Non-Pharmacological Interventions for Diabetes

Consuelo Patterson

Choe, H. J., Rhee, E. J., Won, J. C., Park, K. S., Lee, W. Y., & Cho, Y. M. (2022). Effects of patient-driven lifestyle modification using intermittently scanned continuous glucose monitoring in patients with type 2 diabetes: results from the randomized open-label PDF study. Diabetes Care, 45(10), 2224-2230. https://doi.org/10.2337/dc22-0764

This study investigated the impact of patient-driven lifestyle modification using intermittently scanned continuous glucose monitoring (isCGM) in patients with type 2 diabetes (T2D). This study was a randomized controlled trial comparing the impact of education to support patient behavior modification and self-management using CGM (intervention) and conventional diabetes management (control). The study took place in the endocrinology department of the three university hospitals in Seoul, Korea. Participants were patients diagnosed with type 2 diabetes mellitus, who are between the ages of 19 and 80 years.

The primary outcome was a change in HbA1c levels in 12 weeks. Secondary outcomes include fasting glucose, waist circumference, and body weight. Others include changes in systolic blood pressure, total cholesterol, diastolic blood pressure, and others. All analyses were conducted using IBM SPSS Statistics and R. The study results of the study showed that 126 participants were selected for the study, 63 in the intervention group and the control group. The results showed that the implementation of the SEOUL algorithm with isCGM resulted in significant improvement in HbA1c compared to standard care. Additionally, the intervention group experienced a significant reduction in fasting blood glucose and body weight.

The authors concluded that patient-driven lifestyle modification using isCGM is effective in improving HbA1c levels in patients with T2D. This was a randomized controlled trial (RCT), which is high-level evidence. The methodology and results were comprehensively presented. One limitation of the study is that it did not present the information on socioeconomic status or the education level of the participants and that could affect the efficacy of the current intervention. However, this study is useful because it informs the effectiveness of patient-driven lifestyle modification in the management of type 2 diabetes mellitus.

Newman, P. M., Franke, M. F., Arrieta, J., Carrasco, H., Elliott, P., Flores, H., & Palazuelos, D. (2018). Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ global health, 3(1), e000566. http://dx.doi.org/10.1136/bmjgh-2017-000566

This study aimed to evaluate the effect of a community health worker (CHW) led intervention on disease management and adherence in patients with diabetes and hypertension. The researchers conducted a prospective observational study on adult patients. Outcomes included self-reported adherence to medication, hemoglobin A1c, and blood pressure. These outcomes were measured after three months between 2014 and 2016. The CHW-led intervention involved basic disease education, psychosocial support, and promotion of active care retention. The care staff visited patients at home and gathered necessary data in all communities involved.

The study results showed that 108 patients were analyzed in this study. The intervention led to a two-fold increase in the odds of disease control. However, there were fluctuations in the rates over time. Regarding adherence outcomes, the intervention was associated with an 86% increase in the odds of optimal adherence measured by a 30-day recall. It led to more than a twofold increase in the odds of positive adherence behavior. This study was a quasi-experimental study, which is high-level evidence. Valid and reliable methods of statistical analysis were used. A limitation is that it used a small sample that might affect generalizability. However, the findings of this study can help inform stakeholders of the importance of CHWs and the effectiveness of the intervention in diabetes management.

Liss, D. T., Finch, E. A., Cooper, A., Sheth, A., Tejuosho, A. D., Lancki, N., & Ackermann, R. T. (2018). One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial. Diabetes research and clinical practice, 140, 36-44. https://doi.org/10.1016/j.diabres.2018.03.030

The purpose of this study was to investigate the real-world effect of a group-based lifestyle intervention (GLI) in adults with diabetes. This was a randomized encouragement trial, involving comparing standard care alone and standard care plus being provided with free-access to group-based lifestyle intervention. Participants in both groups received dietary and lifestyle information at baseline and follow-up visits at 6 months and 12 months. The study included adult patients, diagnosed with type 2 diabetes and a BMI of greater than or equal to 24kg/m2, in primary care in metropolitan Chicago. A total of 331 participants (167 in the control group and 164 in the intervention group) were selected for the study.

