Prediabetics

1. ASESSMENTOFLIFESTYLE INTERVENTIONINMEN ANDWOMEN(24-50)YEARSOF
AGEWITHIMPAIREDGLUCOSETOLERANCEORPREDIABTESINMUMBAI.
BY
KARISHMA SHAH,
MSC-2 (CND),
DR B.M.N COLLEGE

2. INTRODUCTION
 Clinical practice guidelines have defined pre-diabetes as either impaired fasting
glucose (IFG) (fasting plasma glucose [FPG] of 100–125 mg/dl) or impaired
glucose tolerance (IGT) (glucose of 140–199 mg/dl on a 2-h oral glucose
tolerance test [OGTT]. 1
 The prevalence of pre-diabetes among U.S. adults was 12.6% by the A1C
criterion and 28.2% by the fasting glucose criterion.2
 The prevalence of pre diabetes (impaired fasting glucose and/or impaired
glucose in Maharashtra was 14.6%.
 Significant risk factors for pre diabetes is age, family history of diabetes,
abdominal obesity, and hypertension and income status.

3. Since increased weight, BMI, waist circumference, wrong eating
habits and physical inactivity
leads to increased risk of diabetes and pre diabetes, the current
study therefore has been undertaken to investigate the effect of
nutrition education and lifestyle intervention on pre diabetic patients
with the following objectives:
To assess the nutritional status by anthropometric measurements.
To assess the nutritional status of pre diabetic patients using food
frequency questionnaire.
To see the effect of nutritional education and lifestyle intervention
programme on pre diabetic patients.
To see the effect of physical activity on anthropometric and
biochemical parameters.
To see the effect of eating pattern on anthropometric and
biochemical parameters

4. METHODOLOGY
It was then checked if their biochemical parameters, eating habits, physical activity had improved in order to prevent
type 2 diabetes
After 2 months the post questionnaire was again introduced with same format and procedure as done at the time of
collecting pre questionnaire
During follow up the participants were asked if they were following the guidelines and education and recipes given to
them initially.
The nutrition and education was given by preferred mode of understanding i.e. (reading, demonstration, listening) by
participants.
After the initial meeting, the participants were again called for follow-up depending upon their convenience
After which nutrition education was given in guideline format and recipe sheet which was then explained to them
verbally.
As the participants were not well educated the questionnaire was not filled by them they were verbally asked questions
in preferred language by participants.
The sampling technique used was purposive sampling. The data was collected using pre and post questionnaire
The participant chosen for study were in age group of (24-50) and total participants were 35 out of which 21 were
females and 14 were males.
The study was carried out in four dispensaries across Mumbai city from the areas of kandivali, borivli, and currey road.

5. REVIEW OF LITRERATURE
 It is well known that people with pre-diabetes have an increased risk of
progression to type 2 diabetes mellitus. (J Unwin, et al, 2002)
 Study done by (Y Zhang, et al, 2009) describes the possible causes and
distribution of diabetes over the last 20 years has been extraordinary. These
studies continue to confirm that it is the low- and middle income countries that
face the greatest burden of diabetes. Population-based diabetes studies
consistently show that a substantial proportion of those found to have diabetes
had not been previously diagnosed. Many people remain undiagnosed largely
because there are few symptoms during the early years of type2 diabetes, or
those symptoms may not be recognized as being related to diabetes.
 In recent 12 epidemiological studies in Chennai have indicated a rapid
conversion of IGT to diabetes, resulting in increased prevalence of diabetes with
a concomitant reduction in the number of IGT participants. (A Ramachandra, et
al, 2008)

6.  A Study done by (Lindstrom J, et al, 2006) evaluated 577 participants with IGT
who were randomized to a control group or to one of three active treatment groups
(diet only, exercise only, or diet plus exercise). After a 6-year follow-up period, it
was found that the diet, exercise, and diet-plus-exercise interventions were
associated with 31%, 46%, and 42% reduction in risk of developing diabetes,
respectively.
 The Finnish Diabetes Prevention Study (DPS) showed that it is possible to achieve
primary prevention of T2DM by changing lifestyle (diet and exercise) in
participants with IGT (n=522), reducing the risk of diabetes by 58% in the
intervention group. The participants were randomly allocated either into the control
group or an intensive lifestyle intervention group, and the cumulative incidence of
diabetes after 4 years was 11% in the intervention group and 23% in the control
group. (Tuomilehto J, et al, 2001).
 In a recent meta-analysis of 23 studies, structured exercise training was associated
with a 0.7% fall in HbA1c, compared with controls. Structured exercise of .150
min/week was associated with a fall in HbA1c of 0.9%, 150 min/week with a fall of
0.4%. Overall, interventions of physical activity advice were associated with lower
HbA1c levels only when combined with dietary advice. (Kirk AF, et al, 2007).

