Dietary and exercise interventions versus insulin injections for type 2 diabetes

¶ … Evidence Synthesis

Diabetes is regarded as one of the most problematic and major health concerns that has become prevalent across the globe. According to Kam et al. (2016), in 2012, diabetes resulted in the deaths of 1.5 million people throughout the world. Given its prevalence and devastating impacts, effective prevention and management of diabetes has become a major issue, especially among high-risk individuals/populations. Based on existing findings in the public health sector, dietary and lifestyle changes have been identified as the most suitable prevention and management techniques of diabetes. This study focuses on examining whether an intervention consisting of a traditional, organic, and all-natural diet of locally grown/produced foods plus exercise is more effective in addressing the body's issues in creating or absorbing insulin than insulin injections. In this regard, the researcher has identified relevant studies that will be synthesized based on their relevance, rigor, and level of evidence in relation to the phenomenon under investigation.

Approach to Synthesizing Evidence

For this study, the researcher utilized a mixed methods approach for synthesizing evidence. The mixed-methods approach involved conducting systematic reviews of complex, behavioral change interventions, which are regarded as effective measures for summarizing evidence based on their relevance and effectiveness to the issue under investigation (Leeman et al., 2011). When synthesizing the evidence, the researcher identified some variables of interest that guided the process. Some of these variables of interest include dietary and exercise interventions for Type II diabetes, creation and/or absorption of insulin, and insulin injections. These variables of interest were identified based on the PICOT question and the purpose/significance of the study.

Brief Description of the Selected Intervention

Based on a review of existing evidence and expert opinion, the intervention selected for this research is a combination of traditional, organic and all-natural diet and exercise. Kam et al. (2016) argues that an effective combination of dietary and lifestyle changes including exercise is suitable for prevention and/or management of diabetes. Such changes have been found effective in enhancing the capabilities of high-risk individuals to prevent and/or effectively manage diabetes. Mercola (2014) argues that the failure of conventional treatment/management of diabetes is attributable to flawed dietary recommendations. These traditional dietary recommendations have been associated with severe insulin reactions, which is evident in the body's issues in creating or absorbing insulin. Changing diet from processed foods to traditional, organic and all-natural diet is considered as a suitable measure towards addressing the body's issues in creating or absorbing insulin. In addition, studies have demonstrated that regular and intense exercise increases insulin sensitivity, which is crucial towards effective management or treatment of diabetes. The high insulin sensitivity is experienced even in the absence of weight loss and helps in addressing the condition.

In this case, the project will entail examining whether the use of an organic diet in combination with exercise enhances creation and absorption of insulin as compared to insulin injections among Type II diabetic patients. The researcher will utilize this intervention in the management of the condition vis-a-vis insulin injections.

Synthesis Tables

1

2

3

4

Level I: Systematic review or meta-analysis

Aguiar et al. (2014).

Ajala, English & Pinkney (2013).

Level II: Randomized controlled trial

Oftedal, Bru & Karlsen (2011).

Level III: Controlled trial without randomization

Cunningham-Myrie et al. (2015).

Level IV: Case-control or cohort study

Level V: Systematic review of qualitative or descriptive studies

Strychar, Elisha & Schmitz (2012).

Level VI: Qualitative or descriptive study (includes evidence implementation projects)

Level VII: Expert opinion or consensus

Studies

1

2

3

Interventions

Diet changes or Dietary approaches

Exercise or Physical activity

Insulin injections

1

Aguiar et al. (2014).

Aguiar et al. (2014).

2

Ajala, English & Pinkney (2013).

Cunningham-Myrie et al. (2015).

3

Oftedal, Bru & Karlsen (2011).

Oftedal, Bru & Karlsen (2011).

4

Strychar, Elisha & Schmitz (2012).

Studies

Design

Sample

Outcome

1. Aguiar et al. (2014, January 15). Efficacy of Interventions that include Diet, Aerobic and Resistance Training Components for Type 2 Diabetes Prevention: A Systematic Review with Meta-Analysis. International Journal of Behavioral Nutrition and Physical Activity, 11(2), 1-10.

Systematic review with meta-analysis.

23 articles including randomized controlled trials, single-group pre-post study, quasi-experimental study, and two-group comparison.

- Resistance training should be included in exercise to prevent Type 2 diabetes.

- Multi-components lifestyle interventions for preventing Type II diabetes are relatively effective in generating weight loss, enhancing glucose tolerance and impaired fasting glucose, and improving dietary and exercise outcomes.

2. Ajala O., English, P., & Pinkney, J. (2013). Systemic Review and Meta-analysis of Different Dietary Approaches to the Management of Type 2 Diabetes. American Journal of Clinical Nutrition, 97(3), 505-516.

Systematic review and meta-analysis.

20 random controlled trials across 3460 randomly assigned individuals.

- Low glycemix index Mediterranean diet is impressive in enhancing markers of cardio-risk in individuals with diabetes and should therefore be considered in diabetes management.

3. Cunningham-Myrie, C., Theall, K., Yonger, N., et al. (2015). Associations Between Neighborhood Effects and Physical Activity, Obesity, and Diabetes. The Jamaica Health and Lifestyle Survey, 2008. Journal of Clinical Epidemiology, 68(9), 970-978.

Survey.

2848 respondents from 2007-08 Jamaica Health and Lifestyle Survey.

- ICC = 10.7, Significant clustering in physical activity levels of 20 minutes.

4. Oftedal, B., Bru, E. & Karlsen, B. (2011). Motivation for Diet and Exercise Management Among Adults with Type 2 Diabetes. Scandinavian Journal of Caring Sciences, 25, 735-744.

Cross-section study consisting a postal questionnaire.

425 adults suffering from Type II diabetes aged between 30 and 70 years.

- Extrinsic factors play an important role in determining dietary behavior.

- Intrinsic motivation improves exercise management.

5. Strychar, I., Elisha, B. & Schmitz, N. (2012). Type 2 Diabetes Self-Management: Role of Diet Self-Efficacy. Canadian Journal of Diabetes, 36, 337-344.

Cross-section study design.

19 articles were reviewed for self-management techniques for prevention of Type II diabetes.

- Enhancing dietary self-efficacy has positive effects on management of diabetes.