Managing Type 2 Diabetes in the South Asian Population of the UK

Introduction:

Diabetes is in the fifth rank among the most common causes of death in the world. The life expectancy was reduced up to 10 years for type 2 diabetes, among the population (Meetoo, 2007). The South Asian populace of the United Kingdom makes about one – fifth of the overall diabetic populace of the country. Therefore, the focus group is considered to be more at risk of acquiring the disease in comparison to the European populace (Hanif, 2018). The major life style risk factors that are contributing to the diseased condition are the sedentary lifestyle of the modern people, obesity and high cholesterol level (Ohlson, et al, 1988). The dietary suggested measures in the United Kingdom of for overall sugar and carbohydrate especially starch content should be kept up to maintain a sound weight which is half of the overall dietary vitality consumption (Scientific Advisory Committee on Nutrition, 2015). It is additionally suggested that normal admission of free sugars must not exceed the degree of 5% of the complete dietary vitality as referenced for the age group of 2 years or more (Scientific Advisory Committee on Nutrition, 2015). The rule prescribed for the saturated fat to be 20gms for ladies and 30gms for men (Scientific Advisory Committee on Nutrition, 2015). The practice of the recommended levels of exercise or physical activities may control all the associated causes of mortality. The several advantages of physical activities fluctuate for various age gatherings. For children and youngsters the major factors that need to be considered are the several forms of day to day activities and a varied assortment of exercises. This is on the grounds that their health and their brain are still considered to be in the stage of development. However, for the matured grown-ups the emphasis is on keeping up strength which also includes training on maintaining balance. It is also evident that keeping up of balance and strength in the later part of life means adding extra years to our life, better capacity, better personal satisfaction, and prolonged autonomous living (Sun, et al., 2013). Therefore, the present assignment is chosen on patients with T2D from the focus group population such as South Asian populace and their specialised requirements with regard to diet and physical activity.

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Rationale for the study

The rate of incidence of T2D can be observed among 90 -95% of cases and it occurs due to the consistent lower insulin production or due to the resistance developed against insulin and it expanded four-to six-overlay among South Asian populace. The study conducted by the United Kingdom Asian Diabetes Study (UKADS) reported that the SA populace generally develop diabetes at an early age (57.0 versus 64.8 years) and therefore suffers for a longer time span (Hanif, 2018). The individuals who are in the pre diabetic condition can alleviate the risk of acquiring T2D with the daily practice of physical activity and balanced diet (Duclos, et al., 2013). T2D patients have lower threshold of physical exercises and due to this they are unable to perform the recommended level of physical activities. Therefore, in the present study a detailed analysis had been conducted to estimate the significance of diet and physical activity to control the condition of diabetes especially type 2 diabetes among the South Asian adult populace of London.

Background:

The primary classification of diabetes includes the following two types: type 1 and type 2 diabetes (T2D). In the UK, the risk of T2D is expanded four-to six-overlay among South Asian contrasted with the indigenous populaces. The age of introduction is at the youth, and the condition stays undiscovered in up to 40% among South Asian individuals. South Asian individuals living in the UK at recent speak to 4 percent of the absolute UK populace. Alarmingly, these individuals who live in the UK are up to multiple times bound to have diabetes than the white populace, and with diabetes predominance in England anticipated to increment by 47 percent by 2025, the condition will keep on considerably affecting South Asian people group over the UK (Diabetes, U.K., 2009). As per the reports of Global Diabetes Community 2019, the total cases diagnosed in the United Kingdom were approximately 3.5 million (Shaw, et al, 2010).

The T2D is more common among the young people who are are a part of certain ethnic gathering. The danger of acquiring T2D is additionally a direct result of the family hereditary qualities however the specific variables are not vivid. The hazard likewise increases with age, stationary way of life of the patient and heftiness (Ohlson, et al, 1988). The hazard elements can be constrained by changing the way of life formative methodology such with the every day schedule of physical exercise and healthy diet and thusly the related death rate can likewise be decreased (Ohlson, et al, 1988). It has been reported that the SA individuals demonstrtaed reduced body mass index (BMI), smaller dimensions of waist, reduced SBP, reduced level of HDL, however, higher overall level of cholesterol and raised level of triglycerides and raised level of HbA1c when compared with the European populace as per the findings of the report of survey study UKADS. These factors enhance the hazard of developing T2D among the concerned population (Hanif, 2018). Therefore the next part of the assignment will detail about the benefits and mechanism of alternative diet pattern and physical activities to encounter the rising number of cases with diabetes.

