Adherence to lifestyle interventions and its effect on metabolic and behavioral outcomes in type 2 diabetes mellitus cases

Authors

  • M. Khalid-Al-Azam Department of Biomedical Engineering and Public Health, World University of Bangladesh, Dhaka, Bangladesh
  • Swapan Kumar Sarkar Department of Biomedical Engineering and Public Health, World University of Bangladesh, Dhaka, Bangladesh
  • S. M. Mahmudul Hasan Department of Biomedical Engineering and Public Health, World University of Bangladesh, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20250904

Keywords:

Adherence, Body mass index, Fasting blood glucose, HbA1c reduction, Lifestyle intervention, Type 2 diabetes mellitus

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major global health concern, often exacerbated by sedentary lifestyles and poor dietary habits. Lifestyle interventions, including dietary modifications, physical activity, and behavioral changes, are essential for managing T2DM. However, adherence to these interventions is a significant challenge.

Methods: This cross-sectional observational study was conducted over six months, from July to December 2023, in Rajapur Upazila of Jhalokathi district and Bhandaria Upazila of Pirojpur district under the guidance of the Department of Biomedical Engineering and Public Health, World University of Bangladesh. This study evaluated the effectiveness of a structured non-pharmacological lifestyle intervention on metabolic parameters in individuals with T2DM. The primary outcomes measured were HbA1c, fasting blood glucose, and body mass index (BMI).

Results: Of 150 patients, 124 (82.67%) were uncontrolled (FBS>6.4), and 26 (17.33%) were controlled (FBS <6.4). Most patients (77.33%) had a BMI of 20-29, with a mean BMI of 22.46±3.39 (p<0.001). Hypertension was present in 39 (26%) patients. In group A1 (<50 years, non-pharmacological intervention), post-intervention results showed FBS 6.32±0.72 mmol/l (p<0.001), HbA1c 6.72±0.41% (p<0.001). In group A2 (>50 years, combined intervention), FBS decreased to 6.47±1.00 mmol/l (p<0.001) and HbA1c to 6.86±0.56% (p=0.004).

Conclusions: Non-pharmacological interventions focusing on lifestyle changes can result in meaningful improvements in metabolic control for individuals with T2DM. Enhancing adherence remains a key challenge for maximizing long-term benefits.

Metrics

Metrics Loading ...

References

Lerman I. Adherence to treatment: the key for avoiding long-term complications of diabetes. Archives of medical research. 2005;36(3):300-6. DOI: https://doi.org/10.1016/j.arcmed.2004.12.001

Stenstrom G, Gottsäter A, Bakhtadze E, Berger B, Sundkvist G. Latent autoimmune diabetes in adults: definition, prevalence, β-cell function, and treatment. Diabetes. 2005;54(suppl_2):S68-72. DOI: https://doi.org/10.2337/diabetes.54.suppl_2.S68

Diabetes Prevention Program Outcomes Study Research Group; prepared on behalf of the DPPOS Research Group, Orchard TJ, Temprosa M, Barrett‐Connor E, Fowler SE, Goldberg RB, et al. Long‐term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study. Diabet Medi. 2013;30(1):46-55. DOI: https://doi.org/10.1111/j.1464-5491.2012.03750.x

Trikkalinou A, Papazafiropoulou AK, Melidonis A. Type-2 diabetes and quality of life. World J Diabet. 2017;8(4):120-9. DOI: https://doi.org/10.4239/wjd.v8.i4.120

World Health Organization. Global report on diabetes. Geneva: WHO; 2016. Available at: https://iris.who.int/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=8EDCB5690D2ABF80CBD833A6925F66AC?sequence=1. Accessed 01 December 2024.

Rahul A, Chintha S, Anish TS, Prajitha KC, Indu PS. Effectiveness of a non-pharmacological intervention to control diabetes mellitus in a primary care setting in Kerala: A cluster-randomized controlled trial. Front Publ Heal. 2021;9:747065. DOI: https://doi.org/10.3389/fpubh.2021.747065

Koenigsberg MR, Bartlett D, Cramer JS. Facilitating treatment adherence with lifestyle changes in diabetes. Ame Fam Phys. 2004;69(2):309-16.

Garcia-Molina L, Lewis-Mikhael AM, Riquelme-Gallego B, Cano-Ibanez N, Oliveras-Lopez MJ, Bueno-Cavanillas A. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Europ J Nutrit. 2020;59(4):1313-28. DOI: https://doi.org/10.1007/s00394-019-02147-6

Mendez FJ, Belendez M. Effects of a behavioral intervention on treatment adherence and stress management in adolescents with IDDM. Diabetes Care. 1997;20(9):1370-5. DOI: https://doi.org/10.2337/diacare.20.9.1370

Karki A, Vandelanotte C, Khalesi S, Dahal P, Rawal LB. The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis. Plos one. 2023;18(10):e0293028. DOI: https://doi.org/10.1371/journal.pone.0293028

