Lifestyle intervention in people with insulin-dependent diabetes mellitus (IDDM)

Abstract

Objective: To investigate the impact of intensive lifestyle education on dietary practices, exercise and metabolic measurements in people with insulin-dependent diabetes mellitus (IDDM). Design: Sixty-one volunteer subjects with IDDM were randomised to intensive (Group 1) or standard (Group 2) education programmes for six months. During a second six month period of observation Group 1 subjects received routine surveillance for their condition and those in Group 2 were given intensive advice (phase 2). Current insulin regimens were modi®ed to optimise glycaemic control before the start of the intervention phase. Nutrient intakes, weight, blood pressure, glycated haemoglobin (HbA 1 ), plasma lipids, lipoproteins and maximal oxygen consumption (VO 2 max) were measured at the time of recruitment and at three monthly intervals during the trial and phase 2. Setting: Department of Human Nutrition at the University of Otago. Results: Glycated haemoglobin decreased signi®cantly in both groups between recruitment and randomisation, the improvement being sustained during the six months of the randomised trial and for group 1 during the six months of post trial observation. A further decrease was seen in Group 2 during the second six month period when they were given intensive advice. Comparable changes were seen with total and low density lipoprotein (LDL) cholesterol in Group 1 during the trial, but signi®cant decreases were only seen in Group 2 in association with intensive intervention (phase 2). These changes occurred in parallel with increases in intakes of carbohydrate and monounsaturated fatty acids, a reduction in intakes of total and saturated fat, and an improvement in maximum oxygen consumption. Conclusions: A lifestyle programme for people with IDDM results in modest changes in diet and exercise habits suf®cient to improve measures of glycaemic control and lipoprotein mediated risk of coronary heart disease independent of changes in insulin regime. More innovative approaches to achieve lifestyle changes are required to meet current recommendations which in turn are likely to produce even greater bene®cial changes than those observed here.

Self-Management Education for Adults With Type 2 Diabetes

“…In one study (40), we assumed that the stated variance was actually the SD; in a second (51,52), we assumed it to be the SE; in a third (47), we assumed a SD rather than a SE. In studies that involved crossover designs, fol- low-up comparison was made before the comparison group received the intervention (53)(54)(55)(56). One study (57) had two comparison groups, and the randomized control group was used as the comparison group.…”

Effectiveness of Self-Management Training in Type 2 Diabetes

“…Most studies with positive results involved regular contacts or reinforcement sessions (38,47,66,76,82,84) or very short follow-up periods (72,74), although four studies had follow-up periods of Ն5 months (36,38,80,82). All other studies with follow-up of Ն6 months after the end of the intervention failed to show significant differences in weight loss between control and interventiongroups (30,31,61,65,71,73,77,79,84,87,88,90,91). A number of other studies with shorter follow-up periods also had combined I-1 and I-2 C: Relaxation training to cope with stress All groups got nine weekly sessions of 1.5 h BL, baseline; BS, blood sugar; BP, blood pressure; C, C-1, C-2, control groups; CAI, computer-assisted instruction; CHO, carbohydrate; D/SBP, diastolic/systolic blood pressure; DM, diabetes mellitus; DM2, type 2 diabetes; FBS, fasting blood sugar; F/U, follow-up; HCW, health-care worker; I, I-1, I-2, I-3, intervention groups; IP, inpatient; NSD, no significant difference; OP, outpatient; PA, physical activity; q, every; RN, registered nurse; SD, significant difference; TC, telephone call.…”

“…Some studies demonstrated a decrease in systolic blood pressure (Ϫ4 mmHg) (28) and diastolic blood pressure (Ϫ3 to -8 mmHg) (27)(28)(29)76), whereas others showed no significant changes (34,73,82,89).…”

Benefícios da atividade física no perfil lipídico de pacientes com diabetes tipo 1

“…Outros estudos, envolvendo modificações no estilo de vida durante poucas semanas, também foram efetivos em melhorar o controle glicêmico e modificar favoravelmente vários fatores de risco cardiovascular no DM1 (13,25). Entretanto, estes diferem de nosso estudo uma vez que encontramos, durante um perío -do de somente oito dias, queda significante nos níveis de colesterol total e LDL, assim como um aumento no HDL-colesterol.…”

“…Tais anormalidades podem ser modificadas por medidas terapêuticas adequadas. Alterações no estilo de vida de indivíduos com diabetes tipo 1, dieta com menores conteúdos de gordura saturada e aumento da atividade física, mostraram-se eficazes em melhorar o controle glicêmico e o perfil lipídico, a longo prazo e independente das alterações nas doses de insulina (13).…”