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Research Question

"Do type 2 diabetic patients achieve better glucose control with physical activity as their primary treatment compared to type 2 diabetic patients treated with medication therapy?"

Background

Type II diabetes mellitus (T2DM) has been recognized as an epidemiological health burden, especially observed in developing nations. As per the statistical estimation by the International Diabetes Federation (IDF), T2DM is prevalent among 536.6 million individuals globally (adults 10.5% approx.) in 2021 and is expected to show an increase to 783.2 million (12.2% approx.) by 2045 (Yan et al. 2021). Evidence-based understanding further implies that diabetes has been highly prevalent in recent years, and China is one of the most significant contributors to the rising statistics of T2DM. According to Wexler (2021), treatment procedures for T2DM patients in recent years involve health education, micro and macro-vascular complications evaluation, reducing the rate of cardiovascular symptoms, and glycemic control. While understanding treatment modalities and therapeutic approaches to treat unmodifiable risk factors, certain factors are modifiable risks and need proper attention. This involves patient education, a sedentary lifestyle, and smoking or drinking habits (Yan et al., 2021).

Study Outline

The concerned study has reviewed four journal articles considered for annotated bibliography and addresses the research question. Through this approach, each of the papers has been explored thoughtfully and commenced whether the papers have produced insights into the IDF-recommended health interventions for T2DM. Notably, the first study by Syeda et al. (2023) explained the importance of physical exercise in managing glycemic control in diabetes and how continuous aerobic exercise can help manage the glucose level in the blood. The following study by Yang et al. (2019) demonstrated the effectiveness of physical activity as a common therapy to prevent diabetes and provided theoretical perspectives with confirmed benefits of physical exercise. The third study by Bétry et al. (2023) explained the questionable impact of physical activity on weight gain by insulin therapy and presented contradictory information based on a randomized, controlled, and multicentered trial. Upon focusing on the fourth study by Suprapti et al. (2023), specific significance is given to regular exercise and medication nonadherence among diabetic patients. Through this information, the research outcome is expected to deliver an understanding of the contradictory benefits of physical exercise for T2DM patients and the nonadherence to medication therapy.

Annotated Bibliography

Syeda, U. A., Battillo, D., Visaria, A., & Malin, S. K. (2023). The importance of exercise for glycemic control in type 2 diabetes. American Journal of Medicine Open, 9, 100031. https://doi.org/10.1016/j.ajmo.2023.100031

Aim: The study investigated the potential of exercise as a first-line therapy, which is recommended for type II diabetes patients. The information produces extensive insights into the prevalent condition of diabetes in the US and states that approximately 3.8% of adults are undiagnosed. Moreover, approximately 45.8% of the adult population is indicated with prediabetic conditions, thus increasing the economic burden concerning healthcare. Based on the purpose of the study, significant knowledge is gained on type II diabetes and prediabetes, which has been characterized by a reduction of insulin sensitivity and dysfunctional condition of β-cells. This emphasis puts forward an understanding of the cause for the reduction and explicitly provides information regarding the necessity of overnutrition and exercise to promote hypersecretion.

Methodology: A systematic review is performed by gathering information from different observational studies. The information is highly specific and designed to introduce lifestyle programs recommended by ACSM, IDF, and ADA to increase the effort of physical exercise to prevent diabetes by enhancing glycemic control. The systematic literature review provides extensive information on dose-response relationships, glycemic control, and physical exercise's influence on controlling body weight from clinical interventions.

Result: As per the implication of the outcome presented with the information on T2DM prevention and control, observational outcomes from clinical trials provide specific knowledge on the significance of lifestyle programs and an effort to prevent glucose levels and manage glycemic conditions within a range. Particularly, the information provides insights into the efficiency of weight loss through daily aerobic exercise for 150 minutes/week (vigorous) or 75 minutes/week (moderate). More specific observation from the review has outlined that caloric restriction with continuous physical exercise with improved insulin sensitivity and glucose tolerance level can yield significant gain. Moreover, adding aerobic exercise for caloric restriction can improve weight regulation, essential to control diabetes. Distinctly, participants aged 50-70 years are reviewed to implicate their varying exercise intensities, which shows that participants with high resistance and moderate endurance exercise groups show a more significant reduction of visceral fat across the 11-month supervised program.

