Meta-Analysis of the Effects of Diet and Physical Activity on HbA1c in Type II Diabetes Mellitus Patients
Abstract
Background: Type II Diabetes Mellitus is still a global health problem. The prevalence of diabetes has increased over the decades due to the increased incidence of Type II DM. This study aims to analyze the effectiveness of diet therapy and physical activity on HbA1c levels in type II DM patients.
Subject and Method: This study is a systematic and meta-analysis study, with the following PICO Population = Patients diagnosed with type II DM. Intervention= High physical activity and diet therapy. Comparison = Low physical activity and no diet. Outcome= HbA1c level. The articles used in this study were obtained from several databases, including PubMed, Science Direct, Scopus, Clinical Key, and Google Scholar. The keywords used were: “tertiary prevention and DM”, “diet”, “physical activity”, “diet and DM” “physical activity and DM”, “diet and tertiary prevention and DM”. The inclusion criteria were full-text articles, experimental study design using randomized controlled trial (RCT). Articles were collected using PRISMA flow diagram. Articles were analyzed using Review Manager 5.3 application.
Results: A meta-analysis of 9 articles on the effectiveness of diet therapy on HbA1c levels from Spain, the United States, Japan, the United Kingdom, and Israel concluded that Type II DM patients on diet therapy had an HbA1c level of 0.49 units compared to Type II DM patients without treatment, and the results were statistically significant (SMD= -0.49; 95% CI= -0.56 to -0.42; p < 0.001). A meta-analysis of 9 articles on the effectiveness of physical activity on HbA1c levels from the United States, Australia, Italy, and India concluded that Type II DM patients with high physical activity had HbA1c levels by 0.81 units lower than Type II DM patients with low physical activity, and the results were statistically significant (SMD= -0.81; 95% CI= -1.20 to -0.43; p < 0.001).
Conclusion: Diet therapy and high physical activity reduce HbA1c levels in type II DM patients.
Keywords: Physical activity, diet, HbA1c, type II DM
Correspondence: Utari Kusumaningrum. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: utariikusuma@gmail.com. Mobile: +6289636061501.
Indonesian Journal of Medicine (2022), 07(02): 172-187
https://doi.org/10.26911/theijmed.2022.07.02.06
References
Abbate R, Mannucci E, Cioni G, Fatini C, Marcucci R. Diabetes and sex: from pathophysiology to personalized medicine (2012). Intern Emerg Med. 7(3): S2159. doi: 10.1007/s117390120804y.
Abidah N, Fitria E, Zulhaida A (2016). Hubungan pola konsumsi dengan diabetes melitus tipe II pada pasien rawat jalan di RSUD Dr. Fauziah Bireueun Provinsi Aceh. Jurnal Media Litbangkes. 26(3):145150.
ADA (American Diabetes Association) (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care.
Andrew JM, Cooper SB, Ulf E, Nicholas JW, Simon JG, Rebecca KS (2013). Association bet]ween objectively assessed sedentary time and physical activity with metabolic risk factors among people with recently diagnosed type 2 diabetes. J Diabetologia. 57 (2014): 7382. DOI: 10.1007/s0012501330698.
Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ (2015). Physical activity and the risk of type 2 diabetes: a systematic review and doseresponse metaanalysis. Eur J Epidemiol. 30(7): 52942. doi: 10.1007/s106540150056z.
Castaneda C, Layne JE, MunozOrians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, et al. (2002). A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 25(12):233541. doi: 10.2337/diacare.25.12.2335
Church TS, Blair SN, Cocreham S, Johannsen N, Johnson W, Kramer K, Mikus CR, et al. (2010). Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 304(20): 225362. doi: 10.1001/jama.2010.1710.
Damayanti S (2015). Diabetes melitus dan penatalaksanaan keperawatan. Yogyakarta: Nuha Medika
Danaei GKG, Andrews CR, Sudfeld G, Fink DC, McCoy, Peet E, Sania A, et al (2016). Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PloS Med. 13(11): e1002164: 118. doi: 10.1371/journal.pmed.100216.
Downes L (2015). Physical acitivity and dietary habits of college students. J. Nurse Pract. 11(2): 192198. doi: https://doi.org/10.1016/j.nurpra.2014.11.015
Dunstan DW, Daly RM, Owen N, Jolley D, De Courten M, Shaw J, Zimmet P (2002). Highintensity resistance training improves glycemic control in older patients with type 2 diabetes. Diabetes Care. 25(10):172936. doi: 10.2337/diacare.25.10.1729
Goday A, Bellido D, Sajoux I, Crujeiras AB, Burguera B, GarcíaLuna PP, Oleaga A, Moreno B, Casanueva FF (2016). Shortterm safety, tolerability and efficacy of a very lowcalorieketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutr Diabetes. 6(9):e230. doi: 10.1038/nutd.2016.36
GoldhaberFiebert JD, GoldhaberFiebert SN, Tristán ML, Nathan DM (2003). Randomized controlled communitybased nutrition and exercise intervention improves glycemia and cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care. 26(1): 249. doi: 10.2337/diacare.26.1.24.
Goldstein T, Kark JD, Berry EM, Adler B, Ziv E, Raz T (2020). The effect of a low carbohydrate energyunrestricted diet on weight loss in obese type 2 diabetes patients: A randomized controlled trial. Eur J Clin Nutr. 6(4): e178e186 doi: https://doi.org/10.1016/j.eclnm.2011.04.003
Iqbal N, Vetter ML, Moore RH, Chittams JL, DaltonBakes CV, Dowd M, WilliamsSmith C, Cardillo S, Wadden TA. Effects of a lowintensity intervention that prescribed a lowcarbohydrate vs. a lowfat diet in obese, diabetic participants. Obesity (Silver Spring). 2010 Sep;18(9):17338. doi: 10.1038/oby.2009.460. Epub 2009 Dec 17. PMID: 20019677.