The study results showed that the effects of the intervention at 6 months was 0.95% (95% Cl, 0.13- 1.77%; P=0.02) weight loss and 1.20% weight loss at 12 months (95% CI, 0.05-2.36%; P=0.04). There was also a reduction of hemoglobin A1 at 12 months; however, it was not statistically significant. The authors concluded that group-based lifestyle intervention is effective in weight loss at 6 and 12 months among patients with diabetes. This study has a high external validity; the study cohort reflects the diversity of type 2 diabetes prevalence across the United States. This study is high-level evidence because it is RCT. However, the study did not present the cost of the intervention; future research should assess that. This study can be used in a clinical setting to improve weight loss in patients with diabetes.

Rahul, A., Chintha, S., Anish, T. S., Prajitha, K. C., & Indu, P. S. (2021). Effectiveness of a Non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial. Frontiers in public health, 9, 747065. https://doi.org/10.3389/fpubh.2021.747065

The purpose of this study was to find evidence of standardized non-pharmacological interventions to achieve and maintain glycemic control in patients diagnosed with diabetes. This was a cluster randomized controlled trial carried out among adult patients diagnosed with diabetes mellitus in a primary care setting in South Kerala in India. The researchers recruited 72 participants for the intervention group while the control group had 60 participants at the end of the study. The intervention group received extra training while the control group continued to receive standard management. A module was designed to train junior public health nurses (JPHNs), which focused on improving the individuals’ knowledge, skills, and attitude in diabetes management. The training covered areas such as adequate exercise, a healthy diet, cessation of smoking, compliance, and others.

Six-hour training was conducted for the JPHNs in the intervention group, which included role-play, discussions, and hands-on sessions. The researchers conducted a pre-and-post-intervention evaluation of JPHNs using a structured questionnaire to assess knowledge and a checklist to assess skills and practice. For six months, there was monthly monitoring of post-prandial blood sugar (PPBS), fasting blood sugar (FBS), and health-related behaviors. The study result indicated that the intervention resulted in a significant reduction in FBS and PPBS. There was a better trend with glycemic control. In addition, this RCT produced a high level of evidence. The study topic, methodology, and results align, indicating valid study methodologies. However, it was a single-setting study although it consisted of patients from across the State. This study is important because the interventions can be applied in a clinical setting to improve the attitude and skills of caregivers which are essential in managing diabetes.

Zhou, R., Cui, Y., Zhang, Y., De, J., An, X., Duan, Y., … & Lian, F. (2022). The Long-Term Effects of Non-Pharmacological Interventions on Diabetes and Chronic Complication Outcomes in Patients With Hyperglycemia: A Systematic Review and Meta-Analysis. Frontiers in endocrinology, 13. https://doi.org/10.3389/fendo.2022.838224

The primary objective of the study was to examine whether non-pharmacological interventions can reduce diabetes incidence in patients experiencing pre-diabetes interventions, as well as chronic complications in patients with hyperglycemia. This study was a systematic review and meta-analysis of randomized controlled trials (RCTs). Databases utilized include MEDLINE, EMBASE, PubMed, the Cochrane Library, and the Web of Science Core Collection. A total of 20 articles were identified for the study. Two independent investigators retrieved relevant data and quality assessment. The third investigator addressed disagreements.

Some studies indicated that non-pharmacological interventions can significantly reduce diabetes incidence more than the comparator groups. In addition, patients with hyperglycemia showed a reduction in microvascular incidence associated with the use of non-pharmacological interventions. Furthermore, some studies showed that non-pharmacological interventions led to an overall reduction in diabetes incidences. The strengths of the study include it includes RCTs and extended follow-up studies. A limitation is a high heterogeneity among the studies. The findings of this study can be used to improve diabetes care.

