Lifestyle Interventions for Adults Diagnosed with or at Risk for Type 2 Diabetes

Kristin Caroza, OTS and Leslie Ramos, OTS

OT16.Kristin.Caroza@nv.touro.edu; OT16.Leslie.Ramos@nv.touro.edu
Touro University Nevada, School of Occupational Therapy

Introduction
Diabetes Mellitus
Prediabetes occurs when blood glucose levels are higher than
normal but not within range to be classified as diabetes (Mayo
Clinic, 2014a).
Diabetes mellitus is a group of chronic diseases that affects the
way the body metabolizes glucose (Mayo Clinic, 2014b).
Type 2 diabetes occurs when the body cannot effectively use
the insulin it produces (WHO, 2015).
9% of adults are diagnosed with diabetes around the world and
90% of those individuals have type 2 diabetes (WHO, 2015).
Although the cause is unknown, some risk factors include
excessive weight and physical inactivity (WHO, 2015).
Lifestyle Interventions
Lifestyle intervention is a broad form of treatment that is geared
toward helping individuals establish health-promoting
behaviors that are intended to be sustained throughout life.
Examples of forms of delivery of lifestyle interventions include
health education, self-management, community-based
programs, psychoeducation, and mindfulness-based cognitive
therapy.
Quality of Life
Improving quality of life is important in clinical treatment
because it is concerned with an individuals hopes, selfconcept, life satisfaction, and overall health functioning (AOTA,
2014).
Quality of life can be viewed in both aspects of physical and
mental health.

Lifestyle Intervention [Photograph]. (2010). Retrieved from

https://www.wageningenur.nl/en/project/lekkerlangleven.htm

Research Question
What is the effectiveness of lifestyle interventions including selfmanagement and mindfulness on perceived quality of life
among adults diagnosed with or at risk for type 2 diabetes?

Methods

Summary of Study Designs

Client Population
Intervention

Adults with or at risk for diabetes

Lifestyle interventions, self-management,
Mindfulness-Based Cognitive Therapy

Outcome

Quality of Life

Inclusion Criteria
Level I or Level II articles
Written in English
Published within 10 years
Full length articles published in peer-reviewed journals
Exclusion Criteria
Level III, IV, or V articles
Non-English
Published before 2005
Dissertation or masters thesis

Databases Academic Search Complete, Academic Search

Elite, CINAHL Plus, ERIC, Google Scholar,
MEDLINE, Psych INFO

Results

Level of Evidence
I
II
III

Study Design
Systematic review, meta-analyses, randomized control trials
Two groups, nonrandomized studies (cohort, case-control)
One group, nonrandomized (before and after, pretest and
posttest)

Number of Articles Selected

9
1
0

IV
V

Descriptive studies that include analysis of outcomes

Case reports and expert opinion that include narrative literature
reviews and consensus statements

0
0

Other

Qualitative studies

0
10

TOTAL:

Implications for Occupational Therapy

The clinical and community-based practice of OT: Lifestyle modifications can be an effective treatment for
individuals diagnosed or at risk for type 2 diabetes if the intervention is highly structured and individualized.
Occupational therapist specialized in providing holistic and client centered care; therefore, they can addresses what
may hinder or support an individuals success to incorporate a healthier lifestyle in their daily activities and routines.
Program development: The development of a lifestyle modification program should address all factors of the individual
including health education, lifestyle choices, and mental health. OTs serve a role in implementing strategies to develop
a schedule to promote a healthy diet and incorporate physical activity in an individuals daily routine. In addition, it is
important to address the individuals perceived health through acceptance of their disease.
Societal needs: Lifestyle interventions can be utilized on a community level to address a large scale such as
populations that may be at a higher risk for developing type 2 diabetes. OTs are experts in participation in daily life
activities and have the potential to support communities and transition them towards a healthier lifestyle long term.
Healthcare delivery and policy: Preventative health promoting interventions may be a more cost effective method of
treatment. Implementation of lifestyle interventions in OT requires more advocacy to gain support in healthcare.
Education and training of OT students: Students will need general knowledge about the diagnosis of diabetes.
Additional training or certification is required to implement specific lifestyle intervention programs.
Refinement, revision, and advancement of factual knowledge or theory : Follow up studies are required to
determine if healthy behaviors learned from lifestyle interventions was sustained.

Prevention
Intensive lifestyle interventions that incorporate individualized
treatment are correlated with positive outcomes for quality of life
(Sagarra, Costa, Cabr, Sol-Morales & Barrio, 2014).
Individuals actively participating in a prevention program
experience a rapid decline in quality of life after being diagnosed
with diabetes (Marrero et al., 2014).
Psychosocial Treatment Emphasis
Participants of a Mindfulness-Based Cognitive Therapy program
showed a significant decrease in stress with improved physical
and mental quality of life (Van Son et al., 2013).
Lifestyle interventions that addressed health promotion and
psychosocial management strategies showed a significant
increase in quality of life (Toobert et al., 2007).
Conclusions
Community-based Treatment
Implementation of group-based health education workshops and
counseling showed a significant increase in healthy behaviors and There were mixed results for the efficacy of lifestyle
interventions
quality of life (Kanaya et al., 2012).
More research for lifestyle interventions is needed
Health management and exercise community programs showed
within the field of occupational therapy
significant improvements in quality of life and weight loss; however,
Implementation of lifestyle interventions as a
weight was not sustained in follow up measures (Oh et al., 2010).
treatment allows clients to be an active member in
managing their own health.
Health Education
Occupational therapist have the potential to be leading
Education on diabetes focused on lifestyle factors shows no
practitioners in the prevention of diabetes in health
significant difference in quality of life in comparison to the
care.
education alone intervention (Khunti et al., 2012).
Enhancing self-efficacy through a self-management program did
not show a significant difference from the education alone

References (Partial List)

Cezaretto, A., Siqueira-Catania, A., de Barros, C., Salvador, E., & Ferreira, S.
(2012). Benefits on quality of life concomitant to metabolic improvement in
intervention program for prevention of diabetes mellitus. Quality Of Life
Research, 21(1), 105-113. doi:10.1007/s11136-011-9919-2
Kanaya, A. M., Santoyo-Olsson, J., Gregorich, S., Grossman, M., Moore, T., &
Stewart, A. L. (2012). The Live Well, Be Well study: A community-based,
translational lifestyle program to lower diabetes risk factors in ethnic minority and
lower-socioeconomic status adults. American Journal of Public Health, 102(8),
1551-1558. doi: 10.2105/AJPH.2011.300456
Khunti, K., Gray, L. J., Skinner, T., Carey, M. E., Realf, K., Dallosso, H., & ...
Davies, M. J. (2012). Effectiveness of a diabetes education and self management
programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus:
three year follow-up of a cluster randomised controlled trial in primary care. BMJ:
British Medical Journal (Overseas & Retired Doctors Edition),344(7860), 15.
doi:10.1136/bmj.e2333