Ziegler AG, Rewers M, Simell O, Simell T, Lempainen J, Steck A, et al. Seroconversion to multiple islet autoantibodies and risk of progression to diabetes in children. Jama-J Am Med Assoc. 2013;309:2473-9. DOI: https://doi.org/10.1001/jama.2013.6285

West DS, Coulon SM, Monroe CM, Wilson DK. Evidence-based lifestyle interventions for obesity and Type 2 diabetes: The Look AHEAD intensive lifestyle intervention as exemplar. Am Psychol. 2016;71(7):614. DOI: https://doi.org/10.1037/a0040394

Grave RD, Calugi S, Centis E, Marzocchi R, Ghoch ME, Marchesini G. Lifestyle modification in the management of the metabolic syndrome: achievements and challenges. Diabetes, metabolic syndrome and obesity: targets and therapy. 2010:373-85. DOI: https://doi.org/10.2147/DMSO.S13860

Knip M, Korhonen S, Kulmala P, Veijola R, Reunanen A, Raitakari OT, et al. Prediction of type 1 diabetes in the general population. Diabetes Care. 2010;33(6):1206-12. DOI: https://doi.org/10.2337/dc09-1040

Fappa E, Yannakoulia M, Pitsavos C, Skoumas I, Valourdou S, Stefanadis C. Lifestyle intervention in the management of metabolic syndrome: could we improve adherence issues?. Nutrit. 2008;24(3):286-91. DOI: https://doi.org/10.1016/j.nut.2007.11.008

Gregg EW, Chen H, Wagenknecht LE, Clark JM, Delahanty LM, Bantle J, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. Jama. 2012;308(23):2489-96. DOI: https://doi.org/10.1001/jama.2012.67929

Chen L, Pei JH, Kuang J, Chen HM, Chen Z, Li ZW, et al. Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metabolism. 2015;64(2):338-47. DOI: https://doi.org/10.1016/j.metabol.2014.10.018

Seib C, Parkinson J, McDonald N, Fujihira H, Zietek S, Anderson D. Lifestyle interventions for improving health and health behaviours in women with type 2 diabetes: A systematic review of the literature 2011-2017. Maturitas. 2018;111:1-4. DOI: https://doi.org/10.1016/j.maturitas.2018.02.008

Sayon-Orea C, Razquin C, Bullo M, Corella D, Fito M, Romaguera D, et al. Effect of a nutritional and behavioral intervention on energy-reduced Mediterranean diet adherence among patients with metabolic syndrome: interim analysis of the PREDIMED-Plus randomized clinical trial. Jama. 2019;322(15):1486-99. DOI: https://doi.org/10.1001/jama.2019.14630

Magkos F, Yannakoulia M, Chan JL, Mantzoros CS. Management of the metabolic syndrome and type 2 diabetes through lifestyle modification. Annual Revi Nutrit. 2009;29(1):223-56. DOI: https://doi.org/10.1146/annurev-nutr-080508-141200

Dunkley AJ, Bodicoat DH, Greaves CJ, Russell C, Yates T, Davies MJ, et al. Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabet Care. 2014;37(4):922-33. DOI: https://doi.org/10.2337/dc13-2195

Waugh N, Scotland G, McNamee P, Gillett M, Brennan A, Goyder E, et al. Screening for type 2 diabetes: literature review and economic modelling. Heal Technol Assessment-Southampt. 2007;11(17). DOI: https://doi.org/10.3310/hta11170

Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Int Medi. 2015;163(11):848-60. DOI: https://doi.org/10.7326/M15-1400

Kim SH, Lee SJ, Kang ES, Kang S, Hur KY, Lee HJ, et al. Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus. Metabol. 2006;55(8):1053-9. DOI: https://doi.org/10.1016/j.metabol.2006.03.017

Balducci S, D’Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, et al. Effect of a behavioral intervention strategy on sustained change in physical activity and sedentary behavior in patients with type 2 diabetes: the IDES_2 randomized clinical trial. Jama. 2019;321(9):880-90. DOI: https://doi.org/10.1001/jama.2019.0922

Nerat T, Locatelli I, Kos M. Type 2 diabetes: cost-effectiveness of medication adherence and lifestyle interventions. Patient preference and adherence. 2016:2039-49. DOI: https://doi.org/10.2147/PPA.S114602

Vermeire EI, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane database of systematic reviews. 2005;(2). DOI: https://doi.org/10.1002/14651858.CD003638.pub2

Downloads

Published

2025-03-28

How to Cite

Khalid-Al-Azam, M., Sarkar, S. K., & Hasan, S. M. M. (2025). Adherence to lifestyle interventions and its effect on metabolic and behavioral outcomes in type 2 diabetes mellitus cases. International Journal Of Community Medicine And Public Health, 12(4), 1611–1616. https://doi.org/10.18203/2394-6040.ijcmph20250904

Issue

Section

Original Research Articles