Sarker, Anupam, Rina Das, Saraban Ether, Md Shariful Islam, and K. M. Saif-Ur-Rahman. “Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomized controlled trials.” BMJ open 12, no. 6 (2022): e062671. http://dx.doi.org/10.1136/ bmjopen-2022-062671

This study evaluates the effectiveness of non-pharmacologic programs to prevent type 2 diabetes mellitus (T2DM) in patients who are prediabetes and those who do not have diabetes in low-income and middle-income countries (LMICs). This was a systematic review carried out using databases such as MEDLINE through PubMed, Embase, the Cochrane Library, and others. Two independent reviewers careened the articles and a third reviewer addressed any disagreement. The risk ratio was the primary outcome while secondary outcomes include body mass index (BMI), weight, and fasting blood glucose levels.

Five studies were selected for review that had about 1734 participants from three counties. Three of the five studies showed a significant reduction in type 2 diabetes mellitus incidence after an intervention that involved physical training and dietary changes. Four of the studies also showed a significant improvement in some of the secondary outcomes such as BMI, weight, fasting and 2-hour plasma glucose, and HbA1c. All five studies showed a low risk of bias. The authors concluded that utilizing non-pharmacological interventions for T2DM prevention can improve health outcomes and lessen economic burdens, which will be of paramount importance in LMICs. The main strength of the study was the inclusion of randomized controlled trials only. The weakness is that a small number of articles were reviewed. The findings can educate care providers about the effectiveness of non-pharmacological interventions in preventing diabetes in at-risk patients.

Taylor, J., Stubbs, B., Hewitt, C., Ajjan, R. A., Alderson, S. L., Gilbody, S., & Siddiqi, N. (2017). The effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in adults with severe mental illness: a systematic review and meta-analysis. PloS one, 12(1), e0168549. https://doi.org/10.1371/journal. pone.0168549

This study was a meta-analysis aimed to assess the clinical effectiveness of non-pharmacological and pharmacological interventions in improving glycaemic control in patients diagnosed with severe mental illnesses. The researchers conducted a systematic literature search that included randomized controlled trials in adults with or without diabetes. These RCTs assessed fasting blood glucose or glycated hemoglobin (HbA1c). Independent investigators carried out data extraction. Databases used include

Cochrane Collaboration’s tool was used to assess the risk of bias. The searchers selected 54 randomized controlled trials that were eligible for the study. Out of the 54 articles, 40 assessed pharmacological interventions, 13 assessed behavioral interventions, and one was a mixed intervention study. Databases used include CINAHL (EBSCO), PsycINFO (Ovid), Embase Classic+Embase, Ovid Medline, PubMed, Cochrane Database of Systematic Reviews (Wiley), and Central Register of Controlled Trials among others. The non-pharmacological interventions include lifestyle interventions, physical exercise programs, dietary recommendations, and others. The non-pharmacologic interventions showed improved fasting glucose. Based on the results, non-pharmacologic intervention can lead to clinically important improvement in glycaemic measurement in the study group. Most of the studies reviewed were RCTs, which are high-level evidence. A large sample of research studies (54 articles) was used. Limitations include the researchers did not explore differential effects between non-diabetes and diabetes patients. The findings of this study can be used to improve diabetes management.

Hassan, F., & Hatah, E. (2022). A Thematic Analysis of Non-Pharmacological Intervention Strategies in the Management of Diabetic Patients in Malaysia. Archives of Pharmacy Practice Volume, 13(3), 63. https://doi.org/10.51847/KkiibdIIok

The purpose of this study was to analyze the themes for all non-pharmacological intervention strategies that are applied in the management of diabetic patients in Malaysia. The articles were searched in four online databases such as PubMed, SCOPUS, Web of Science, and OVID. The inclusion criteria included articles reporting on non-pharmacological interventions in managing diabetes. Only the articles written in English were included. The thematic analysis using qualitative data analysis software to code the relevant information before the creation of the themes. After a thorough analysis, 22 articles met the inclusion criteria. The majority of the studies measured other outcomes such as blood pressure, lipids profile, body weight, and others.

