The Effectiveness of Lifestyle Intervention among Pre-Diabetes Patients in Melaka, Malaysia.

Abstract

Introduction: The aim of this study is to evaluate the effectiveness of lifestyle intervention on physical (weight, body mass index (BMI), blood pressure, waist circumference) and biochemical (fasting blood sugar (FBS), 2 hours postprandial (2HPP), and lipid profile) parameters among individuals with pre-diabetes. Methods: This study involved 185 pre-diabetics patients from fourteen selected health clinics in Melaka. The patients were divided into three groups based on the intervention that they received namely lifestyle intervention (n=62), pharmacological intervention (n=60), and control group (n=63). Each clinic applied only one type of intervention. The control group received only the conventional education. the lifestyle intervention group underwent group and individual dietary counseling together with exercise programme, and the pharmacological intervention group were given the oral Metformin (500 mg b.i.d). Results: Both blood glucose profiles included FBS and 2HPP with the mean difference of 0.24 ± 0.94 mmol/L were significantly reduced in the lifestyle intervention group. Waist circumference and LDL-cholesterol were significantly reduced while HDL-cholesterol was significantly elevated in both lifestyle and pharmacological intervention groups. The greatest reduction of body weight and BMI were seen in pharmacological intervention group with the mean difference of 2.06 ± 2.68 kg and 0.89 ± 1.17 kg/m 2 respectively as compared to the lifestyle intervention and the control group with the mean difference of 1.49 ± 2.98 kg, 0.46 ± 2.02 kg/m 2 ; 0.61 ± 1.16 kg, 0.10 ± 1.03 kg/m 2 respectively. The lifestyle intervention showed significant reduction in weight (p=0.004), BMI (p=0.023) and waist circumference (p=0.005) as compared to the control group. Multivariable analysis, the lifestyle intervention still had an effect on fasting blood sugar (FBS), 2 hours postprandial (2HPP), and body mass index (BMI) after all the baseline differences were controlled. The lifestyle intervention showed the greater decreased in FBS (0.279 mmol/L) than pharmacological intervention (0.245 mmol/L). Conclusion: Lifestyle intervention was effective in reducing blood sugar profile of pre-diabetic patients as compared to the pharmacological intervention and the control group. Keywords: Prevention T2DM, primary intervention, impaired glucose tolerance, pre-diabetes. I. INTRODUCTION Type 2 diabetes mellitus (T2DM) is a major health problem associated with excess morbidity and mortality, and is on increasing prevalence worldwide 1 . It is a widespread health problem and may be life- threatening from associated complications such as coronary artery, cerebrovascular, retinal, neurological, and renal diseases 2-4 . The rise in diabetes mellitus is largely attributed to the epidemic of obesity together with sedentary lifestyle as well as unhealthy dietary habit. Therefore, efforts are needed to determine the possible ways to early intervene those who are at high risk of T2DM. Diabetes is a lifestyle disease and preceded by pre- diabetes for years before manifests as overt hyperglycaemia. The symptoms, however, can be managed by a healthy lifestyle. Pre-diabetes is a condition of people who were diagnosed with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) 4 . They have increased risk of developing T2DM 5 and cardiovascular disease 6,7 . It is estimated that approximately 25% of people diagnosed with IGT or IFG progress to diabetes mellitus over a 3 to 5 year period 8 (Nathan, 2007). Patients with both IGT and IFG, older age, overweight, or other diabetic risk factors are more likely to progress to diabetes. Other risk factors for diabetes include family history of diabetes, sedentary lifestyle, hypertension, dyslipidemia, history of gestational diabetes or large for gestational age infant, and polycystic ovarian syndrome. The primary prevention of diabetes mellitus is based on knowledge of the natural history of the development of IGT and its risk factors.This is an important to identify an intervention targeted on individuals who are at highest risk of developing the disease