Literature Evaluation Table

Type 2 diabetes is among the major causes of global mortalities, prolonged hospitalization, compromised quality of life, and increased care costs. Although pharmacologic interventions like insulin administration are vital in reducing the disease’s progression, it is essential to evaluate the effectiveness of non-pharmacologic interventions like physical activity in regulating blood glucose and other parameters of type 2 diabetes. As a result, this literature evaluation table consolidates findings from scholarly studies that provide insights into the effectiveness of physical activities in controlling blood glucose in people with type 2 diabetes.

Literature Evaluation Table 

Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal (Peer-Reviewed), and 

Permalink or Working Link to Access Article

 

 Conners, R. T., Caputo, J. L., Coons, J. M., Fuller, D. K., & Morgan, D. W. Clinical Diabetes. https://doi.org/

10.2337/cd17-0066

Hicks, D., Hickner, R. C., Govinden, U., & Sookan, T. Journal of Endocrinology, Metabolism, and Diabetes of South Africa. https://doi.org/10.1080/

16089677.2020.1850033  

 Mikhael, E. M., Hassali, M. A., Hussain, S. A., & Shawky, N. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. https://doi.org/10.2147

/dmso.s183776

 Mustapa, A., Justine, M., Latir, A. A., & Manaf, H. Annals of Rehabilitation Medicine. https://doi.org/10.

5535/arm.21102

Article Title and Year Published

 

 Impact of underwater treadmill training on glycemic control, blood lipids, and health-related fitness in adults with type 2 diabetes (2018)  Acute effects of single-bout exercise in adults with type 2 diabetes: A systematic review of randomized controlled trials and controlled crossover trials (2020)  Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, Iraq: A qualitative study (2018) Home-Based physical activity in patients with type 2 diabetes mellitus: A scoping review (2021)
Research Questions (Qualitative)/Hypothesis (Quantitative) 

 

 An underwater treadmill walking program can improve glycemic control and reduce the complications associated with type 2 diabetes  A single bout of exercise can improve glycemic control and insulin sensitivity in individuals with type 2 diabetes.  What is the role of knowledge, and behaviors in self-management among Iraqi type 2 diabetes patients?

What barriers do they face?

Does home-based physical activity improve diabetes management?
Purposes/Aim of Study To determine if an underwater treadmill walking program featuring a gradual and progressive increase in walking speed and duration has a positive effect on glycemic control. To examine relevant published studies that compared to acute effects of single bouts of exercise on glycemic control and insulin sensitivity in individuals with type 2 diabetes. To understand the knowledge, behaviors, and barriers to diabetes self-management among Iraqi type 2 diabetes patients To outline the characteristics of exercise protocols for home-based physical activity (PA) and the challenges in implementing home-made PA in patients with type 2 diabetes.
Design (Type of Quantitative, or Type of Qualitative)

 

Quantitative (Randomized controlled trial (RCT) Quantitative (A systematic review of randomized controlled trials and controlled crossover trials). A qualitative study Qualitative research (Scoping review of literature)
Setting/Sample

 

26 adults with physician-diagnosed type 2 diabetes Articles published in BMC Endocrine Disorders, Cochrane Library, and PubMed. 25 patients in the National Diabetes Center, Baghdad, Iraq  10 studies from Scopus, Cochrane Library, Springer, ProQuest, Google Scholar, and Science Direct
Methods: Intervention/Instruments

 

Random allocations to intervention and control groups. The intervention group participated in three exercise sessions per week on alternate days for a total of 12 weeks. Researchers implemented gradual progression of exercise intensity and duration. Researchers used keywords such as glucose control, single bout, exercise, insulin resistance, and type 2 diabetes to select journal articles.

Researchers utilized the standardized pre-piloted data extraction form to extract data from the selected studies

The researchers interviewed the participants and organized views on various study themes, including general knowledge about diabetes, diabetes self-management, barriers to self-management, and programs. Researchers used a standardized methodological framework and the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) to conduct the scoping review.
Analysis

 

The researchers analyzed the impact of the treadmill walking program on various primary health outcomes, including glycemic control and blood lipid profile, and cardiovascular functions.  The researchers analyzed various themes from the selected studies, including glucose control, fasting serum insulin concentrations, and healthy dietary instructions.  An analysis of respondents’ knowledge and behaviors consistent with diabetes and self-management interventions formed the basis of the study The researchers analyzed the studies’ findings by focusing on themes like exercise frequency, intensity, duration, and type.
Key Findings

 

A1C levels decreased in the intervention good (M=-0.67) compared to the control group (M=0.02) The selected studies demonstrated that improvements in glucose control can be detected following a single bout of exercise. Patients generally lacked proper information/knowledge about the importance of self-management practices. Four studies showed significant improvement in HbA1c consistent with combined exercise and resistance exercise alone.