These studies were different based on intervention strategies, time, and providers based on the results. Most of the interventions focused on improving the knowledge and self-efficacy of patients. The identified intervention strategies include diabetes education, patient empowerment, adherence support, lifestyle adjustment, psychosocial intervention, and shared decision-making. Most of the articles used a combination of these strategies in their study. These themes showed that non-pharmacological interventions are effective in addressing diabetes. For example, diabetes education covered areas such as healthy diet, medication adherence, and exercise. Due to the effectiveness of the intervention, the authors concluded that it is vital to design and implement a single education program through the collaboration of multi-disciplinary professionals to ensure the program’s success. The strengths of this study include the use of credible databases, and a large number of articles. However, the author states that it was difficult finding more relevant studies. This study gives a better understanding of how healthcare providers use various interventions to manage diabetes.

Tuudah, E., Foye, U., Donetto, S., & Simpson, A. (2022). Non-Pharmacological Integrated Interventions for Adults Targeting Type 2 Diabetes and Mental Health Comorbidity: A Mixed-Method Systematic Review. International Journal of Integrated Care, 22(2). https://doi.org/10.5334/ijic.5960

This research study aimed to assess the effectiveness of integrated non-pharmacological interventions for adults on diabetes-related symptoms, general health, psychological outcomes, feasibility, and acceptability of the interventions, among other influencing factors. Non-pharmacological integrated care entails multiple approaches to improve outcomes and quality of life. These approaches include motivational interviewing, psychoeducation, nutritional support, physical activity support, or talking therapies. The study protocol was registered on the international perspective register of systematic reviews. The inclusion criteria for full-text articles and those translated into English, among other measures. Outcome measures include diabetes knowledge, glycaemic control, quality of life, general health, and others.

The findings showed that integrated non-pharmacologic interventions indicated a limited effect on diabetes control. The results showed further that only collaborative care model intervention led to improvement in diabetes management. Studies focusing on lifestyle interventions and collaborative care models led to a reduction in BMI. The systematic review has indicated that there is mixed evidence regarding the effectiveness of self-management and lifestyle intervention to improve the health status of patients diagnosed with type 2 diabetes mellitus and severe mental illnesses. However, there is moderate evidence to support the effectiveness, feasibility, and acceptability of integrated non-pharmacological interventions.

Yamamoto, J. M., Kellett, J. E., Balsells, M., García-Patterson, A., Hadar, E., Solà, I., & Corcoy, R. (2018). Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care, 41(7), 1346-1361. https://doi.org/10.2337/dc18-0102

The purpose of this study was to investigate the effect of modified dietary interventions in improving glycemia and birthweight outcomes in women diagnosed with gestational diabetes mellitus. The researchers performed a systematic review and meta-analysis based on a published protocol (PROSPERO CRD42016042391). The reporting was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various databases were used to extract important information. These databases include PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts, ProQuest, Web of Science Core Collection were all utilized.

The study titles and abstracts were assessed independently to identify some of the articles that require full-text review. Inclusion criteria included randomized controlled trials, evaluation of modified dietary interventions, glucose intolerance or hyperglycemia during pregnancy, and others. The primary outcomes of the study included maternal glycemic outcomes and neonatal birth weight outcomes. The researchers pooled data into relative risks or mean differences with 95% Cl for dichotomous outcomes and continuous outcomes, respectively. The random effects models were used to perform the meta-analysis study. A prespecified analysis consisting of the type of diet and quality assessment was carried out to find out a possible reason for understudy variation.

The study result showed that 18 randomized controlled trials were used. A pooled analysis indicated that modified dietary interventions were significantly associated with a decrease in fasting and postprandial glucose, as well as a lower need for medication treatment. In addition, the results showed that modified dietary was related to lower infant birth weight and less macrosomia. The authors concluded that modified dietary interventions have a positive impact on outcomes related to maternal glycemia and birth weight. Credible databases were used in this study. High-quality articles were also reviewed. A limitation is that some studies had fewer than 50 participants which can affect the primary outcomes. This study is important because it informs about the effectiveness of dietary interventions to manage diabetes.