Evaluation: The study highlights extensive information based on the 3-week supervised program and further 11-month self-management compliance protocols and present validated information, which are adequate to recognise the suitability of exercise as a primary intervention to prevent T2DM. The study emphasized recent evidence published by DPP, IDF, and other health authorities that have supported lifestyle programs and notably indicates weight loss's significance in preventing diabetes. While considering the study's strength, it is also discerned that the recognition for optimal exercise dosage to control blood glucose is unclear, thus showing the gap in the literature.

Conclusion: Undoubtedly, the study provides rigorous knowledge of the significance of physical activity over medication therapy as the primary level of treating type II diabetes. However, statistical estimations should intervene with a more demonstrative exercise trial that explains the benefits of some physical activities while giving clear insights into the lack of others.

Yang, D., Yang, Y., Li, Y., & Han, R. (2019). Physical exercise as therapy for type 2 diabetes mellitus: From mechanism to orientation. Annals of nutrition and metabolism, 74(4), 313-321. https://doi.org/10.1159/000500110

Aim: The study demonstrates the importance of exercise therapy as an essential intervention to prevent and control type II diabetes. The information gives insights into exercise training and comprehensive programs that play a potential role in improving body metabolism among patients with diabetes. The study has increasingly discerned knowledge of various necessary modulation factors essential in controlling and preventing diabetes in patients. More importantly, the study has introduced classific diabetes protocols on “5-carriages” management, which shows that exercise therapy has become a lifestyle intervention strategy which is easily accessible and cost-effective. The focused information has detailed the mechanism of progressive intervention of physical exercise and its link to T2DM.

Methodology: A systematic literature review focuses on exercise therapy and its importance in preventing and treating type II diabetes. The review has detailed analyses based on cohort observation and clinical trials with varying study populations, detection methods and sample sizes. The discovery of information has recognised novel indicators such as cytokine, which is an essential hormonal regulator to mediate exercise therapy. Overall, the information is specific to different modulators and management protocols relevant to unwinding the significance of physical activity rather than pharmacological evidence.

Result: The specific deliverables from the study adhere to exercise therapy and provide necessary insights on its importance as a first-line intervention in preventing diabetes. As explained, different modulators are explored in the study to understand various complicated mechanisms. In this regard, the contribution of cytokines is disclosed, especially irisin, osteoclast, and ADP. These cytokines have incorporated a novel insight from reviewed studies and are considered to be potential mediators to enhance physical activity to prevent T2DM and other metabolic diseases. Study participants focused on during the systematic review reflect healthy young individuals, overweight and obesity-induced individuals. Since the outcome is focused on different mediators, insights have been deduced into the biological functions of these mediators. Adipokine - an adipose-derived secretion factor released by adipose tissues shows a link to pathophysiological processes and has a positive correlation with insulin sensitivity.

Evaluation: The evaluation of the information has validated the significance of the study and revealed various complicated mechanisms aligned to exercise therapy intervention in the prevention of diabetes. Insights from the review have explained the biological functions of different cytokines and provided distinct knowledge of their adherence to enhanced exercise therapy to prevent metabolic diseases like diabetes and cardiovascular disease. However, it is observed that there is a higher discrepancy in information, particularly in implicating the association between exercise and variation in cytokine levels. Moreover, the prevalence of complication mechanisms that adhere to T2DM management by exercise therapy is an unclear concept.

Conclusion: Even though the study provides insights into the essentiality of physical exercise in preventing diabetes, high-quality and randomized-controlled studies are necessary to develop and understand the mechanism and provide theoretical perspectives regarding exercise therapy with new therapeutic approaches for T2DM.

