L.Narayanan
Department of Medicine, KMI Taman Desa Medical Centre,
Academic Department, MEDIT
Background:
The management of Type 2 Diabetes Mellitus (T2DM) has historically relied on pharmacologic interventions such as oral glucose-lowering medications and/or insulin therapy with a less-personalised effort to lifestyle modification. While effective in glucose control, these approaches may not address the multifactorial nature of this disease.
Objective:
This observation aims to report a 2-year observation of incorporating intensive lifestyle modifications alongside a frequent intermittent glucose monitoring system in prediabetes and Type 2 diabetes outpatient settings in Kuala Lumpur, Malaysia.
Methods:
A total of 60 individuals were enrolled in this observational study over a period of 2 years in cohorts of 5 every 2 months. Of the 60 individuals, 32 were diagnosed as prediabetic, and the remaining had Type 2 diabetes mellitus diagnosed in the past 5 years. Amongst the 28 individuals who had Type 2 diabetes mellitus, 16 had been on 2 or more oral hypoglycaemic agents, and the remaining were on 1 agent. Lifestyle interventions included a triad approach focusing on dietary modification, physical activity enhancement, and sleep quality optimisation.
Individuals were trained to maintain food journals, portion their meals, prioritize low-glycemic-index and adjust calories based on their age, gender and activity level. Physical activities were personalized, with an emphasis on Non-Exercise Activity Thermogenesis (NEAT), cardiovascular exercises, strength training, and flexibility routines. Sleep quality was continually assessed and managed through sleep trackers. A distinct component in this approach was integrating a frequent intermittent glucose monitoring system typically using flash glucose monitors which enabled real-time glucose tracking in the intensive monitoring period. The system was an invaluable educational tool, facilitating better patient understanding of the glucose-insulin dynamic and fostering self-management.
Results & Conclusion
Early findings indicated a reduction in HbA1c levels, improvement in metabolic parameters, and an enhanced patient-reported quality of life. Notably, the adoption of glucose monitoring technology was linked to increased adherence to lifestyle interventions. The observation advocates for the incorporation of a holistic strategy in the management of T2DM. It argues that combining technological innovation with lifestyle modification offers a more robust solution, empowering patients in self-management, and thereby augmenting the conventional therapeutic measures in T2DM care.
References
Lifestyle Management: Standards of Medical Care in Diabetes—2019' (2018) Diabetes Care, 42(Supplement_1), pp. S46–S60.
Krakauer, M. et al. (2021) 'A review of flash glucose monitoring in type 2 diabetes,' Diabetology & Metabolic Syndrome, 13(1).
Blum A. Freestyle Libre glucose monitoring system. Clin Diabetes. 2018;36(2):203–4.