A community-based lifestyle intervention program for adults with type 2 diabetes mellitus in a low socio-economic status community

Fryer, Bradley James (2016-03)

Thesis (PhD)--Stellenbosch University, 2016

Thesis

ENGLISH ABSTRACT : The prevalence, and associated burden of type-two diabetes mellitus (T2DM), is rapidly increasing globally, and in South Africa, with men and women of all ages being affected. While there has been an extensive research into the pathophysiological mechanisms, and to some extent, the management of T2DM, healthcare systems are still not able to adequately deal with the increasing number of patients being diagnosed with the disease. Professional- and community-led lifestyle interventions have recently showed the most promise in combating T2DM. There is however, a paucity of data on comprehensive lifestyle interventions in communities of low socio-economic status (SES), where the incidence of T2DM and its related complications is high. The primary aim of this study was to determine the effectiveness of a community-based, 10-week lifestyle intervention on physiological, psychological and health-related outcomes in adults suffering with T2DM in a low SES community. Forty-three participants completed the study (age 59.5 ± 12.2 years, 25 Women; 18 Men), of which 23 made up the experimental group (EXP; BMI: 33.8 ± 7.5; HbA1c: 8.8 ± 2.1) and 20 made up the control group (CON; BMI: 34.4 ± 9.7; HbA1c: 9.4 ± 2.3). The control group completed a pre- and post-testing session, while experimental completed an additional post-testing retention session. The experimental group participated in a 10-week comprehensive lifestyle intervention. A number of anthropometric, cardiovascular and functional measurements were carried out, and questionnaires related to health-related quality of life (HRQoL), social support, dietary habits and lifestyle behaviours, as well as health professional usage were also administered. Following the 10-week comprehensive lifestyle intervention, there was a positive change in the outcome variables measured. There was a statistically significant decrease (p < 0.05) in body fat percentage, diastolic blood pressure and HbA1c, with a statistically significant increase in the total distance walked during the six-minute walk test (6MWT) (p < 0.05). Furthermore, there was a statistically significant improvement (p < 0.05) in all but three of the HRQoL domains. Dietary habits and lifestyle behaviours improved significantly (p < 0.05), with the exception of eating times where there was no change. The frequency at which the participants actively sought professional assistance with the management of their T2DM did not change significantly (p > 0.05). The results from the retention period, obtained 10-weeks after the conclusion of the intervention, suggest that the changes as a result of the program were maintained, however, it is uncertain if those results can be attributed to the use of the post-intervention guide. The findings of this study indicate that a 10-week comprehensive lifestyle intervention is effective in improving physiological, psychological and health-related outcomes in adults with T2DM living in a low SES community. The use of a post-intervention guide as an assistive device to maintain these improvements requires further investigation and revision. Furthermore, this study reveals the opportunity for community-based interventions to assist the primary healthcare sector in the management and prevention of T2DM.

AFRIKAANSE OPSOMMING : Die toeneemende voorkoms en geassosieerde las van tipe-twee diabetes mellitus (T2DM), global en in Suid Afrika, affekteer beide mans en vrouens van alle ouderdomme. Alhoewel daar ekstensiewe navorsing gedoen is in patofisologiese meganismes en tot sekere mate die bestuur van T2DM, sukkel gesondheidsorg stestels nogsteeds met ‘n toename in pasïente gediagnoseerd met die siekte. Onlangs is dit bewys dat professionele- en geemeenskap begeleide leefstyl intervensies toon die hoogste potensiaal om T2DM teen te werk. Daar is egter min data oor volledige leefstyl intervensies in geemeenskappe van lae-ekonomiese status (LES) waar die voorkoms van T2DM en sy verwante komplikasies hoog is. Die primêre doel van die studie was om die effektiwiteit van ‘n gemeenskap-gebaseerde 10-weke leefstyl intervensie op fisiologiese, sielkundige en gesonheids-verwante uitkomste in volwassenes met T2DM in LES gemeenskap te bepaal. Drie en veertig deelnemers het die studie voltooi (ouderdom 59.5 ± 12.2 jaar, 25 Vrouens; 18 Mans). 23 deelnemers was deel van die eksperimentele groep (EKS; LMI: 33.8 ± 7.5; HbA1c: 8.8 ± 2.1) en 20 deelnemers het gedien as die kontrole groep (KON; LMI: 34.4 ± 9.7; HbA1c: 9.4 ± 2.3). Die kontrole groep het voor en na toetsing vooltooi, terwyl die eksperimentele groep ‘n addisionele toetsing na ‘n retensie periode afgelê het. Die eksperimentele groep het deelgeneem in ‘n 10-weke volledige leefstyl intervensie. Antropometriese, kardiovaskulêre en funksionele metings is geneem, en vraelyste aangaande gesondheids verwante lewens kwaliteit (HRQoL), sosiale bystand, dieet en leefstyl gewoontes, asook gebruik van mediese dienste was geadministreer. Daar was positiewe uitkomsveranderlikes na die 10-weke volledige leefstyl intervensie. Daar was ‘n statistiese beduidende daling (p < 0.05) in liggaamsvet persentasie, diastoliese bloeddruk, en HbA1c, met ‘n statistiese beduidende toename (p < 0.05) in die totale afstand gestap gedurende die ses minute stap toets (6MST). Verder, was daar ‘n statistiese beduidende verbetering (p < 0.05) in almal behalwe drie van die HRQoL domeine. Dieet en leefstyle gewoontes het statisties beduidende verbeter (p < 0.05) met die uitsondering van etenstye waar geen verandering plaasgevind het nie. Daar was geen statistiese beduidende verandering (p > 0.05) in die gebruik van mediese dienste om T2DM te bestuur nie. Na gelang van die 10-weke retensie periode blyk dit dat die uitkomste van die intervensie behoue gebly het, alhoewel dit onseker is of dit toegesryf kan word aan die oefenings handleiding. Die bevindinge van die studie bewys dat ‘n 10-weke volledige leefstyl intervensie effektief is om fisiologiese, sielkundige en gesonheids-verwante uitkomste in volwassenes met T2DM in LES gemeenskappe te verbeter. Die oefenings handleiding as ‘n addisionele hulpbron om die verbetering te behou verg verdere ondersoek. Die studie toon die geleentheid vir verder gemeenskap gebasseerde intervensies om die primêre gesonheidsdiens sektor by te staan met die bestuur en voorkoms van T2DM.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98537
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