Bétry, C., Lablanche, S., Carvalho, M., Amougay, H., Du-Boullay, H., Crand, A., ... & Borel, A. L. (2023). Effect of a lifestyle intervention to prevent weight gain at initiation of insulin pump therapy in type 2 diabetes: A randomized, controlled, multicentre trial. Diabetes Research and Clinical Practice, 200, 110698. https://www.sciencedirect.com/science/article/abs/pii/S0168822723004618

Aim: The study investigates the potential of insulin therapy as a pharmacological intervention to reduce glycemic control in type II diabetes patients. In this assessment, the study also outlined the weight gain condition linked to the therapy. Upon providing insights into the therapeutic intervention, the study significantly draws attention to investigating the effectiveness of dietary and exercise therapy programs for six months. Further, the assessment compared the usual medication therapy and prevention of weight gain during post-insulin pump.

Methodology: A multicentre randomized and controlled study has been conducted with a study population of 54 participants. Since the study focuses on a quantitative method, primary endpoints are denoted among groups with specific differences in weight gain during six months. Study participants have been randomized based on two significant arms split into a 1:1 ratio - intervention arm and control arm. The randomized intervention arm has received home-based diet and exercise program support. On the contrary, the control arm has received the standard management program based on insulin therapy.

Result: Among the 54 randomized participants, 53 have been analyzed, of which 28 participants are included in the intervention group while 25 participants are included in the control group. Based on the information outlet from the study, it has been observed that the diabetes treatment is intensified with insulin therapy in the control group and initially treated with multi-daily injections combined with metformin. It has effectively reduced glycemic index; however, it encourages 1kg weight gain with an HbA1c drop of 1%. Correspondingly, there was no decrease in weight gain in the intervention group with a home-based diet and physical activity program for six months.

Evaluation: The evaluation of the result provides contradictory information on the effectiveness of lifestyle intervention programs with physical activity to control diabetes. Although it is clear from the outcome that insulin therapy leads to weight gain with a decrease in the glycemic level, hypothetical observation shows no adherence between weight gain prevention and home-based intervention to prevent diabetes.

Conclusion: Upon evaluating the outcome, it can be concluded that further studies are necessary to address the research question. It concerns exercise therapy as a novel intervention to prevent type II diabetes and consequent weight gain from medication therapy.

Suprapti, B., Izzah, Z., Anjani, A. G., Andarsari, M. R., Nilamsari, W. P., & Nugroho, C. W. (2023). Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study. Global Epidemiology, 100113. https://doi.org/10.1016/j.gloepi.2023.100113

Aim: The study assessed medication adherence and glycemic control as well as the influence of different mediating factors to control diabetes among OPD patients in the Indonesian clinic. The study deduced insights specific to the Indonesian population with diabetes in adults aged 20-79 years, which is approximately 19.5 million individuals in 2021. It is recognised that diabetes needs proper therapeutic approaches for its prevention and control. The assessment provides a comparison of self-care approaches with medication adherence and underlying complications.

Methodology: A cross-section quantitative study was conducted on type II diabetes patients admitted to an Indonesian hospital-based clinic. The experimental study was conducted in September-December 2018, and purposive sampling was applied. Study participants aged 18 years or above with diabetes and other comorbidities received various hypoglycemic agents, and their informed consent was included. A questionnaire based on brief medication is distributed among respondents to evaluate medication adherence, and HbA1C levels are utilized to measure glycemic index. Further logistic regression has been performed to evaluate factors linked to medication adherence & glycemic control.

Result: Among 321 participants (patients), 268 participants are reported to be medication nonadherent. Accordingly, individuals without physical activity show a solid adherence to medication. It has been observed that inadequate glycemic control is indicated among 106 participants. Consequently, patients more often took a combined oral dosage of hypoglycemic agents & insulin but showed nonadherence to biguanide, thus indicating hyperglycemia and other metabolic diseases.

