a main risk factor for Type 2 diabetes. If at a high risk, the individual should consult with their doctor regarding the types of exercises they can do and possibly a diet as well. Perhaps in studies to come, the researchers could focus more on an exercise or physical activity plan and a diet guide to help the participants to head in the right direction easier. Individuals who are at high risk of Type 2 Diabetes are encouraged to conduct extra research to learn more about their metabolic disease, perhaps starting with Diabetes Australia. There are also support groups available, such as friendlies pharmacies, for individuals wanting to reduce their risks.

## References

* ↑ 1. Diabetes Care, American Diabetes Association: Diagnosis and Classification of Diabetes Mellitus; 2004 (Cited 29 Aug, 2018)]
* ↑ 2. Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D. The New England Journal of Medicine. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes. Jan 30, 2003. (Cited Aug 29, 2018)
* ↑ 3. Normand G, Boule, MA. Elizabeth Haddad, MA. Glen. REVIEW. Effects of Exercise on Glycemic control and Body Mass in Type 2 Diabetes Mellitus. 2007 (Cited 19 Aug, 2018)
* ↑ 4. Sullivan GM. Getting off the “gold standard”: Randomized controlled trials and education research. Journal of graduate medical education. 2011 Sep;3(3):285-9.
* ↑ 5. Ronald J, Sigal. David H, Wasserman. Glen P, Kenny. Carmen Casteneda-Sceppa. Technical Review. Physical Activity/Exercise and Type 2 Diabetes. 2004. 2;10
* ↑ 6. Frank B. Hu, M.D., Joanne E. Manson, M.D., Meir J. Stampfer. The New England Journal of Medicine: Diet, Lifestyle and the risk of Type 2 Diabetes Mellitus in Women. (2001) Vol. 345, No. 11
* ↑ 7. Diabetes Australia.Tilt+Co [internet]
* ↑ 8. HBF Pharmacy Pty Ltd; Friendlies Pharmacy [Internet] (2018)