Kadoglou NP, Iliadis F, Angelopoulou N, Perrea D, Ampatzidis G, Liapis CD, Alevizos M (2007). The antiinflammatory effects of exercise training in patients with type 2 diabetes mellitus. Eur J Cardiovasc Prev Rehabil. 14(6): 83743. doi: 10.1097/HJR.0b013e3282efaf50.
Kadoglou NP, Iliadis F, Sailer N, Athanasiadou Z, Vitta I, Kapelouzou A, Karayannacos PE, Liapis CD, et al. (2010). Exercise training ameliorates the effects of rosiglitazone on traditional and novel cardiovascular risk factors in patients with type 2 diabetes mellitus. Metabolism. 59(4):599607. doi: 10.1016/j.metabol.2009.09.002.
Lisiswanti R, Cordita RN (2016). Aktivitas fisik dalam menurunkan kadar glukosa darah pada diabetes melitus tipe II. Majority. 5(3): 140–144.
Masharani U, Sherchan P, Schloetter M, Stratford S, Xiao A, Sebastian A, Nolte Kennedy M, Frassetto L (2015). Metabolic and physiologic effects from consuming a huntergatherer (Paleolithic)type diet in type 2 diabetes. Eur J Clin Nutr. 69(8):9448. doi: 10.1038/ejcn.2015.39.
Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D (2017). Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 317(9): 912924. doi:10.1001/jama.2017.0947
Middlebrooke AR, Elston LM, Macleod KM, Mawson DM, Ball CI, Shore AC, Tooke JE (2006). Six months of aerobic exercise does not improve microvascular function in type 2 diabetes mellitus. Diabetologia. 49(10): 226371. doi: 10.1007/s001250060361x
Mirza MPJ (2019). Pengaruh terapi yoga terhadap perubahan kadar gula darah pasien diabetes mellitus tipe II pada lansia di Puskesmas I kembaran. Skripsi. Fakultas Ilmu Kesehatan Universitas Muhammadiyah Purwokerto. Retrieved from: http://repository.ump.ac.id/9466/
Morris E, Aveyard P, Dyson P, Noreik M, Bailey C, Fox R, Jerome D, et al. (2020). A foodbased, lowenergy, lowcarbohydrate diet for people with type 2 diabetes in primary care: A randomized controlled feasibility trial. Diabetes Obes Metab. 22(4):512520. doi: 10.1111/dom.13915
Nuraini HY, Surpiatna R (2016). Hubungan pola makan, aktivitas fisik, dan riwayat penyakit keluarga terhadap diabetes melitus tipe II. Jurnal Ilmu Kesehatan Masyarakat. 5(1): 514. doi: https://doi.org/10.33221/jikm.v5i1.14
Nurayati L, Adriani M (2017). Hubungan aktivitas fisik dengan kadar gula darah puasa penderita diabetes melitus tipe II. Journal Amerta Nutrition. 1(2): 8087. doi: https://doi.org/10.20473/amnt.v1i2.2017.8087.
Rahati S, Shahraki M, Arjomand G, Shahraki T. (2014). Food pattern, lifestyle and diabetes mellitus. Int J High Risk Behav Addict. 3(1):e8725. doi: 10.5812/ijhrba.8725.
Saslow LR, Kim S, Daubenmier JJ, Moskowitz JT, Phinney SD, Goldman V, Murphy EJ, et al. (2012). A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PLoS One. 9(4): e91027. doi: 10.1371/journal.pone.0091027.
Sato J, Kanazawa A, Makita S, Hatae C, Komiya K, Shimizu T, Ikeda F, et al. (2017). A randomized controlled trial of 130 g/day lowcarbohydrate diet in type 2 diabetes with poor glycemic control. Clin Nutr. 36(4):9921000. doi: 10.1016/j.clnu.2016.07.003
Sigal RJ, Kenny GP, Boulé NG, Wells GA, Prud'homme D, Fortier M, Reid RD, et al. (2007). Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 147(6):35769. doi: 10.7326/00034819147620070918000005
Sridhar B, Haleagrahara N, Bhat R, Kulur AB, Avabratha S, Adhikary P (2010). Increase in the heart rate variability with deep breathing in diabetic patients after 12month exercise training. Tohoku J Exp Med. 220(2):10713. doi: 10.1620/tjem.220.107.
Werdani, Aprilya, R., Triyanti. 2014. Asupan karbohidrat sebagai faktor dominan yang berhubungan dengan kadar gula darah puasa. National Public Health Journal. 9(1): 7177. doi: 10.21109/kesmas.v9i1.459
Westman EC, Yancy WS Jr, Mavropoulos JC, Marquart M, McDuffie JR (2008). The effect of a lowcarbohydrate, ketogenic diet versus a lowglycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond). 5(1): 36. doi: 10.1186/17437075536.
World Health Organization. 2016a. Global [report on diabetes: Retrieved from: https://www.who.int/diabetes/globalreport/en/.
Yamada Y, Uchida J, Izumi H, Tsukamoto Y, Inoue G, Watanabe Y, Irie J, Yamada S. A noncalorierestricted lowcarbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern Med. 53(1): 139. doi: 10.2169/internalmedicine.53.0861
Zethelius B, Gudbjörnsdottir S, Eliasson B, EegOlofsson K, Cederholm J, Swedish National Diabetes Register (2014). Level of physical activity associated with risk of cardiovascular diseases and mortality in patients with type2 diabetes: report from the Swedish National Diabetes Register. Eur J Prev Cardiol. 21(2): 244 51. doi: 10.1177/2047487313510893.