Diet and Type 2 Diabetes:

An overview on the nutrition utilization pattern of the people aged between in the middle of 19-64 years in the UK featured that a mean of 271 and 248 of starch utilization was seen inside 2000 - 2001 and 2008 - 2009 separately (Whitton, et al, 2011). This review was led to explore about the nourishment propensity status and prominence within the UK populace with regard to sugar or carbohydrate consumption. These findings also highlighted the facts that high starch and lipid containing diet and sedentary life styles augments the development of diabetes along with co morbidities related to life style disorders. Concerning on the issue of weight reduction in order to control diabetes, an idea of a “low sugar diet” has immerged which is recently on the speculation now (Oh, 2020). Therefore, this is powerful for both the aspect of weight reduction and control of diabetes among the populace. In this manner, this specific methodology has been as of late named as the "carbohydrate insulin model" (Oh, 2020). A few examinations have recommended that the low carb diet is better than several models of diet with regard to control of diabetic condition (Bueno, et al, 2013; Nordmann, et al, 2006; Tobias, et al, 2015).

Without the utilization of prescriptions for diabetes, checking starch admission is significant for the regulation of glycaemia for both T1D and T2D cases. It is clear that the admission of dietary carbohydrates upgrades insulin requirements; accordingly a decrease of starch utilization can viably lessen glucose levels. Therefore medical nutrition therapy has been included as an option in the current guidelines to control diabetes. Moreover, the dietician also recommends that management of diabetes could be done on the basis of in taking of appropriate diet such as low fat and carbohydrate containing diet and high fibre containing meals at the right time (Sami, 2017).

Physical Activity and Diabetes:

It has been established from various studies that the condition of T2D can be managed with the daily practice of moderate to vigorous level of physical activity (Fagour, et al, 2013). According to a study, the most recommended physical activity on a daily basis for the patients of T2D is walking for a minimum period of 30 minutes every day which reduces the risk by approximately 50% along with the reduction in mortality (Yardley, et al, 2014; Sayer, et al, 2005).

It is evident that with the daily practice of exercise, the various parameters such as the lipid profile, the resistance developed to insulin can be improved though the blood pressure can also rise during the exercise. The benefits observed in the metabolic rate with the daily practice of exercise become negligible within a span 3 -10 days of stoppage of the regular practice of exercise (Sami, et al., 2017). Therefore as per the recommendation of the United Kingdom, at least 30 minutes of physical exercise for five days every week should be practiced by the adults to reduce the developmental risk of T2D as every step combines for the betterment of the health. It should also be taken into consideration that the individuals should also enjoy while performing the exercise (Sami, et al., 2017). The other factors that have to be considered before the practice of exercise by the T2D patients are: the individual should take care of his oral hypoglycaemic therapy and the schedule of meal, the glucose level of blood before physical activity, if the blood sugar level is low one should postpone the exercise for having snacks or should keep glucose at hand; the other major clinical conditions should also be monitored for the diabetic patients such as the autonomic neuropathy, peripheral neuropathy, the peripheral arterial disease, the condition of hypoglycaemia after long hours of exercise (Colberg, et al, 2010). A diabetic patient should also avoid the high impact exercise that may traumatise the feet and exercise should not be performed if the individual is suffering from the associated condition of active retinal haemorrhage or current retinal photocoagulation (Colberg, et al, 2010).

Research Aim:

To study the impact of lifestyle changes in terms of diet and physical activity affecting the risk factors of type 2 diabetes among the South Asian populace residing at London.

Research Objectives:

1. To increase the awareness with regard to the significance of physical exercise and diet pattern alteration among the focus group populace to control the rising cases of T2D.

2. To conduct a detailed review about the factors that are contributing to high cases of T2D among the South Asian Populace which can be altered with the aid of diet pattern alteration and physical activity therapies.

3. To discuss the gaps and required recommendations for effective formulation of combined diet and physical activity regime based on individual patient requirements.