7. Demographic profile
The subjects in the present study belonged to three religions viz. Hindu, Christian
and Muslims.
 There were 32 participants who belonged to the Hindu religion, 2 from the
Christian religion and only 1 was found to be from the Muslim religion.
 The high percentage of Hindu participants was evident because the area in which
the dispensaries were located majorly had Hindu residing population.
The mean Age, Height, Weight BMI of male and female participants were as
follows:
RESULTSAND DISSCUSSIONS
Anthropometric
measurement
Female Male
AGE (years) 42.73±4.74 years
HEIGHT (cms) 155.764 ± 4.39 164.14± 4.24
WEIGHT (kgs) 64.67 ± 3.61 70.00±10.8
BMI (kg/m²) 26.7 ± 1.67 25.9± 3.50

8.  The common occupation amongst subjects were found to be Business class,
service class and Housewives. Majority of participants i.e. 19% were housewives
13% were employed and rest 3% were from business community.
 The participants were primarily found to be from the medium socio economic
group from the point of view of the average monthly income of the participants
being between 10,000 -15,000 INR. However out of 35 subjects 19 of the subjects
i.e. the housewives reported that they would not like to be considered in any of the
range of monthly income as their complete expenditure was dependent on their
spouses and children in some cases.
Lifestyle pattern of participants
 Since the subjects were within the medium socio economic status and hence the
lifestyle modification that were introduced was within the affordable range. The life
style modification that was incorporated was such that the subjects are restricted to
certain diet and encouraged to do more physical activity. There was no introduction
of high priced supplements or elite foods to be consumed.
 It was found that out of 35 participants 15 of them are having family history of
diabetes and rest 20 participants did not show any family history of diabetes or pre
diabetes.

9. Impact of nutrition education on food consumption pattern
 The guidelines to prevent type 2 diabetes provided to the participants included that the
participants should have more of whole grains and high protein food and less processed
foods in their diet. The participants were seen to be consuming more of Bajra, Bengal
pulses, non-vegetarian foods, nuts and oilseeds and less of bread, vegetables and fruits
and other processed foods after receiving guidelines on lifestyle modification in the pre-
diabetic patients.
 The consumption of whole grains was seen to increase considerably after the
guidelines were given to the participants. The importance of eating whole grains which
are a major source of fibre and protein in the diet of pre-diabetic or diabetic patients was
explained that whole grains play an important role in lowering the risk of chronic
diseases, such as coronary heart disease, diabetes, and cancer, and also contribute to
body weight management and gastrointestinal health.4
 Also in the present study it was found that that consumption of home-made dairy
products like curd, buttermilk, milkshake (suggested to take without sugar), paneer
cheese was seen to increase from never to once in 15 days and occasionally. And rest
ice-cream, butter, buffalo milk were seen to decrease. The participants were encouraged
to consume buttermilk, curd, milkshake and cheese occasionally as these are low fat and
high in calcium.

10. FIGURE 1. CONSUMPTION OF FRIED & JUNK FOOD
 The consumption of fried foods, bakery foods and was seen to be reduced in post as people
who use to consume these foods frequently have shown to either completely stop it or
consume it occasionally. The overall consumption of butter was also seen to reduce.
However the junk food i.e. pizza, burger etc was seen to be same in pre and post.
 Current dietary recommendations advise reducing the intake of saturated fatty acids (SFAs)
to reduce coronary heart disease (CHD) and diabetes risk, This expert panel reviewed the
evidence and reached the following conclusions: the evidence from epidemiologic, clinical
studies is consistent in finding that the risk of CHD and other non-communicable diseases
risk is reduced when SFAs are replaced with polyunsaturated fatty acids (PUFAs).7
0
5
10
15
20
25
30
35
never
ocassionaly
once in 15 days
once a week
2-3 days
4-5 days
daily

