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Diabetes is a chronic condition that affects the body's ability to convert sugar into energy. The economic burden of T2D among South Asians makes this an important global clinical and public health challenge. Nearly one in ten people globally will have some form of diabetes by 2035, the International Diabetes Federation predicts in a new report. Below, check out the IDF’s chart on the current number of diabetes sufferers by region, and where the rates are projected to increase. The US currently spends 1 in 5 healthcare dollars on diabetes — or 36% of the world total of diabetes spending on adults, the IDF says. We welcome comments that advance the story through relevant opinion, anecdotes, links and data. Wonder if our sedentary life style, especially developing in youths, will increase the number of diabetics. Type I diabetes is an autoimmune disease of the pancreas that afflicts about 1 person in 700. Type II diabetes is a disease created by a definition based on the number of standard deviations a person’s fasting blood sugar is above the mean. If it were a real disease, it would have done something demonstrably destructive to me by now, but it hasn’t. I would like to see more studies about the Women’s Health Initiative effect on the decline of HRT. In order to understand the Pyramid and how this will help in our understanding of the types and amounts of foods which we would eat, let us break down the Pyramid into its various components. Later when you see the Diet Charts which are based on the Exchange system, you will see that depending on the calories you would eat in a day, the meals and snacks are divided into servings or portions of these foods. The results of the phase 2 randomized trial were published Online First Sunday in The Lancet. Note: Burant is an unpaid consultant and advisor to Takeda Global Research and Development which discovered TAK-875. You have a higher risk of type 2 diabetes if you are older, obese, have a family history of diabetes, or do not exercise. You may be eligible for money damages if you owned or leased one of these VW, Porsche or Audi vehicles. Science, Technology and Medicine open access publisher.Publish, read and share novel research.
Socio-Ecological Approach to Self-Management of Type 2 Diabetes: Physical Activity and Dietary InterventionRashid M. A Beck, J Scott, P Williams, et al1997A randomized trial of group outpatient visits for chronically older HMO members: the cooperative health care clinic. R Ewing, T Schmid, R Killingsworth, 2003Relationship between urban sprawl and physical activity, obesity, and morbidity.
H Frumkin, L Frank, R Jackson, 2004Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities. D Haire-joshu, 1996Management of Diabetes Mellitus: Perspectives of care across the lifespan. This allows sugar (glucose) levels to build up in the blood. Type 2 Diabetes (T2D) is the fifth leading cause of death worldwide, and a major contributor to development of coronary heart disease, stroke, peripheral vascular disease and end-stage renal disease. There are some 382 million people living with the disease, but that could jump 55% by 2035, the IDF says. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links.
Type I diabetics’ immune systems usually go on to destroy other organs, typically the arteries and kidneys, which is why 65% of Type I diabetics die from heart attacks and strokes.
The single biggest cause of Type II diabetes is the lack of Type I diabetics sufficient to make money for Big Pharma. They rigged diesel emission controls so you, nor regulators, would know how much pollution their cars were adding to our environment. Diabetes Criteria for patientsAll the participants will adhere to their usual medications as recommended by their doctors. M Ansari, 2009Effect of physical activity and obesity on type 2 diabetes in middle-aged population. A Brown, 1990Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. P French, V Senior, J Weinman, et al2001Causal attributions for heart disease: a systematic review.

H Jafar, N Chaturvedi, G Pappas, 2006Prevalence of overweight and obesity and their association with hypertension and diabetes mellitus in an Indo-Asian population. The number of Chinese with the disease is skyrocketing as well, up to 114 million in 2010 from just 22 million in 2007. In order to assess the effectiveness of this intervention, it was advised not to modify the medications during this trial. Statistical analysis The primary outcome will be analysed by an un-paired sample t-test (mean difference between baseline and final HbA1c). V Hedges, 1994Predicting metabolic control in diabetes: a pilot study using meta-analysis to estimate a linear model. X Zhang, K Merrell, et al1998Diabetes in the African-American Medicare population: morbidity, quality of care, and resource utilization. A Brownson, O Tool, ML et al2005Ecological approaches to self-management: The case of diabetes. H Jensen, et al2003Multifactorial intervention and cardiovascular disease in patients with Type 2 diabetes. A Strycker, D Toobert, J et al2000The Chronic Illness Resources Surveys: A social-ecologic approach to assessing support for disease self-management. G Eakin, et al1997Quality of life and associated characteristics in a large diverse sample of adults with diabetes.
