Published online Jun 15, 2020. doi: 10.4239/wjd.v11.i6.261
Peer-review started: December 26, 2019
First decision: February 19, 2020
Revised: March 30, 2020
Accepted: May 5, 2020
Article in press: May 5, 2020
Published online: June 15, 2020
Processing time: 154 Days and 6.7 Hours
The prevalence rate of type 2 diabetes mellitus (T2DM) in rural areas is increasing rapidly, and lifestyle interventions can effectively reduce blood glucose in patients with T2DM, but the current diet and exercise guidance remains at the laboratory level, which is difficult for subjects to understand and operate. Existing exercise and diet management regimens are associated with two problems: Unclear exercise methods and schedule can lead to exercise injuries, hypoglycemia, and poor results; and poor compliance can lead to poor long-term hypoglycemic effects and incomplete correction of glucose metabolism disorders. It is urgent to refine diet and exercise programs and improve their effectiveness and patient compliance. The Human Metabolism Analyzer accurately analyzes the effects of food types, food intake sequence, and activity/exercise mode and schedule on the production and consumption of blood glucose, thereby providing simple and effective interventions for patients with T2 DM. Our small clinical observation pilot study demonstrated good clinical efficacy of real-life lifestyle interventions on T2DM, as well as on pre-type 2 DM, simple obesity, and polycystic ovary syndrome.
To turn the scientific data provided by the Human Metabolism Analyzer into life-oriented intervention measures, and apply the life-oriented intervention measures to the prevention and treatment of T2DM to observe its effectiveness and compliance, so as to provide effective and continuous intervention measures for the prevention of T2DM in rural residents.
The main goal was to observe the effect of life-style interventions on the metabolic indexes of rural patients with T2DM, and the secondary goal was to observe the compliance with this method.
Ten natural villages in Chaoshui Town, Penglai City, Shandong Province were randomly selected to screen the villagers over 50 years old. In the natural village as a group, 12 patients with type 2 DM were randomly selected from each group as the study subjects, and all the subjects were given lifestyle interventions and medication guidance. Lifestyle interventions included changing meal order (A), postprandial activity (B), anti-resistance exercise (C), and anti-abdominal breathing (D). DM education was carried out at least once a month, and a weekly telephone follow-up was conducted to supervise exercise and diet. Before and 3 mo after intervention, the differences of waist circumference, blood pressure, body mass index (BMI), motor function, body composition, blood glucose, and glycosylated glycosylated protein were compared, and the compliance of patients and the adjustment of hypoglycemic drugs were evaluated. All the data were processed with SPSS17.0 statistical software, and the data of waist circumference, BMI, blood glucose, HbA1c, blood pressure, motor function, and body composition before and after intervention were analyzed by paired t-test. Compared with the current lifestyle intervention methods for the treatment of T2DM, this study has achieved innovative breakthroughs in the following four aspects: (1) The way T2DM patients ate was defined. Based on each person's digestive ability (gastric acid secretion pattern), the diet structure that each subject was suitable for was determined, and the diet order of the subjects was guided at the same time. It not only ensured that the subjects did not have to go on a diet and had adequate nutrition, but also ensured the stability of postprandial blood glucose and the reduction of fat synthesis; (2) The activity and movement mode was defined. One hundred and twenty minutes of indoor and outdoor activities after a meal is the most effective activity or exercise time to reduce postprandial blood sugar and control fat synthesis. Anti-resistance exercise not only increases the number and strength of muscles, but also expels fat from muscles, which is the main measure to reduce insulin resistance; (3) The quantitative principle of gradually reducing the dose of insulin and other drugs was clarified. The subjects were instructed to reduce the drug dose step by step based on the blood glucose values monitored every day, so as to achieve the goal of gradually reducing the drug dose or even stopping the drug under the condition of stable blood glucose; and (4) Scientific methods were used in daily life. In this study, all these methods were transformed into life language and content that were easy to operate in daily life. The current pre-research work has proved the effectiveness and good compliance of this method.
One hundred and eight subjects completed the experiment. The compliance rates of A, B, C, and D lifestyle interventions were 57.79%, 60.55%, 64.22% and 75.23%, respectively. Fifty-four (67.50%) subjects who received hypoglycemic drugs reduced their blood sugar 3 times within 3 mo according to their blood sugar, and five (6.25%) cases gradually stopped using hypoglycemic drugs, and there was no significant fluctuation in blood sugar after drug reduction and withdrawal. After lifestyle intervention, the waist circumference, BMI, fasting blood glucose, and HbA1c decreased significantly (P < 0.001), and the motor function and body composition improved significantly (P < 0.001). The lifestyle intervention measures used in this study come from the accurate data obtained by the Human Metabolism Analyzer, which is effective, simple, and easy, without the hunger of ketogenic diet, and reduces the harm that high-intensity exercise may bring. For the first time, anti-abdominal breathing was used in the intervention of abdominal obesity and the prevention and treatment of DM with high compliance. Further research on the lifestyle intervention measures used in this study is still needed to clarify the molecular mechanism of improving insulin resistance and the duration of insulin resistance improvement, so as to provide more evidence for the fundamental solution of insulin resistance in patients with T2DM.
In the past, the lifestyle intervention measures for the prevention and treatment of T2DM only stayed in the laboratory stage, which was difficult for patients to master and their compliance was not high. This study uses the scientific data provided by the Human Metabolism Analyzer to transform all these methods into life language and content that are easy to operate in daily life. Specifically, it includes defining the diet, activity and exercise patterns, and the quantitative principle of gradually reducing the dose of insulin and other drugs, so as to truly achieve the daily life of scientific data. It is assumed that this method can effectively control the metabolic indexes of patients with T2DM, reduce the use of hypoglycemic drugs, and improve the compliance of patients. The results showed that lifestyle intervention could significantly improve the metabolic indexes such as waist circumference, BMI, blood pressure, HbA1c, body composition, exercise function and so on. Some patients could gradually reduce or stop using hypoglycemic drugs, and lifestyle intervention in T2DM had good compliance. This study realized the experimental hypothesis and provided effective and simple lifestyle intervention measures for rural T2DM patients.
The lifestyle intervention measures used in this study come from the accurate data obtained by the Human Metabolism Analyzer, which is effective, simple, and easy, without the hunger of ketogenic diet, and reduces the harm that high-intensity exercise may bring. For the first time, anti-abdominal breathing was used in the intervention of abdominal obesity and the prevention and treatment of DM with high compliance. Further research on the lifestyle intervention measures used in this study is still needed to clarify the molecular mechanism of improving insulin resistance and the duration of insulin resistance improvement, so as to provide more evidence for the fundamental solution of insulin resistance in patients with T2DM.