Houghton, D., Hardy, T., Stewart, C., Errington, L., Day, C. P., Trenell, M. I., & Avery, L. (2018). Systematic review assessing the effectiveness of dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia, 61(8), 1700-1711. 1 https://doi.org/10.1007/s00125-018-4632-0

This systematic review aimed to assess the effectiveness of physical activity/exercise and dietary interventions in modulating the gut microbiota and glucose levels in patient adults diagnosed with type 2 diabetes mellitus. This systematic review was conducted according to PRISMA guidelines. Included articles were randomized controlled trials or specific arms of non-RCTs that focused on dietary interventions and physical activity interventions to manage blood sugar levels. The gut biota was analyzed from the stool samples. The eligible lifestyle interventions include physical activity, diet, and use of probiotics, or a combination of these interventions. To find credible sources of evidence, databases used include y MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Library.

Two independent reviewers had the responsibility of screening titles and abstracts of all the generated studies. The full-text articles were reviewed by the same two independent authors and reassessed by the third author. Data extraction was done from all the included articles and by two independent members of the review team. Eight studies met the inclusion criteria for review. The study results indicated that supplementation with probiotics and the Ma-Pi diet provided changes in the gut microbiota; however, the difference was not significant compared to dietary interventions in the control group. Supplemented participants with probiotics reported significant changes in bacterial composition. Study strength included the transferability of the results to clinical practice. This article is important to clinical practice because it informs the impact of dietary interventions on gut microbiota and glucose levels in diabetes patients.

Kim, J., & Hur, M. H. (2021). The Effects of Dietary Education Interventions on Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 18(16), 8439. https://doi.org/10.3390/ ijerph18168439

The purpose of this study was to assess the effectiveness of dietary education interventions in diabetes management. The researchers carried out a systematic view of randomized controlled trials that provided both qualitative and quantitative data to determine the effectiveness of dietary education intervention in patients suffering from type 2 diabetes mellitus. Literature searches were performed using credible databases such as EMBASE, CINAHL, PubMed, and Cochrane Central. Other databases include DBpia, Korean Studies Information Service System, Research Information Service System, NDSL, and Korea Med. Grey literature such as news, theses, and presentations was used in the study. Two independent investigators evaluated the articles for eligibility. The inclusion criteria included studies that had RCT designs, described type 2 diabetes, and assessed a dietary education intervention.

Data synthesis and analysis included the use of Cochrane Review Manager (RevMan, London, UK) software 5.3 to analyze the selected studies. A total of 33 articles were analyzed to determine the effectiveness of the intervention. The study result showed that dietary education for three months was effective in controlling HbA1c levels. Furthermore, the individual education method turned out more effective. In addition, a combination of diet, exercise, and psychosocial interventions was more effective than diet education alone. A large number of articles were reviewed. Also, credible databases were used to produce quality articles. A limitation is that studies included in this meta-analysis have included complex dietary education interventions, so there may be high heterogeneity. There is a need to interpret the research results. Using the findings of this study, care providers can implement dietary education interventions in patients diagnosed with type 2 diabetes mellitus to improve blood sugar levels.

References

Hassan, F., & Hatah, E. (2022). A Thematic Analysis of Non-Pharmacological Intervention Strategies in the Management of Diabetic Patients in Malaysia. Archives of Pharmacy Practice Volume, 13(3), 63. https://doi.org/10.51847/KkiibdIIok

Houghton, D., Hardy, T., Stewart, C., Errington, L., Day, C. P., Trenell, M. I., & Avery, L. (2018). Systematic review assessing the effectiveness of dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia, 61(8), 1700-1711. 1 https://doi.org/10.1007/s00125-018-4632-0

Kim, J., & Hur, M. H. (2021). The Effects of Dietary Education Interventions on Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 18(16), 8439. https://doi.org/10.3390/ ijerph18168439

Liss, D. T., Finch, E. A., Cooper, A., Sheth, A., Tejuosho, A. D., Lancki, N., & Ackermann, R. T. (2018). One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial. Diabetes research and clinical practice, 140, 36-44. https://doi.org/10.1016/j.diabres.2018.03.030

Newman, P. M., Franke, M. F., Arrieta, J., Carrasco, H., Elliott, P., Flores, H., & Palazuelos, D. (2018). Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ global health, 3(1), e000566. http://dx.doi.org/10.1136/bmjgh-2017-000566