Methodology and Justification:

Research will be based on randomized controlled preliminaries, cohort examines, crossover preliminaries, surveys, clinical reviews, interviews and literature reviews. Therefore, the study was conducted in the approach of systematic literature review. This approach is chosen because it recognizes, illustrates and formulates the findings of varied investigations to develop a summative analysis of the recent existing evidences which in future may contribute to evidence based practice by the health care professionals (Mulrow, 1994).

Search Strategy

The secondary research is considered to be better than the primary one since secondary information assortment is frequently used to pave way for primary research. Thusly the investigation depends on the auxiliary research to accumulate the proof from the current writings. Sensible sources were perceived from distinctive electronic databases which comprises of innumerable brilliant communications, for instance, from Google Scholar, Medline, EMBASE, PubMed, Karger, Taylor, Ovid, EBSCO host and Francis Online and associations, for example, NICE, NHS and PHE will be looked for the various legislations policies. Grey literary works databases that will be utilized by the researcher for glancing through substances are Med Nar, Open Gray and GreyNet International. The surfing was done with confinement to the most revived substance up to the year 2019 so appropriate and latest substance can be available for the composing review reason. Again the search were extended with the use of Boolean operators for example "OR", "AND" for diminishing down the inquiry things. An inside and out examination on the subject of the exploration has been directed dependent on case-controlled and cross-sectional investigations distributed inside the previous 10 years concentrating on the subject of type 2 diabetes among South Asian populaces of the United Kingdom (Machi, 2016). One specific confinement was encountered by the researcher was the non-accessibility of the full-length record because of the non availability of registration facility of the University.

Study selection

The criteria with regard to inclusion and exclusion are formulated after the idea of research becomes familiar with literature topic. To characterize the criteria of exclusion and inclusion with respect to designation of the publication and concept should include the catchphrases along with the positive inquiry context. To illustrate the criteria for rejection, the preliminaries which are not within the scope for the concerned study and not associated with the proposed question of research was not measured (Randolph, 2009).

For this study the inclusion and exclusion criteria include:

inclusion and exclusion criteria

Study Design

As based on past evidences that fundamental foundation of the precise survey is to accumulate accessible confirmations which can clarify the exploration question. Here the use of Positivism hypothesis is thought to be progressively reasonable which communicates about the assessment and comprehension of the investigation data will get productive through the acquired truth and apparent real factors from confirmed sources. This particular technique will allow the researcher to develop an illustrative mind to analyze regarding the problem of research as chosen. A sorted out approach and quantitative in nature will be applied to dealing with the investigation issue. Traditional approach for review has been suggested as the technique with the ultimate objective for composing the review. It is done by applying efficient strategies, for instance, essential assessment consideration of the investigation, examination of the findings of the secondary research, and the findings that was conveyed quantitatively and qualitatively (Saunders, et al, 2018). This specific methodology will be utilized to get a nitty gritty and comprehensive examination of all the accessible sorts of writing on the electronic databases dependent on the incorporation criterias. The advantages related with this technique for foundational audit is that it applies explanatory and logical strategies for distinguishing and choosing the studies which thusly decreases any type of bias in the examination alongside the creations of precise and solid outcomes and ends according to the exploration theory of the investigation.

Risk of bias

Orderly survey is proof based that investigates existing writing in detail and in a methodological manner to respond to a clear inquiry and to perceive the gaps in existing literary works (Betanny-Saltikov, 2012). The tool, ROBINS-E, will took a gander at about a mistake in the assessment structure and besides examined the outcome to assess the possible inclination in the examination. To assess regarding the mistake in a randomized control study, Cochrane device will be applied (Sterne, et al, 2016; Savovic, et al 2014). These tools look at the five changed spaces of inclination, for example, weakening execution, choice, detailing and others.

Ethical Considerations

No moral considerations are required for study including just review of literature. However, the finding details will be kept secured within a proper structure to avoid any illegal infringement (Wager and Wiffen, 2011).

Research Time Table

Research Time Table Research Time Table Research Time Table

Reflection

The composing period of the proposal for research is a critical one as here I completely concentrated on the engaged point. Here I will reflect upon y experiences based on Gibbs reflective model (Sekarwinahyu, 2018).

