Effect of Lifestyle Modification Intervention on Diabetes Mellitus Treatment Outcomes in Tuberculosis Patients with Diabetes Mellitus in Southwest Nigeria

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DOI: 10.21522/TIJPH.2013.11.02.Art030

Authors : Ifeanyi Ugoh Godwin, Nnodimele O. Atulomah

Abstract:

There is an observed poor treatment outcome of Diabetes mellitus (DM) in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to interference of drugs used in the treatment of Tuberculosis (TB) with first- line drugs used in the treatment of DM. Insulin does not interact with TB drugs, but it is not accessible and affordable to low–resource communities due to high cost. Hence a lifestyle-based intervention, which this study evaluated to determine its effect on Diabetes control in these individuals. It is a quasi-experimental intervention with two groups of 25 participants each as experimental and control cohorts, enrolled from Tuberculosis Healthcare centers in Lagos and Oyo states. The questionnaires were administered after the baseline Glycated hemoglobin (HBA1c) has been measured, repeated after 12 weeks, and analyzed with SPSS software. In the control cohort, the difference in the means of HBA1c was statistically significant at 95%CI: 1.1(0.2 – 2.1; p<0.05), indicating a worsening of blood glucose control. The difference in the means of educational scores was not significant 95%CI: -0.04(-2.8 – 2.7; p<0.05), showing no uptake. In the intervention group, the difference in the means of the HBA1c was statistically significant 95%CI: -2.4(-3.1 – 1.6: p<0.05), indicating improvement in glucose control. The difference in the means of the educational and behavioral score was significant statistically 95%CI: 40.6(37.7 – 43.6; p<0.05) indicating uptake of behavioral changes. The intervention with educational and behavioral lifestyle modifications improved the blood glucose control as an adjunct to the conventional treatment with drugs compared to the control group.

Keywords: Behavioral change, Lifestyle, Treatment, Tuberculosis-Diabetes comorbidity.

References:

[1] Saklayen M. G. (2018). The Global Epidemic of the Metabolic Syndrome. Current hypertension reports, 20(2), 12. https://doi.org/10.1007/s11906-018-0812-z.

[2] Dunachie, S., & Chamnan, P. (2019). The double burden of Diabetes and global infection in low and middle-income countries. Transactions of the Royal Society of Tropical Medicine and Hygiene, 113(2), 56–64. https://doi.org/10.1093/trstmh/try124.

[3] Lin, X., Xu, Y., Pan, X. et al. (2020). Global, regional, and national burden and trend of Diabetes in 195 countries and territories: an analysis from 1990 to 2025. SciRep 10, 14790. https://doi.org/10.1038/s41598-020-71908-9.

[4] Khan, M., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. Journal of epidemiology and global health, 10(1), 107–111. https://doi.org/10.2991/jegh.k.191028.001.

[5] World Health Organization. (2021). Diabetes. https://www.who.int/news-room/fact- sheets/detail/diabetes.

[6] Amanat, S., Ghahri, S., Dianatinasab, A., Fararouei, M., & Dianatinasab, M. (2020). Exercise and Type 2 Diabetes. Advances in experimental medicine and biology, 1228, 91–105. https://doi.org/10.1007/978-981-15-1792-1_6.

[7] World Health Organization. (2021). Non-communicable

[8] diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.

[9] Koye, D. N., Magliano, D. J., Nelson, R. G., & Pavkov, M. E. (2018). The Global Epidemiology of Diabetes and Kidney Disease. Advances in chronic kidney disease, 25(2), 121– 132. https://doi.org/10.1053/j.ackd.2017.10.011.

[10] Afroz, A., Alramadan, M. J., Hossain, M. N., Romero, L., Alam, K., Magliano, D. J., & Billah, B. (2018). Cost-of-illness of type 2 diabetes mellitus in low and lower-middle-income countries: a systematic review. BMC health services research, 18(1), 972. https://doi.org/10.1186/s12913-018-3772-8.

[11] World Health Organization. (2020). Tuberculosis. https://www.who.int/news-room/fact- sheets/detail/tuberculosis. Assessed 15/04/21.

[12] Silva, D. R., Muñoz-Torrico, M., Duarte, R., Galvão, T., Bonini, E. H., Arbex, F. F., Arbex, M. A., Augusto, V. M., Rabahi, M. F., & Mello, F. (2018). Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 44(2), 145–152. https://doi.org/10.1590/s1806-37562017000000443.