E Glasgow, L Strycker, 2000Beliefs versus feelings: a comparison of personal models and depression for predicting multiple outcomes in diabetes. R Evenson, P Bors, et al2003Neighbourhood environment, access to places for activity, and leisure-time physical activity in a diverse North Carolina population. In addition, participants will be advised not to take any other new treatments for the management of type 2 diabetes during this study.
The statistical analysis, using STATA will be carried out on an intention to treat basis and that will subject to the availability of data at follow up (after 90 days) as well as at entry level for individual patients. R Brown, et al2000Promoting physical activity in rural communities: walking trail access, use and effects.
W Sokol, D Hallett, 2003Personal persistence, identity development, and suicide: a study of Native and Non- native North American adolescents. L Schmid, 2003Health and Community Design: The Impact of the Built Environment on Physical Activity.
J Barrera, et al2005The Chronic Illness Resources Survey: cross-validation and sensitivity to intervention.
W Terry, et al1984Effects of labelling on income, work and social function among hypertensive employees. All participants will be contacted again after 90 days (3-months) to give their blood sample for HbA1c testing, their weight will be taken and BMI will be calculated.
Study population and randomizationInitially 325 patients with type 2 diabetes will be invited to pre-randomized interview, out of which only 210 patients will be included in the actual trial. For the purpose of this trial, it is expected that out of the 325 patients, 93 patients will not meet the inclusion criteria and 22 patients might refuse to participate in the trial.
Data analysis methodIn this study, the thematic analysis of data will be adopted for analysing the data because the method was developed to meet the needs of investigating the experiences, meanings and the reality of the participants (Braun and Clarke, 2006).
In that case, two hundred and ten (210) patients will agree to participate and will be required to sign informed consent documents at the clinic where they usually visit for their usual medical care for diabetes. The method also allows the study to adopt the element from constructionist notions – to investigate the ways in which events, realities, meanings, experiences are the effects of a range of discourses operating within a society. Therefore, 105 patients will be randomized to intervention group (Physical Activity and Diet) and 105 to the control group (usual medical care). Sample size estimationThe study sample size was determined based on the assumption of the estimation of Standard Deviation (SD). This RCT trial will not be double-blinded as the participants receiving the education on lifestyle modifications in the community and healthcare clinics would know that they are on the active intervention. Therefore, the study design was selected to detect an effect size of 0.5 SD lowering of HbA1c. Once the randomization phase is completed, all patients will be instructed to follow-up the usual medical care for their diabetes for the duration of the 90 days trial. It was assumed that 10% patients might be lost to follow-up in control group over the period of three months and only 5 % patients will be lost to follow-up in intervention group. The patients will not be allowed to adjust their usual medications and follow their previous prescriptions recommended by their doctors. This assumption was based on impact of education and advice on lifestyle behavioural modifications to patients and overall popularity of this approach among the diabetic patients in sub-continent to manage their glycemic control.

In addition, each patient will be asked to go for blood test for HbA1c on day 1 and then return to give blood sample after 90 days. In addition, participants will be advised not to take any other new treatments for the management of type 2 diabetes during the trial periods.
The sample size (N) for each group was =105; therefore, the total, N=210 patients were recruited to participate in both the groups.
Those patients randomized to usual medical care (control group) will be instructed to take their normal medicines and follow-up with their doctor as per their normal schedule. At that time, a questionnaire will be sent via e-mail to participants in intervention group to assess the progress of the physical activity and diet intervention and to control group to assess the progress of the treatment with normal medical care only.