11. FIGURE 2. CONSUMPTION OF SWEETENED PRODUCTS
 In the present study the overall consumption of sweetened products by the participants
was seen to reduce from frequently i.e. 2-3 days or 4-5 days to occasionally eating of
sweetened products.
 Certain studies also say that controlling the intake of sugar sweetened products
represents an important component of lifestyle management for weight control and
maintenance. Limiting sugar sweetened products may also confer favorable benefits on
T2DM and cardiovascular risk such as improving lipid profiles and insulin sensitivity
and reducing blood pressure, inflammation, and accumulation of visceral adiposity.8
0
5
10
15
20
25
never occasionaly once in 15
days
once a week 2-3 days 4-5 days daily
pre ice-cream
post ice-cream
pre sweets
post sweets

12. FIGURE 3. Percentage of participants being involved in daily exercise
and post nutritional intervention
 The participants were asked to increase their physical activities and more number
of participants to be involved in some or the other type of physical activity other
than the normal daily chores. As described in the above figure, the participants were
seen to be involved in certain activities like yoga, jogging or brisk walking.
 The number of participants who reported never being involved in any kind of
physical activity was substantially reduced and participants involved in evening
physical activity was seen to have increased.
Morning Evening Mid -evening Never
Pre 4 7 2 22
Post 6 18 4 7
0
5
10
15
20
25

13.  The overall impact of nutritional education on food consumption and physical activity
was seen to have a positive outcome and hence the blood sugar level of participants was
seen to be reduced to a major extent. As seen in figure below:
 The p value of fasting blood sugar was 0.007 and that of post lunch blood sugar was
seen to be 0.000 which is highly significant.
BIOCHEMICAL
PARAMETERS
Mean ±S.D T Value P Value
Pre: Fasting blood
glucose
114.89 ±7.7
2.880 0.007
Post: Fasting blood
glucose
111.49 ± 8.5
Pre: Post lunch blood
sugar
162.74 ±15.16
3.909 0.000
Post: Post lunch
blood sugar
153.89 ± 10.87

14. RECOMMENDATIONS
The study could have been conducted in younger and older people.
The intervention period of study could have been longer than 2 months.
One on one counselling should be encouraged.
LIMITATIONS
Due to time constraint large sample size could not be considered.
HBA1C and cholesterol levels could not be collected.

15. BIBLIOGRAPHY
 Centre for Disease Control and Prevention. National Diabetes Fact Sheet: General
Information and National Estimates on Diabetes in the United States. Atlanta, GA, U.S.
Department of Health and Human Services, Centres for Disease Control and
Prevention, 2008
 Bullard KM, Saydah SH, Imperatore G, et al. Secular changes in U.S. pre diabetes
prevalence defined by haemoglobin A1c and fasting plasma glucose: National Health and
Nutrition Examination Surveys, 1999–2010. Diabetes Care; 36:2286–2293
 N. Unwin, J. Shaw, P. Zimmet, K.G.M.M. Alberti Impaired glucose tolerance and
impaired
 Zhang Y, Dall TM, Mann SE, et al. The economic costs of undiagnosed diabetes. Popul
Health Manag; 12:95–101
 Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of
type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention
Study. Lancet.2006; 368:1673–1679.
 Ning F, Tuomilehto J, Pyorala K, Onat A, Soderberg S, Qiao Q. Cardiovascular disease
mortality in Europeans in relation to fasting and 2-h plasma glucose levels within a
normoglycemic range. Diabetes Care 2010; 33:2211–2216.

16.  Kirk AF, Barnett J, Mutrie N. Physical activity consultation for people with Type 2
diabetes: evidence and guidelines. Diabet Med 2007; 24:809–816.
 Jonnalagadda, S. S., Harnack, L., Liu, R. H., McKeown, N., Seal, C., Liu, S., & Fahey, G.
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 Astrup, Arne, Jørn Dyerberg, Peter Elwood, Kjeld Hermansen, Frank B. Hu, Marianne
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17. THANK YOU