[13] York E, Atiase Y, et al. (2017). The Bidirectional Relationship between Tuberculosis and Diabetes. Tuberculosis Research and Treatment. 1702578. https://doi.org/10.1155/2017/1702578.

[14] Agha MA, Yousif M, Shehab-Eldin W, El-Helbawy NG, Moustafa RG, Sweed EM. 2020. Latent tuberculosis infection among patients with type 2 diabetes mellitus. Egypt J Chest Dis Tuberc.;69:277-83. http://www.ejcdt.eg.net/text.asp?2020/69/2/277/284334.

[15] Niazi, A. K., & Kalra, S. (2012). Diabetes and tuberculosis: a review of the role of optimal glycemic control. Journal of Diabetes and metabolic disorders, 11(1), 28. https://doi.org/10.1186/2251-6581-11-28.

[16] Alawode, G.O., Adewole, D.A. (2021). Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub- national level actors, healthcare and insurance providers. BMC Public Health 21,124. https://doi.org/10.1186/s12889-020-10133-5.

[17] Riza, A., Pearson, F., Ugarte-Gil, C., Alisjahbana, B., et al. (2014). Clinical management of concurrent Diabetes and Tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol 2014; 2: 74-53. https://ghdonline.org › Lancet_Diab_Endo.

[18] Esourceresearch. (2021). Exploring Social Cognitive Theory. htt ps://www.esourceresearch.org/exploring-social-cognitive-theory/.

[19] Doshmangir, P., Jahangiry, L., Farhangi, M. A., Doshmangir, L., & Faraji, L. (2018). The effectiveness of theory- and model-based lifestyle interventions on HbA1c among patients with type 2 diabetes: a systematic review and meta-analysis. Public health, 155, 133–141. https://doi.org/10.1016/j.puhe.2017.11.022.

[20] Simonds, V. Watts and Rudd, . Rima E. (2016). Diffusion of innovations. Encyclopedia Britannica. https://www.britannica.com/topic/diffusion-of-innovations.

[21] Rogers, L., Matevey, C., Hopkins-Price, P., Shah, P., Dunnington, G., Courneya, K. (2004) Exploring Social Cognitive Theory Constructs for Promoting Exercise Among Breast Cancer Patients, Cancer Nursing: 27; 6 :462-473.

[22] Ryan P. (2009). Integrated Theory of Health Behavior Change: background and Intervention development. Clinical nurse specialist CNS, 23(3), 161–172. https://doi.org/10.1097/NUR.0b013e3181a42373.

[23] Shabibi, P., Zavareh, M., Sayehmiri, K., Qorbani, M., Safari, O., Rastegarimehr, B., & Mansourian, M. (2017). Effect of educational Intervention based on the Health Belief Model on promoting self-care behaviors of type-2 diabetes patients. Electronic physician, 9(12), 5960– 5968. https://doi.org/10.19082/5960.

[24] Dehghani-Tafti, A., Mazloomy Mahmoodabad, S. S., Morowatisharifabad, M. A., Afkhami Ardakani, M., Rezaeipandari, H., & Lotfi, M. H. (2015). Determinants of Self-Care in Diabetic Patients Based on Health Belief Model. Global journal of health science, 7(5), 33–42. https://doi.org/10.5539/gjhs.v7n5p33.

[25] Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Role of self-care in management of Diabetes mellitus. Journal of Diabetes and metabolic disorders, 12(1), 14. https://doi.org/10.1186/2251-6581-12-14. Accessed 28/05/21.

[26] Moshki, M., Dehnoalian, A., & Alami, A. (2017). Effect of Precede-Proceed Model on Preventive Behaviors for Type 2 Diabetes Mellitus in High-Risk Individuals. Clinical nursing research, 26(2), 241–253. https://doi.org/10.1177/1054773815621026.

[27] Green, L.W. (1974). Towards cost-benefit evaluations of health education: some concepts, methods, and examples. Health Education monographs 2 (Suppl. 2): 34-64. https://en.m.wikipedia.org.

[28] Tavakoly Sany, S. B., Ferns, G. A., & Jafari, A. (2020). The Effectiveness of an Educational Intervention Based on Theories and Models on Diabetes Outcomes: A Systematic Review. Current diabetes reviews, 16(8), 859–868. https://doi.org/10.2174/1573399816666191223110314.