Reviewed studies indicated challenges like loss of motivation and fear of injuries as the limitations of home-based physical activity.

Recommendations

 

The use of an underwater treadmill walking program can be an effective strategy for improving glycemic control, blood lipid profile, and cardiovascular function. Regulated intensities and durations of physical exercise can determine the glucoregulatory effects of physical activity. It is essential to educate individuals with type 2 diabetes about self-management interventions, including physical exercise and diet control. It is essential to encourage supervision and consultation throughout the home-based physical exercise to address limitations
Explanation of How the Article Supports EBP/Capstone Project

 

The study establishes an underwater treadmill walking program as a form of physical exercise for controlling glucose levels in people with diabetes type 2. This study presents a single-bout exercise as an ideal strategy for achieving glycemic control. Also, it presents the importance of controlling exercises’ intensity and duration to achieve maximum results. The study presents physical exercise as one of the self-management interventions that regulate blood glucose and reduce complications associated with type 2 diabetes. The study presents home-based physical activity as a profound strategy for glycemic control and management of type 2 diabetes.

 

Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal (Peer-Reviewed), and 

Permalink or Working Link to Access Article

 

  Nojomi, M., Tapehsari, B., Alizadeh, M., Khamseh, M., & Seifouri, S. International Journal of Preventive Medicine.

https://doi.org/10.4103/

ijpvm.ijpvm_202_18

 Pfeifer, L. O., De Nardi, A. T., da Silva, L. X. N., Botton, C. E., do Nascimento, D. M., Teodoro, J. L., Schaan, B. D., & Umpierre, D. Sports Medicine – Open.

https://doi.org/10.

1186/s40798-022-00422-1

 

 Sampath Kumar, A., Maiya, A. G., Shastry, B. A., Vaishali, K., Ravishankar, N., Hazari, A., Gundmi, S., & Jadhav, R. Annals of Physical and Rehabilitation Medicine.

https://doi.org/10.1016

/j.rehab.2018.11.001

 

 Yao, W.-Y., Han, M.-G., De Vito, G., Fang, H., Xia, Q., Chen, Y., Liu, X., Wei, Y., Rothman, R. L., & Xu, W.-H. International Journal of Environmental Research and Public Health.

https://doi.org/10.3390

/ijerph18084292

Article Title and Year Published

 

Physical activity and quality of life in people with type 2 diabetes mellitus: A randomized controlled trial (2020). Association between physical exercise interventions participation and functional capacity in individuals with type 2 diabetes: A systematic review and meta-analysis of controlled trials (2022). Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis (2019).  Physical activity and glycemic control status in Chinese patients with type 2 diabetes: A secondary analysis of a randomized controlled trial (2021).
Research Questions (Qualitative)/Hypothesis (Quantitative)

 

 Physical activity can positively impact the quality of life of individuals with type 2 diabetes. Hypothesis: physical exercise modalities improve diabetes management Hypothesis: structured exercise intervention program can address insulin resistance in type 2 diabetes mellitus. Hypothesis: Physical activity can regulate hemoglobin levels in patients with type 2 diabetes.
Purposes/Aim of Study To determine the effectiveness of physical activity package (PAP) in the quality of life (QoL) in individuals with type 2 diabetes To statistically assess the effect of different physical exercise modalities in patients with type 2 diabetes  To identify evidence for the effectiveness of a structured exercise intervention program for insulin resistance in type 2 diabetes. To evaluate the independent effects of physical activity (PA) on hemoglobin (HbA1c) levels in Chinese patients with type 2 diabetes
Design (Type of Quantitative, or Type of Qualitative)

 

Quantitative (Randomized Controlled Trial) Quantitative (A systematic review and meta-analysis of controlled trials) Quantitative (A systematic review and meta-analysis of controlled trials) Quantitative (A secondary analysis of randomized controlled trial)
Setting/Sample

 

 100 participants referred to the Endocrine Research Center of Iran University of Medical Sciences  29 trials from PubMed, Physiotherapy Evidence Database, Cochrane Library, and Google Scholar 11 trials from MEDLINE, PubMed, CINAHL, Scopus, and Web of Science 799 diabetic patients recruited from the 35 selected clinic sites in China
Methods: Intervention/Instruments

 

Subjects were randomly assigned to intervention (PAP and routine care) and control (just education and routine care) groups. Participants completed questionnaires, forming the basis of data extraction and analysis. Researchers included trials that reported structured physical exercise, including resistance training, power training, aerobic training, functional training, or combined interventions.  Researchers included studies that investigated the primary outcome of insulin resistance, including fasting insulin, fasting blood sugar, and glycated hemoglobin. The patients in the control group received usual care according to the Chinese National Guidelines that include conventional clinical consultations. On the other hand, patients in the intervention group received the usual care and various physical exercise modalities, including walking sessions.
Analysis