Rahul, A., Chintha, S., Anish, T. S., Prajitha, K. C., & Indu, P. S. (2021). Effectiveness of a Non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial. Frontiers in public health, 9, 747065. https://doi.org/10.3389/fpubh.2021.747065

Sarker, A., Das, R., Ether, S., Islam, M. S., & Saif-Ur-Rahman, K. M. (2022). Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ open, 12(6), e062671. http://dx.doi.org/10.1136/ bmjopen-2022-062671

Taylor, J., Stubbs, B., Hewitt, C., Ajjan, R. A., Alderson, S. L., Gilbody, S., & Siddiqi, N. (2017). The effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in adults with severe mental illness: a systematic review and meta-analysis. PloS one, 12(1), e0168549. https://doi.org/10.1371/journal. pone.0168549

Tuudah, E., Foye, U., Donetto, S., & Simpson, A. (2022). Non-Pharmacological Integrated Interventions for Adults Targeting Type 2 Diabetes and Mental Health Comorbidity: A Mixed-Method Systematic Review. International Journal of Integrated Care, 22(2). https://doi.org/10.5334/ijic.5960

Yamamoto, J. M., Kellett, J. E., Balsells, M., García-Patterson, A., Hadar, E., Solà, I., & Corcoy, R. (2018). Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care, 41(7), 1346-1361. https://doi.org/10.2337/dc18-0102

Zhou, R., Cui, Y., Zhang, Y., De, J., An, X., Duan, Y., & Lian, F. (2022). The Long-Term Effects of Non-Pharmacological Interventions on Diabetes and Chronic Complication Outcomes in Patients With Hyperglycemia: A Systematic Review and Meta-Analysis. Frontiers in endocrinology, 13. https://doi.org/10.3389/fendo.2022.838224

Non-Pharmacological Interventions for Diabetes

Consuelo Patterson

Choe, H. J., Rhee, E. J., Won, J. C., Park, K. S., Lee, W. Y., & Cho, Y. M. (2022). Effects of patient-driven lifestyle modification using intermittently scanned continuous glucose monitoring in patients with type 2 diabetes: Results from the randomized open-label PDF study. Diabetes Care, 45(10), 2224-2230. https://doi.org/10.2337/dc22-0764

Hassan, F., & Hatah, E. (2022). A thematic analysis of non-pharmacological intervention strategies in the management of diabetic patients in Malaysia. Archives of Pharmacy Practice Volume, 13(3), 63. https://doi.org/10.51847/KkiibdIIok

Houghton, D., Hardy, T., Stewart, C., Errington, L., Day, C. P., Trenell, M. I., & Avery, L. (2018). Systematic review assessing the effectiveness of dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia, 61(8), 1700-1711. 1 https://doi.org/10.1007/s00125-018-4632-0

Kim, J., & Hur, M. H. (2021). The effects of dietary education interventions on individuals with type 2 diabetes: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(16), 8439. https://doi.org/10.3390/ ijerph18168439

Liss, D. T., Finch, E. A., Cooper, A., Sheth, A., Tejuosho, A. D., Lancki, N., & Ackermann, R. T. (2018). One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial. Diabetes Research and Clinical Practice, 140, 36-44. https://doi.org/10.1016/j.diabres.2018.03.030

Newman, P. M., Franke, M. F., Arrieta, J., Carrasco, H., Elliott, P., Flores, H., & Palazuelos, D. (2018). Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: An observational stepped-wedge study. BMJ Global Health, 3(1), e000566. http://dx.doi.org/10.1136/bmjgh-2017-000566

Rahul, A., Chintha, S., Anish, T. S., Prajitha, K. C., & Indu, P. S. (2021). Effectiveness of a non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial. Frontiers in Public Health, 9, 747065. https://doi.org/10.3389/fpubh.2021.747065

Sarker, Anupam, Rina Das, Saraban Ether, Md Shariful Islam, and K. M. Saif-Ur-Rahman. (2022). Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: A systematic review of randomized controlled trials. British Medical Journal Open 12(6). http://dx.doi.org/10.1136/ bmjopen-2022-062671