Evaluation: The evaluation of the result shows a validated approach to understanding an inverse link between medication nonadherence and high glycemic index. Moreover, it has been indicated that regular physical activity can lead to medication nonadherence and alternatively become a predictor of inadequate glycemic control. Even though the study provides information on a positive link between diabetes control and physical activity, a gap in insights is observed on strategies that explain the contribution of exercise therapy as a primary contributor to glycemic control.

Conclusion: Based on the evaluation, it is integral to explain that medication nonadherence is linked to physical activities among patients with Type II diabetes. However, further studies with quantitative insights into strategies can provide deliverables on exercise therapy, and glycemic control is recommended.

Evaluation of Articles

The literature search performed in this study focuses on developing information that provides arguable insights relevant to the healthcare question. In this regard, the four articles that have been selected provide validated and reliable information, which are both qualitative and quantitative. The peer-reviewed and experimental studies are focused on and collected from a recent time frame (5 years) to optimize the reliability of the information and reduce biases. The literature study selected and emphasized enabled to understand the significance of physical exercise in preventing type II diabetes and also provide implications of how exercise therapy is a potential primary intervention than medication therapy to treat diabetes. Accordingly, each study's research strength and gaps are analyzed based on their methodological approaches and, henceforth, show the research reliability.

Conclusion

The typical assessment of the articles in the annotated bibliography has addressed experimental and explanatory research evaluations critical to explaining the research question. As per the evaluation of each article, it can be stated that the information produces high-quality evidence. However, some information needs further clarification with more in-depth research in the future. Understandably, the information serves as critical evidence on risk factors associated with T2DM prevalence and enables an approach to explore reliable measures that are cost-effective and accessible. It has been observed that medication therapy is effective in reducing glycemic control, but there is a risk of weight gain from specific therapy. On the other hand, exercise therapy is a productive measure that is accessible, cost-effective, and reliable to control diabetes without the risk of weight gain. Based on these papers, the authors have delineated the approach and effectiveness of exercise therapy in T2DM. However, repeatedly discloses the need for further research to unveil different healthcare challenges related to non-infectious disorders.

Reference

Bétry, C., Lablanche, S., Carvalho, M., Amougay, H., Du-Boullay, H., Crand, A., ... & Borel, A. L. (2023). Effect of a lifestyle intervention to prevent weight gain at initiation of insulin pump therapy in type 2 diabetes: A randomized, controlled, multicentre trial. Diabetes Research and Clinical Practice200, 110698. https://www.sciencedirect.com/science/article/abs/pii/S0168822723004618

Suprapti, B., Izzah, Z., Anjani, A. G., Andarsari, M. R., Nilamsari, W. P., & Nugroho, C. W. (2023). Prevalence of medication adherence and glycemic control among patients with type 2 diabetes and influencing factors: A cross-sectional study. Global Epidemiology, 100113. https://doi.org/10.1016/j.gloepi.2023.100113

Syeda, U. A., Battillo, D., Visaria, A., & Malin, S. K. (2023). The importance of exercise for glycemic control in type 2 diabetes. American Journal of Medicine Open9, 100031. https://doi.org/10.1016/j.ajmo.2023.100031

Wexler, D. J. (2021). Initial management of hyperglycemia in adults with type 2 diabetes mellitus. UpToDate, Post, TW (Ed), UpToDate, Waltham, MA. https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus

Yan, Y., Wu, T., Zhang, M., Li, C., Liu, Q., & Li, F. (2022). Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population. BMC Public Health22(1), 1-6. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-13759-9#:~:text=According%20to%20the%20latest%20International,worldwide%20by%202045%20%5B4%5D.

Yang, D., Yang, Y., Li, Y., & Han, R. (2019). Physical exercise as therapy for type 2 diabetes mellitus: From mechanism to orientation. Annals of nutrition and metabolism74(4), 313-321. https://doi.org/10.1159/000500110

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