 

An analysis of variables across the two groups and a comparison of the two groups established the statistical significance of PAP in diabetes management. The researchers analyzed selected trials based on various outcome measures, including limb-muscle strength, physical fitness parameters, walking performance, and chair stands. An analysis of outcome measures reported in the selected studies, including fasting insulin, fasting blood sugar, body mass index, and glycated hemoglobin formed the basis of data extraction and analysis.  The researchers analyzed the difference in glycemic control status between the control and intervention groups.
Key Findings

 

 Physical, psychological, and environmental scores were significantly different between the two groups after PAP intervention (p<0.01) The reviewed trials associated physical exercise training with an increase in functional capacity outcomes.  Three articles (298 patients) revealed that structured physical exercise interventions led to an increase of 4.66 times in the 30-s chair stand test (95% CI, P=0.05)  The mean difference for fasting insulin levels in the intervention and control groups was -1.64 (95% CI; -3.38 to 0.10), fasting blood sugar (-5.12), and hemoglobin A1c (0.63). A significant improvement in HbA1c was observed in the intervention group (-3.49; 95% CI; p<0.05)
Recommendations

 

It is essential to improve individual awareness of physical activity because it results in improved physical, psychological, and environmental determinants of the quality of life.  It is essential to improve structured physical activity to enhance type 2 diabetes management and reduce its complications.  It is vital to emphasize structured physical activity as a strategy for reducing insulin resistance in people with type 2 diabetes.  Physically inactive patients should implement exercise intervention to improve their physiological thresholds and enhance diabetes management.
Explanation of How the Article Supports EBP/Capstone

 

The study supports  the EBP project by providing the statistical significance of physical activity in improving various elements of quality of life (QoL) of individuals with diabetes type 2 The study supports the capstone project by justifying the importance of physical activity in improving diabetes management and control. This study supports the evidence-based project by providing the statistical significance of physical activity in reducing insulin resistance in people with type 2 diabetes. This study strengthens the importance of physical activity in achieving appropriate glycemic control status in patients with Type 2 Diabetes.

References

Conners, R. T., Caputo, J. L., Coons, J. M., Fuller, D. K., & Morgan, D. W. (2018). Impact of underwater treadmill training on glycemic control, blood lipids, and health-related fitness in adults with type 2 diabetes. Clinical Diabetes, 37(1), 36–43. https://doi.org/10.2337/cd17-0066

Hicks, D., Hickner, R. C., Govinden, U., & Sookan, T. (2020). Acute effects of single-bout exercise in adults with type 2 diabetes: A systematic review of randomized controlled trials and controlled crossover trials. Journal of Endocrinology, Metabolism, and Diabetes of South Africa, 1–5. https://doi.org/10.1080/16089677.2020.1850033

Mikhael, E. M., Hassali, M. A., Hussain, S. A., & Shawky, N. (2018). Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, Iraq: a qualitative study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 12, 1–17. https://doi.org/10.2147/dmso.s183776

Mustapa, A., Justine, M., Latir, A. A., & Manaf, H. (2021). Home-Based physical activity in patients with type 2 diabetes mellitus: A scoping review. Annals of Rehabilitation Medicine, 45(5), 345–358. https://doi.org/10.5535/arm.21102

Nojomi, M., Tapehsari, B., Alizadeh, M., Khamseh, M., & Seifouri, S. (2020). Physical activity and quality of life in people with type 2 diabetes mellitus: A randomized controlled trial. International Journal of Preventive Medicine, 11(1), 1–6. https://doi.org/10.4103/ijpvm.ijpvm_202_18

Pfeifer, L. O., De Nardi, A. T., da Silva, L. X. N., Botton, C. E., do Nascimento, D. M., Teodoro, J. L., Schaan, B. D., & Umpierre, D. (2022). Association between physical exercise interventions participation and functional capacity in individuals with type 2 diabetes: A systematic review and meta-analysis of controlled trials. Sports Medicine – Open, 8(1). https://doi.org/10.1186/s40798-022-00422-1

Sampath Kumar, A., Maiya, A. G., Shastry, B. A., Vaishali, K., Ravishankar, N., Hazari, A., Gundmi, S., & Jadhav, R. (2019). Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine, 62(2), 98–103. https://doi.org/10.1016/j.rehab.2018.11.001

Yao, W.-Y., Han, M.-G., De Vito, G., Fang, H., Xia, Q., Chen, Y., Liu, X., Wei, Y., Rothman, R. L., & Xu, W.-H. (2021). Physical activity and glycemic control status in Chinese patients with type 2 diabetes: A secondary analysis of a randomized controlled trial. International Journal of Environmental Research and Public Health, 18(8), 4292. https://doi.org/10.3390/ijerph18084292