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Research Article
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Role of Physical Activity and Nutrition in Controlling Type 2 Diabetes Mellitus-2007
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Mohsen Seyyednozadi,
Mohammad Taghi Shakeri,
Reza Rajabian
and
Ali Vafaee
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ABSTRACT
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This interventional study was designed to evaluate the
role of recommended physical activity and diet in control of type 2 diabetes
in order to choose an appropriate strategy for controlling diabetes according
to condition of our community. This study carried out in a time-period
between 2006-2007 and study`s community of this research was Persian Diabetes
Clinic and Khorasan Diabetes Research Center: Mashhad, Khorasan Razavi.
In this community based interventional study diabetic patients (type 2)
with informed consent allocated randomized in one of the following groups,
recommended physical activity, recommended both physical activity and
diet, control group and laboratory test included: FBS, 2hpp, HbA1c and
urinalysis before intervention and 2 months after intervention. Results
were compared in four groups. Data were collected by a designed questionnaire
and analyzed by SPSS 11.5 software. Comparison of 4 groups showed recommended
physical activity has significant effect in decreasing FBS, 2hpp and HbA1c
(p<0.030) Whereas the recommended diet led to merely significant decreasing
in FBS (p = 0.032). Diabetic patients who were recommended for both physical
activity and diet have improved variables but they are not significant
although they have decreased the weight and drug (p<0.024). It is considerable
that in controlling group variables a significant increase in the drug
usage is recommended (p = 0.001). The result of the study show that simple
and practical appropriate diet and physical activity is effective in control
of diabetes. We suggest further consideration regarding this subject.
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INTRODUCTION
Whereas common infectious and parasitic diseases such as malaria and
the HIV/AIDS pandemic remain major unresolved health problems in many
developing countries, emerging non-communicable diseases relating to diet
and lifestyle have been increasing over the last two decades that in this
way diabetes mellitus is one of them (Amuna and Zotor, 2008). Diabetes
is the most common endocrine disease and it is a major problem in medicine,
not only for diabetic patients, but also as a general health problem (Zeqiri
et al., 2007). Diabetes is a syndrome of a relative or absolute
lack of insulin resulting in hyperglycemia. Patients with type 1 diabetes
need insulin to regulate their blood glucose levels, while for patients
with type 2 diabetes, weight loss and dietary management may be sufficient
in controlling blood glucose levels (Nair, 2007). The statistics show
that, in 1997 approximately 124 million people had this disease (Amos
et al., 1997) and this number according to estimation of WHO will
reaches 300 million till 2025 (WHO, 1997). Disadvantages of diabetes with
it side effects on life quality and life expectancy is 10-15 years lower
than people without diabetes (Williams et al., 2000). Global variation
shows higher rates of prevalence in developing countries and in developed
ones with groups of lower economical-social conditions (Harris, 2000).
According to WHO prevalence of diabetes in Iran in 1995 and 2000 and 2025,
respectively is 5.5, 5.7 and 6.8% this means we have respectively according
to mentioned years 1.6, 1.9 and 5.1 million people with diabetes (King
et al., 1998). One of important factors of access and increase
of diabetes are related to nowadays lifestyles like lack of activity,
inappropriate nutrition habits which leads to increase obesity and also
increase mental stresses. Appropriate physical activity is an important
factor in preventing chronic diseases like diabetes. Even approximately
60% of world population neglect at least 30 min daily physical activities
(Bouchard et al., 1994). Daily physical activities and healthy
diets are playing an important role in prevention diabetes mellitus; according
to WHO report in 2002 cause of 1.9 million mortalities worldwide is lack
of physical activities which estimated 10 to 16% because of diabetes and
22% are because of heart ischemic diseases (American Diabetes Association,
1997). Aim of this study which is community-based one is to assess methods
of simple diet and normal physical activities in controlling diabetes,
because these simple and applicable recommendations are not limited to
the period of this study but also guarantee the long term continuance
of these methods whereas in type 2 diabetes beside medical treatment,
other methods of control have great importance in controlling disease.
Assessing the role of physical activities and diet in decreasing glucose
and controlling diabetes mellitus can define proper options in controlling
this disease.
MATERIALS AND METHODS
This study carried out in a time-period between 2006-2007 and Study`s
community of this research was Persian Diabetes Clinic and Khorasan Diabetes
Research Center: Mashhad, Khorasan Razavi. This study has conducted in
community-based intervention method. Study`s community of this research
is diabetes clinic and diabetes studies center. Members of population
are type 2 diabetic patients who were eligible to recruit in this study.
Samples were selected by non-probable (aim-based) method, thus clienteles
which have the eligibility to recruit in this study, sample were selected
after gaining written agreement, they were allocated randomly to one of
4 groups. Before any intervention, FBS test and 2 h postprandial blood
sugar test, HbA1C and complete urine test for each patient have been made.
Height, weight and blood pressure of patients were measured and data were
recorded in questionnaire.
Considered groups include:
Group 1 |
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Under train people who were recommended to do physical
activities |
Group 2 |
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Under train people who were recommended to respect diet |
Group 3 |
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Under train people who were recommended to do both physical activity
and respect diet |
Group 4 |
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Control group |
FBS, 2 h postprandial blood sugar and HBA1C tests had repeated after
2 months.
Exclusion criteria were as follows: FBS more than 250 and less than 126,
age more than 60 and less than 35, gestation, cardiovascular diseases,
persons who had severe physical activity, BMI less than 20.