Taylor, J., Stubbs, B., Hewitt, C., Ajjan, R. A., Alderson, S. L., Gilbody, S., & Siddiqi, N. (2017). The effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in adults with severe mental illness: A systematic review and meta-analysis. PloS One, 12(1), e0168549. https://doi.org/10.1371/journal. pone.0168549

Tuudah, E., Foye, U., Donetto, S., & Simpson, A. (2022). Non-pharmacological integrated interventions for adults targeting type 2 diabetes and mental health comorbidity: A mixed-method systematic review. International Journal of Integrated Care, 22(2). https://doi.org/10.5334/ijic.5960

Yamamoto, J. M., Kellett, J. E., Balsells, M., García-Patterson, A., Hadar, E., Solà, I., & Corcoy, R. (2018). Gestational diabetes mellitus and diet: A systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care, 41(7), 1346-1361. https://doi.org/10.2337/dc18-0102

The study result showed that 18 randomized controlled trials were used. A pooled analysis indicated that modified dietary interventions were significantly associated with a decrease in fasting and postprandial glucose, as well as a lower need for medication treatment. In addition, the results showed that modified dietary was related to lower infant birth weight and less macrosomia. The authors concluded that modified dietary interventions have a positive impact on outcomes related to maternal glycemia and birth weight. Credible databases were used in this study. High-quality articles were also reviewed. A limitation is that some studies had fewer than 50 participants, which can affect the primary outcomes. This study is important because it informs about the effectiveness of dietary interventions to manage diabetes.

Zhou, R., Cui, Y., Zhang, Y., De, J., An, X., Duan, Y., & Lian, F. (2022). The long term effects of non-pharmacological interventions on diabetes and chronic complication outcomes in patients with hyperglycemia: A systematic review and meta-analysis. Frontiers in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.838224

Some studies indicated that non-pharmacological interventions significantly reduced diabetes incidence more than the comparator groups. In addition, patients with hyperglycemia showed a reduction in microvascular incidence associated with the use of non-pharmacological interventions. Furthermore, some studies showed that non-pharmacological interventions led to an overall reduction in diabetes incidences. The strengths of the study include it includes RCTs and extended follow-up studies. A limitation is a high heterogeneity among the studies. The findings of this study can be used to improve diabetes care.

References

Choe, H. J., Rhee, E. J., Won, J. C., Park, K. S., Lee, W. Y., & Cho, Y. M. (2022). Effects of patient-driven lifestyle modification using intermittently scanned continuous glucose monitoring in patients with type 2 diabetes: Results from the randomized open-label PDF study. Diabetes Care, 45(10), 2224-2230. https://doi.org/10.2337/dc22-0764

Houghton, D., Hardy, T., Stewart, C., Errington, L., Day, C. P., Trenell, M. I., & Avery, L. (2018). Systematic review assessing the effectiveness of dietary intervention on gut microbiota in adults with type 2 diabetes. Diabetologia, 61(8), 1700-1711. 1 https://doi.org/10.1007/s00125-018-4632-0

Liss, D. T., Finch, E. A., Cooper, A., Sheth, A., Tejuosho, A. D., Lancki, N., & Ackermann, R. T. (2018). One-year effects of a group-based lifestyle intervention in adults with type 2 diabetes: A randomized encouragement trial. Diabetes Research and Clinical Practice, 140, 36-44. https://doi.org/10.1016/j.diabres.2018.03.030

Newman, P. M., Franke, M. F., Arrieta, J., Carrasco, H., Elliott, P., Flores, H., & Palazuelos, D. (2018). Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: An observational stepped-wedge study. BMJ Global Health, 3(1), e000566. http://dx.doi.org/10.1136/bmjgh-2017-000566

Rahul, A., Chintha, S., Anish, T. S., Prajitha, K. C., & Indu, P. S. (2021). Effectiveness of a non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A cluster-randomized controlled trial. Frontiers in Public Health, 9, 747065. https://doi.org/10.3389/fpubh.2021.747065

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Consuelo Patterson

Consuelo Patterson

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