Volume : 5, Issue : 8, AUG 2019




INTRODUCTION: Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia. It was first reported in Egyptian manuscript about 3000 years ago. It has dreadful complications and can significantly compromise quality of life. Currently India is having second position in respect of most number of diabetes patients after China. By 2045 it was expected that India will have 134.3 million diabetes patients. The prevalence of diabetes in Tirupati was found to be 12.4%. DM has well known risk factors like age, heredity, obesity, hypertension (HTN), lack of exercise, smoking, alcoholism, dyslipidemia and positive family history. Proper drug therapy, social support, health education, and psychological care in diabetes are essential but are usually deficient, especially in developing countries. Financial restrictions, distance from hospital, low levels of education, and less disease awareness among the patients are the limiting factors in the effective follow-up of diabetic patients under treatment. Exercise is considered a crucial component of disease management for individuals with type 2 diabetes, and it is associated with extensive health and mental health benefits. Regular physical activity improves blood glucose control, may prevent or delay T2DM, and enables better and more effective glucose utilization by reducing insulin resistance. Furthermore, it affects blood lipids, blood pressure, cardiovascular risk factors, mortality, and quality of life in a positive way. Although the benefits of exercise are well established, most people with diabetes do not engage in physical activity in a regular and sustained manner. To address this, it is important to develop interventions that are easily and broadly accessible and that address specific barriers that prevent individuals with diabetes from participating in physical activity. Hence the present study is done to find the effect of the easiest and cheapest means of communication i.e., telehealth in engaging the diabetes patients in physical activity and thus enhancing the quality of life with proper diabetes management. AIM OF THE STUDY: The aim of the study is to find out the effect of telehealth on glycemic control, physical activity and quality of life in type 2 DM individuals. OBJECTIVES:  To find out the effect of telehealth on glycemic control through FPG, HbA1c in type 2 DM individuals.  To study the effect of telehealth on physical activity (PA) through, BP, BMI, International Physical Activity Questionnaire (IPAQ) (Telugu translation) in type 2 DM individuals.  To study the effect of telehealth on quality of life (QOL) through Quality of Life Instrument for Indian Diabetes Patients Questionnaire (QOLID) (Telugu translation) in type 2 DM individuals. Study design: This is a randomized controlled study. Study Setup: Patients with type 2 DM attending to SVIMS Endocrinology OP. Period of follow up: 3 months Study sampling: Simple randomized sampling Sample size calculation: Minimum of 128 subjects in both groups, hence 70 subjects in each group. METHODOLOGY: Baseline information of BP, BMI, THR, HbA1c, FPG, PA, and QOL are taken along with their contact number and with informed consent at the first time of visit to SVIMS Endocrinology OP. Advice about regular physical activity adherence, diet, lifestyle modification and diabetes management will be given orally and in the form of handouts for the subjects in both the groups along with weekly thrice phone calls and motivation and encouragement about regular physical activity participation is advised for the subjects in experimental group. Follow up is taken after three months about BP, BMI, HbA1c, FPG, PA and QOL. RESULTS: The pre and post experimental mean value, t-test and p values of all the outcomes that is BP, BMI, HbA1C, FPG, PA, QOL shows significance (0.05) in both the groups. CONCLUSION: Hence, the study concluded that telehealth showed a significant improvement in glycemic control, physical activity and quality of life at 0.05 level of significance.