Below formula has been used to determine the sample size:
According to available information in decreasing FBS, HBA1C, sample size
has estimated in binary compare (β = 20% and α = 5%) and sample
size in any of groups were determined less than 50 which in this research
for any groups 50 patients were considered. Before gathering data, explanatory
meetings for personnel of diabetes centers and questioners have been done.
In this study to compare results before and after intervention, Wilcoxon
test specified for even sampling data was used. Using even sampling t-test
was not applicable, whereas difference numbers was not in a normal distribution.
Kolmogorov test was used to control the normal distribution. ANOVA was
also used to compare the difference numbers in four groups. In this study
SPSS 11.5 software package was used. In order to control the homogeneity
of people in test, people in different groups were investigated by ANOVA
for age and χ2 test for sex. Meaningful level in all tests
(p<0.05) was considered.
RESULTS AND DISCUSSION
Several studies have been done in the field of the effect of physical
activity and diet in controlling the diabetes. In these studies the interventions
have been precise control on physical activities or diet. They were scientifically
planned and patients usually used it during the study but because of the
limitation it made for them, they frequently stopped it after research
period. In this study, comparison of 4 groups showed recommended physical
activity has significant effect in decreasing FBS, 2hpp and HbA1c (p<0.030).
Whereas the recommended diet led to merely significant decreasing in FBS
(p = 0.032). Diabetic patients who were recommended for both physical
activity and diet have improved variables but they are not significant
although they have decreased the weight and drug (p<0.024). It is considerable
that in control group variables decrease with increasing the drug usage.
Findings of research showed that recommended physical activities have
great role in decreasing important variables such as: FBS test, 2 h postprandial
blood sugar test and hemoglobin rate of A1C. Interesting point in regard
to this matter that intake medicine and insulin didn`t have significant
difference (i.e., consumption of medicine didn`t differ) but doing physical
activity according to the recommended pattern caused the above variables
to have significant decrease (p<0.030); so it seems that physical activity
and exercise are critical components of diabetes management (Kollipara
and Warren-Boulton, 2004) (Table 1). Some studies put
the role of physical activity in debt (National Institutes of Health,
1998) but studies of Harry et al. (2002) showed that patients without
physical activity have chance of 2.71 times lack of control of diabetes
mellitus. In another meta-analysis which results of 89 studies were analyzed,
results indicate physical activity has significant role in decreasing
weight (1.55 kg) and hemoglobin A1C (0.8%) (Brown et al., 1996).
Also in other meta-analysis which concluded from 14 studies (11 randomized
clinical training and 3 non-randomized clinical training) showed physical
activity decreases the rate of hemoglobin A1C significantly (Boule et
al., 2001). Further studies devote that even if exercising does not
lead to loss of weight, it can still decrease the plasmid level of glucose
and increase the insulin-sensitivity (Udezue et al., 2005). In
this way doing aerobic sports such as trotting, biking, swimming and jogging
can also be effective in controlling the disease (Snowling and Hopkins,
2006).
Table 1: |
Comparing studied variables before and after physical
activity changes |
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Table 2: |
Comparing studied variables before and after diet changes |
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Table 3: |
Comparing studied variables before and after both physical
activity and diet changes |
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Another result concluded from research is that considering the food pattern
only decrease the FBS test (p = 0.032) (Table 2). Strano
and his coworkers believe that with sustaining a pattern of an appropriate
and modified diet, they can partly succeed in controlling the diabetes
(Strano-Paul and Phanumas, 2000). Also by comparing two presented methods
it is concluded that the role of physical activity in compare with food
diet is more significant because it can play more active role in decreasing
2 h postprandial blood sugar and Hemoglobin in A1C. A remarkable point
is that respecting the recommended nutrition pattern play a great role
in controlling the medicine consumption and stops the increase of it also
but it doesn`t decrease other variables significantly.
Investigating the role of both respecting the recommended food pattern
and having physical activity more than before methods simultaneously,
indicate that this method will lead to significant decrease in consumption
of Glibenclamide (p = 0.021) and also the weight of patient only (p =
0.021) (Table 3). Although in this section positive
changes in second level has been made comparing with first level but these
changes were not significant. Maybe results show that concentration of
patients on two methods and recommend them doesn`t effect well and thus
recommending a one method have much significant effect. Comparing the
changes of studied patients before and after intervention indicate the
insensible decrease in some variables after intervention (Table
4).
Table 4: |
Comparing the changes of studied variables before and
after intervention |
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CONCLUSION
Totally what should be conveyed is that the recommended physical activity
can affect most in controlling the diabetes mellitus. If any individual
in regard to his physical condition can not do physical activity, respecting
a proper food pattern is in the second place of importance. Comparing
the different physical activities such as, walking, track and field and
etc., considering the individual`s physical conditions, can be a better
solvent for controlling this disease. Besides from the stress-controlling
viewpoint studies over changing the life style can be suggested to be
able to evaluate the role of this feature of life style in controlling
the diabetes. Prosecution of recent study-groups can also indicate the
proceeding of each recommended method and its influence on controlling
the considered variables.
ACKNOWLEDGMENTS
I would like to acknowledge the institutes which helped us in this study,
Endocrine and metabolism diseases Center in Tehran University of Medical
Sciences, Endocrine and metabolism diseases Center in Mashhad University
of Medical Sciences, Persian Diabetes Clinic and Khorasan Diabetes Research
Center.
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