Post #4 (Week 12)

So this week, I’ll be talking about a research article that I have found on www.pubmed.com about lifestyle intervention, which includes physical activity as well as diet, for people who are at risk for type 2 diabetes mellitus. This research was done to compare the results of individual interventions and group interventions and its effect on diabetes risk-factors. The exact article can be found here, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247299/?tool=pubmed. The research article is split into 4 sections: background, method, results, and conclusion. Although the article is relatively easy to understand, there are a lot of figures and a bit of scientific jargon in the article and I shall try my best to summarize the article, by sections, in colloquial terms

The first section of the article is the background, which is basically an introduction to the article and a very brief overview of the trial. The article begins talking about type 2 diabetes and facts about the disease. Next the article discusses that a combination of diet and exercise is best when it comes to reducing type 2 diabetes risk factors. This research is randomized and controlled with a focus on seeing the effectiveness of interventions, by a physician, on a group versus being alone. It should be noted the lifestyle interventions are relatively the same except that the group based interventions have group meetings.

Basic timeline of the 2 groups

  The methods section of the article discusses the "how's" of this article. So test subjects were referred by their doctors who used the "Finnish Diabetes Risk score" (FINDRISC) to screen at-risk individuals. The FINDRISC accounts for waist circumference, body mass index (BMI), age, blood pressure, level of physical activity, insulin history and daily consumption of vegetables. The referred individuals were then examined, all by the same physician, and asked if they would like to participate in the study. If they agreed they were given the advice, the same for all, and randomly selected to participate as an individual (IG) or part of a group (2G). In summary, the advice was to eat healthily and to exercise regularly in order to decrease risk of type 2 diabetes and heart disease. The 1G participants, individuals, were basically free to do as they pleased and were only required to meet 3 times (6 months apart) with their study physician, who basically just interviewed, assessed, and motivated the individual. The 2G group participants had to do the same as the 1G except that they also needed to have 7 group meetings, all once a week and the first 6 in 6 consecutive weeks with the last meeting occurring 6 weeks after the last previous meeting. During the meetings, general information about diabetes was given out as well as a few group physical activities. During the assessments with the study physician, data about the subject’s blood pressure, waist circumference, height, weight, diet, and physical tests were taken in. So to sum it all up the study split the subjects into 2 categories to see the results of lifestyle intervention on individuals versus groups with assessments by physicians during the duration of the study.

Number of participants from referral to the end

  The results showed a multitude of statistical data in relation to their findings. Basically the statistics of the study are being examined and there’s a lot of numbers all over the page, so I will attempt to summarize the entire section. There was a 15% dropout rate in the study and the dropouts were generally unhealthier, at consultation, than those who finished the study. The randomization of individuals to the 2 categories seemed successful except that the individuals in 1G (individuals) were overall healthier than those of 2G at consultation. There was an emphasis on the improvement of aerobic ability and the overall improvement in dieting. Overall, both groups made improvements to their health, in terms of reducing diabetes risk-factors from consultation to the end of the project.

The article also notes the limitations that the study has:

1.      The information on diets was self-reported, meaning individuals could have lied about their diets to appease their physicians.

2.      28% of those who completed the study did not perform the treadmill test, which actually lowers the results of the fitness portion

3.      The study physician, the same one for 1G and 2G was aware of the randomisation of the participants which may of lead to some sort of biasness.

4.      The dropouts were “unhealthier” than those who completed the study, which means that the withdrawal in the study is more common among individuals who are “fed up” with the study. This creates a major healthcare challenge; a paradox, that those who are in desperate need of a lifestyle change are also those who are most likely to give up on the intervention.

5.      The results could be skewered due to the referral and selection process which could have been bias. But it should also be noted that the FINDRISC screening is a quantative analysis and shows that subjects were indeed at-risk of diabetes.

 The conclusion was short and sweet; group intervention is not necessarily better or worse than individual intervention even with the additional awareness and a group setting. Also, that improving diet and regular exercise makes one healthier... what a surprise.

This will be my last blog post for awhile and I hope I have been able to entertain you and shown you the importance of physical activity, although diet should not have been neglected as well.

Tim Cho.

 Works Cited:

Nilsen, Vegard, Per S. Bakke, and Frode Gallefoss. Effects of Lifestyle Intervention in Persons at Risk for Type 2 Diabetes Mellitus - Results from a Randomised, Controlled Trial. Rep. no. PMC3247299. PubMed, 25 Nov. 2011. Web. 14 Mar. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247299/?tool=pubmed>.