Minimizing the bias It is possible that the outcome measures associated with physical activity and diet interventions will be subject to bias particularly when treatment will be in progress or just afterwards. The main difference between usual medical care alone for the patients and usual medical care with physical activity and dietary interventions will occur after 3 months period of trial. Measurement The factors which will be measured in this study are the physical activity of participants (an intervention), hemoglobin (HbA1c – primary outcome variable), blood pressure and weight (secondary outcome) whereas the body mass index (BMI) is a calculated variable. In order to reduce the bias, the questionnaire will be sent to patients at home or via e-mail to minimize any chance that their answers might be affected by actual or perceived influence by medical practitioners at clinic.
The linear regression analysis will be performed after three months between HbA1c and on the blood glucose results to see the reliability of measurement data and to observe any relationship between the two variables. Physical activity is a key component of lifestyle modification that can help individuals prevent or control type 2 diabetes.
Discussions The results of this randomized controlled trial will support the research question that lifestyle interventions (physical activity and diet) with usual medical care for type 2 diabetes is more effective than the usual medical care alone. It is considered that diet is probably more important in the initial phases of weight loss, incorporating exercise as part of a weight loss regimen helps maintain weight and prevent weight regain (Klein et al. The higher % age of lost to follow up throughout this trial (Figure 2) in those patients with usual medical care (10%) than in those in intervention group (5%) suggests greater satisfaction with physical activity and dietary education and advice. The difference at 3 months follow up is the mean change in HbA1c levels for the intervention group minus the mean change of HbA1c for the control group.
In this study, the message will be given to participants to do 30 minutes of moderate physical activity daily (approximately 8000 step count) and it may offer greater benefits to these patients in managing their diabetes (Wright and Royson, 1996).For measurement of physical activity, the method of step count using pedometer will be used as it has been demonstrated to have a superior validity of step counts over a questionnaire approach in predicting health markers such as BMI and waist circumference (Ewald et al.
The participants will be given pedometer for a week for the measurement of physical activities (step counts). At 3 months follow-up, the patients would show significantly greater improvement and lower values of HbA1c by 1%. These participants will be instructed to wear the pedometer on a waist belt, either side and wear it from the early morning till they go to bed in the night. This would support the hypothesis 1 that the lifestyle interventions (physical activity and diet) in patients with poorly controlled diabetes will lead to reduction of 1% hemoglobin (HbA1c) in 90 days trial. The participants will record the start and end time for each day wearing the pedometer and in the evening record the step count showing on the display without resetting the counter. Table 2 shows the baseline characteristics of participants in intervention and control group. Testing Hypothesis 2 (Secondary outcome variable)The hypothesis 2 will be supported if we can provide evidence that the type 2 diabetic patients after the 90 days trial would reduce 5% weight and consequently the BMI as compared to the these values at baseline.
The polynomial regression analysis will be used to generate the reference range models as these models do not make assumptions about linearity of step count with age (Wright and Royson, 1996). The changes in BMI from the base line values will determine the level of reduction in weight and BMI based on physical activity, diet and exercise.16. Ethical consideration The scientific validity of the study is a fundamental ethical protection and this study has a scientific merit and clinical value as it aims at using the socio-ecological approach to self-management of type 2 diabetes and will help diabetic patients to control their hemoglobin (HbA1c) and help them to understand the importance of physical activity and healthy diet and to enjoy a healthy lifestyle.All the patients will be provided clear instruction about the study and informed consent will be obtained and ethical clearance will be taken from a legal authority before conducting this study. Finally, the main contribution of this trial is to provide health professionals (diabetes care providers) and patients with type 2 diabetes an insight into the ways in which diabetes is viewed and managed in that region of Pakistan which will help them in the self-management and treatment of type 2 diabetes.17. Conclusion It has been demonstrated in this study that the level of HbA1c (primary outcome) will reduce by 1% in the patients of poorly controlled type 2 diabetes after the 90 days trial of physical activity and dietary interventions and hence will support the hypothesis and the research question. This study will enhance the relationship between the medical practitioner and the patients of diabetes and will improve the health care system in that region of the country in managing and treating the patients with chronic disease such as diabetes.

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