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The first step is description of the problem where it addressed the focus populace who are experiencing T2D in more prominent degree in contrast with the nearby population of the UK. Besides, I likewise expanded information about the significance and risk factors of the ailment. The second step is concerned about the feelings where I felt that I have tended to a basic issue that requests urgent consideration for the advancement of the spotlight group populace. The third step is the evaluation where I concentrated on the strategies that must be utilized for expanding mindfulness, for instance up taking of the sound eating regimen and legitimate physical activities for the management of the disease. At last to conclude an effective proposal is formulated to conduct the investigation so that appropriate recommendations could be formulated.

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References:

Bettany-Saltikov, J., Kandasamy, G., Van Schaik, P., McSherry, R., Hogg, J., Whittaker, V., Arnell, T. and Racero, G.A., 2019. School‐based education programmes for improving knowledge of back health, ergonomics and postural behaviour of school children aged 4–18: A systematic review. Campbell Systematic Reviews, 15(1-2), pp.1-11.

Bhanpuri, N.H., Hallberg, S.J., Williams, P.T., McKenzie, A.L., Ballard, K.D., Campbell, W.W., McCarter, J.P., Phinney, S.D. and Volek, J.S., 2018. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovascular diabetology, 17(1), p.56.

Bueno, N.B., de Melo, I.S.V., de Oliveira, S.L. and da Rocha Ataide, T., 2013. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), pp.1178-1187.

Diabetes, U.K., 2009. Diabetes UK and South Asian Health Foundation recommendations on diabetes research priorities for British South Asians. Diabetes Uk, london.

Duclos, M., Oppert, J.M., Verges, B., Coliche, V., Gautier, J.F., Guezennec, Y., Reach, G. and Strauch, G., 2013. Physical activity and type 2 diabetes. Recommandations of the SFD (Francophone Diabetes Society) diabetes and physical activity working group. Diabetes & metabolism, 39(3), pp.205-216.

Fagour, C., Gonzalez, C., Pezzino, S., Florenty, S., Rosette-Narece, M., Gin, H. and Rigalleau, V., 2013. Low physical activity in patients with type 2 diabetes: the role of obesity. Diabetes & metabolism, 39(1), pp.85-87.

Hanif, R.W. and Susarla, R., 2018. Diabetes and cardiovascular risk in UK South Asians: an overview. The British Journal of Cardiology, 25(2), pp.S8-S13.

Machi, L.A. and McEvoy, B.T., 2016. The literature review: Six steps to success. Corwin Press.

Nordmann, A.J., Nordmann, A., Briel, M., Keller, U., Yancy, W.S., Brehm, B.J. and Bucher, H.C., 2006. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Archives of internal medicine, 166(3), pp.285-293.

Oh, R. and Uppaluri, K.R., 2020. Low carbohydrate diet. In StatPearls [Internet]. StatPearls Publishing.

Ohlson, L.O., Larsson, B., Björntorp, P., Eriksson, H., Svärdsudd, K., Welin, L., Tibblin, G. and Wilhelmsen, L., 1988. Risk factors for type 2 (non-insulin-dependent) diabetes mellitus. Thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913. Diabetologia, 31(11), pp.798-805.

Randolph, J., 2009. A guide to writing the dissertation literature review. Practical Assessment, Research, and Evaluation, 14(1), p.13.

Sami, W., Ansari, T., Butt, N.S. and Ab Hamid, M.R., 2017. Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences, 11(2), p.65.

Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H. and Jinks, C., 2018. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity, 52(4), pp.1893-1907.

Savović, J., Weeks, L., Sterne, J.A., Turner, L., Altman, D.G., Moher, D. and Higgins, J.P., 2014. Evaluation of the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation. Systematic reviews, 3(1), p.37.

Sayer, A.A., Dennison, E.M., Syddall, H.E., Gilbody, H.J., Phillips, D.I. and Cooper, C., 2005. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg?. Diabetes care, 28(10), pp.2541-2542.

Scientific Advisory Committee on Nutrition, 2015. Carbohydrates and health.

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Tobias, D.K., Chen, M., Manson, J.E., Ludwig, D.S., Willett, W. and Hu, F.B., 2015. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. The lancet Diabetes & endocrinology, 3(12), pp.968-979.

Wager, E. and Wiffen, P.J., 2011. Ethical issues in preparing and publishing systematic reviews. Journal of evidence-based medicine, 4(2), pp.130-134.

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