Treatment and lifestyle - key issues
Prevention of Type 2 diabetes
Lifestyle interventions are an effective approach to preventing diabetes and should be targeted at people identified as high risk of developing Type 2 diabetes. This includes people with impaired glucose tolerance (IGT) and/or impaired fasting glycaemia (IFT).
Modifications in diet and exercise are likely to be a first option for preventing Type 2 diabetes. In many cases the advice on healthy eating and exercise will replicate that advocated for the population as a whole. Interventions will be aimed at reducing weight, blood pressure and levels of blood lipids - the fats found in the blood, and improving glycaemic control.
Comparisons have been made of four large prevention trials which indicated the onset of diabetes can be prevented or delayed by 33% to 58% in high risk individuals using life-style interventions of varying intensity and duration which combined different intervention components (Samuel-Hodge et al 2006, pages 569 to 574).
A Chinese study of 577 men and women with impaired glucose tolerance randomised to lifestyle intervention groups had a 43% lower diabetes incidence for up to 14 years after the active intervention ceased. Also, diabetes onset was delayed on average by three to six years. The three interventions were dietary, exercise and combined interventions. Comparisons with other similar studies involving other cultures suggest that the effects of these interventions extend across cultures (Li et al 2008).
Compliance, concordance or adherence?
Diabetes is a complex condition requiring management across a range of lifestyle activities as well as management of medication. There is no single set of exact recommendations that can be applied in every case. However issues around non-compliance or non-adherence to treatment or what may be perceived as this can often arise.
Various factors can impact on this. For example the person with diabetes may not understand all the information and instructions they are given. Adherence in one area may not be replicated in another. A Cochrane systematic review was unable to establish what interventions were clearly effective in enhancing adherence to treatments, not including diet or exercise, in Type 2 diabetes (Vermeire et al 2005). Young people may experience particular challenges in dealing with the lifestyle and treatment regimens posed by Type 1 diabetes (Huus and Enskar 2007).
These complexities require a more patient-centred and shared approach to diabetes care. In relation to medication the term concordance is increasingly used rather than compliance to reflect this partnership approach. As with many emerging concepts definitions evolve and change and the publication of the NICE guideline on medicines adherence has added to the discussions on how compliance, adherence and concordance might be defined. For the purposes of the guideline the term adherence was preferred and is defined as "the extent to which the patient's behaviour matches agreed recommendations from the prescriber" (National Institute for Clinical Excellence 2009b, page 31).
Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the Reference list.
Resources
You will find here links to evidence-based resources which support this topic. You may also want to refer to information about the national service frameworks and strategies across the UK.
There are separate resources lists for specific aspects of treatment and lifestyle - see Treatment and lifestyle topics.
Some of the resources on this page are in PDF format - see how to access PDF files.
Guidelines and guidance
National Institute for Health and Clinical Excellence (NICE) (2009) Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence
This clinical guideline is about enabling patients to make informed choices by involving and supporting them in decisions about prescribed medicines.
NICE public health guidance (2011) Preventing type 2 diabetes – population and community interventions
This guidance (PH35) makes a series of eleven n recommendations including the integration of national strategy on type 2 diabetes with national activities to prevent other non-communicable diseases.
NICE Pathways: Diabetes overview
NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams.
One of the topic areas is on preventing type 2 diabetes.
Scottish Intercollegiate Guidelines Network (2010) Management of diabetes: SIGN publication number 116
This updates the SIGN guideline 55 published in 2001 incorporating all the new evidence published since then. The guideline includes recommendations for lifestyle interventions, for the management of cardiovascular, kidney and foot diseases and for the prevention of visual impairment. Specific advice for pregnant women with diabetes is provided. There are new sections on psychosocial issues and on glucose-lowering therapies in people with type 2 diabetes.
Systematic reviews and evidence summaries
Bandolier: Lifestyle Interventions to Prevent Diabetes
A review of an article providing evidence on the impact of diet and exercise on Type 2 diabetes.
BMJ: Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis
The review aimed to investigate the independent effects of intake of fruit and vegetables on incidence of type 2 diabetes. The report of the review published in the British Medical Journal concludes that "increasing daily intake of green leafy vegetables could significantly reduce the risk of type 2 diabetes and should be investigated further".
For more information about Cochrane Systematic Reviews, examples of which appear below, visit the page within this resource on the Cochrane Library.
Cochrane Review: Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus
"Nurse led interventions, home aids, diabetes education, pharmacy led interventions, adaptation of dosing and frequency of medication taking showed a small effect on a variety of outcomes including HbA1c."
Cochrane Review: Interventions for latent autoimmune diabetes (LADA) in adults
The best treatment strategies for latent autoimmune diabetes in adults (LADA) is unclear. This review aimed to compare interventions used for LADA.
Cochrane Review: Effect of the treatment of Type II diabetes mellitus on the development of cognitive impairment and dementia
This review was undertaken because epidemiological evidence shows a relationship between cognitive impairment and Type 2 diabetes.
Other resources
BBC Health Diabetes Guide
The BBC, in their pages on health, has put together information under headings including: about diabetes, living with diabetes, treating diabetes, and research into diabetes. Useful contacts and a range of personal stories are also included.
Better testing
This website aims to be an information source on tests for health care professionals, particularly those working in primary care, and assumes knowledge of the context in which the tests are used. Information in each topic area is presented around a series of questions and answers based on evidence that exists particularly in the form of best practice reviews and consensus statements. There is the diabetes topic area.
Diabetes UK: Emotional well-being
This area of the Diabetes Uk website looks at the emotional impact of diabetes which in some people may lead to depression. It provides information on possible treatments and support including details of the Diabetes UK Careline.
Diabetes UK: Living with Diabetes
This section of the website covers many different aspects of coping with diabetes and its impact on daily living. It includes information for those caring for someone with diabetes and a microsite for younger people.
Diabetes UK and the All Parliamentary Group for Diabetes (2006) Diabetes and the disadvantaged: reducing health inequalities in the UK
This report looks at links between Type 2 diabetes, socio-economic deprivation and diversity in the UK, and examines possible solution to tackling the increasing prevalence of diabetes and poor health outcomes in diverse communities.
There are separate resources lists for other specific aspects of treatment and lifestyle - see Treatment and lifestyle topics.