[29] Zare, S., Ostovarfar, J., Kaveh, M. H., & Vali, M. (2020). Effectiveness of theory-based diabetes self-care training interventions; a systematic review. Diabetes & metabolic syndrome, 14(4), 423–433. https://doi.org/10.1016/j.dsx.2020.04.008.

[30] Doshmangir, P., Jahangiry, L., Farhangi, M. A., Doshmangir, L., & Faraji, L. (2018). The effectiveness of theory- and model-based lifestyle interventions on HbA1c among patients with type 2 diabetes: a systematic review and meta-analysis. Public health, 155, 133–141. https://doi.org/10.1016/j.puhe.2017.11.022.

[31] Centers for Disease Control and Prevention (.gov). › eat-well › meal-plan-method. https://www.cdc.gov.

[32] Wolff, K., Cavanaugh, K., Malone, R., et al. (2009). The Diabetes Literacy and Numeracy Education Toolkit (DLNET): materials to facilitate diabetes education and management in patients with low literacy and numeracy skills. The Diabetes Educator. 35(2):233-6, 238-41, 244-5. DOI: 10.1177/0145721709331945.

[33] Africa, S. S. (2006). Diabetes Education Training Manual. www.worlddiabetesfoundation.org.

[34] Wenzel, I. C. ., Silva, K. A. ., Furino, V. de O. ., Duarte, F. O. ., Castro, C. A. de, & Duarte, A. C. G. O. (2022). Impact of Postural Corrective Training (TCP®) on overall glycemic control in diabetic middle-aged women. Research, Society and Development, 11(14), e194111435600. https://doi.org/10.33448/rsd-v11i14.35600).

[35] Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84(7 Suppl 1), S15–S21. https://doi.org/10.3949/ccjm.84.s1.03.

[36] Yang D, Yang Y, Li Y, Han R. (2019). Physical Exercise as Therapy for Type 2 Diabetes Mellitus: From Mechanism to Orientation. Ann Nutr Metab. 74:313–321. DOI: 10.1159/000500110.

[37] Katula, J. A., Kirk, J. K., Pedley, C. F., Savoca, M. R., Effoe, V. S., Bell, R. A., Bertoni, A. G., & LIFT Diabetes Team (2017). The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Contemporary clinical trials, 53, 89–99. https://doi.org/10.1016/j.cct.2016.12.005.

[38] Alessandra Celli, Yoann Barnouin, Bryan Jiang, Dean Blevins, Georgia Colleluori, Sanjay Mediwala, Reina Armamento-Villareal, Clifford Qualls, Dennis
T. Villareal. (2022). Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care. 45 (9), 1943–1952. https://doi.org/10.2337/dc22-0338.

[39] Bretschneider, M. P., Klásek, J., Karbanová, M., Timpel, P., Herrmann, S., & Schwarz, P. E. H. (2022). Impact of a Digital Lifestyle Intervention on Diabetes Self-Management: A Pilot Study. Nutrients, 14(9), 1810. https://doi.org/10.3390/nu14091810.

[40] Merino, J. (2022). Precision nutrition in diabetes: when population-based dietary advice gets personal. Diabetologia 65, 1839–1848. https://doi.org/10.1007/s00125-022-05721-6.

[41] Jayedi, A., Zeraattalab-Motlagh, S. et al. (2022). Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials, The American Journal of Clinical Nutrition. 116(1): 40–56. https://doi.org/10.1093/ajcn/nqac066.

[42] Sami, W., Ansari, T., Butt, N. S., & Hamid, M. R. A. (2017). Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences, 11(2), 65–71.

[43] Yoshino, M., Kayser, B. D., Yoshino, J., Stein, R. I., Reeds, D., Eagon, J. C., ... & Klein, S. (2020). Effects of diet versus gastric bypass on metabolic function in diabetes. New England Journal of Medicine, 383(8), 721-732.

[44] Enikuomehin, A., Kolawole, B. A., Soyoye, O. D., Adebayo, J. O., & Ikem, R. T. (2020). Influence of gender on the distribution of type 2 diabetic complications at the obafemi awolowo teaching hospital, Ile-Ife, Nigeria. African health sciences, 20(1), 294–307. https://doi.org/10.4314/ahs.v20i1.35.