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1. "About diabetes". World Health Organization. Archived from the original on 31 March 2014. Retrieved 4 April 2014. 2. International Diabetes Federation. IDF Diabetic Atlas 8th Edition. Available at http://www.idf.org/idf-diabetes-atlas -eighth-edition. Accessed 5 December, 2017. 3.https://www.idf.org/our-network/regions-members/so uth-east-asia/members/94-india.html 4. Prevalence of diabetes in India Study, Study of diabetes. Diabetes Research and Clinical Practice, 2004; 66: 309-315. 5. American Diabetes Association. Diagnosis & classification of DM. Diabetes Care. 2010;33(Suppl 1):S62-9. 6.https://www.idf.org/aboutdiabetes/what-is-diabetes/co mplications.html 7. Gautam Y, Sharma A, Agarwal A, Bhatnagar M, Trehan RR. A cross-sectional study of QOL of diabetic patients at tertiary care hospitals in Delhi. Indian J Community Med. 2009;34:346–50. [PMC free article] [PubMed] 8. Krishna S, Boren SA. Diabetes self-management care via cell phone: A systematic review. J Diabetes Sci Technol. 2008;2:509–17. [PMC free article] [PubMed] 9. Promoting Physical Activity in Individuals With Diabetes: Telehealth Approaches DeAnna L. Mori, PhD, Amy K. Silberbogen, PhD, Allison E. Collins, PhD, Erin W. Ulloa, PhD, Kirstin L. Brown, BA, and Barbara L. Niles, PhD 10. Craig CL, Marshall AL, Sjöström M, et al.: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc, 2003, 35: 1381–1395. [Medline] [CrossRef] 11. Saglam M, Arikan H, Savci S, et al.: International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills, 2010, 111: 278–284. [Medline] [CrossRef] 12. Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, et al. Whole Systems Demonstrator Evaluation Team. Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): Nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial. BMJ. 2013;346:f653. [PMC free article][PubMed] 13. Hopp FP, Hogan MM, Woodbridge PA, Lowery JC. The use of telehealth for diabetes management: A qualitative study of telehealth provider perceptions. Implement Sci. 2007;2:14. [PMC free article][PubMed] 14. Telephonic Consultation and follow-up in Diabetics: Impact on Metabolic Profile, Quality of Life, and Patient Compliance, Rupinderjeet Kaur, Krishan Singh Kajal, [...], and Paramdeep Singh 15. Rawat N, Mathur N, Harikrishnan R, Choudhary J, Rawat K, Mathur M. A study of correlation of serum ferritin with glycated haemoglobin in diabetes mellitus type 2 patients: a case control study. Asian Pac J Health Sci. 2016;3(4):83-8. 16. Nagpal J, Kumar A, Kakar S, Bhartia A. The development of 'Quality of Life Instrument for Indian Diabetes Patients (QOLID): A validation and reliability study in middle and higher income groups. J Assoc Physicians India. 2010;58:295–304. [PubMed] 17. H. E. Bays,1 R. H. Chapman,2 S. Grandy3 for the SHIELD Investigators’ Group: The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys 18. Thommasen HV, Zhang W. Health-related quality of life and type 2 diabetes: A study of people living in the Bella Coola Valley. BCMJ. 2006;48:272–278. [Google Scholar] Ahmed AM (2002) History of diabetes mellitus. Saudi Med J 23: 373-378. 19. International Journal of Research in Medical Sciences Mathur M et al. Int J Res Med Sci. 2018 Mar;6(3):950-954 www.msjonline.org 20. Mugo MN, Stump CS, Rao PG, et al. Hypertension and diabetes mellitus. In: Black HR, Elliott WJ, editors. Hypertension: A Companion to Braunwald's Heart Disease. Elsevier; 2007. p. 409. 21. Bernard M. Y. Cheung & Chao Li Diabetes and Hypertension: Is There a Common Metabolic Pathway? Curr Atheroscler Rep (2012) 14:160–166 DOI 10.1007/s11883-012-0227-2 22. Kumar PJ, Clark M (2002) Textbook of Clinical Medicine. Pub: Saunders, London, UK. 1099-1121. 23. Mahler RJ, Adler ML (1999) Clinical review 102: Type 2 diabetes mellitus: update on diagnosis, pathophysiology, and treatment. J Clin Endocrinol Metab 84: 1165-1171. 24. Botero D, Wolfsdorf JI (2005) Diabetes mellitus in children and adolescents. Arch Med Res 36: 281-290. 25. Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, et al. (2010) Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 362: 800-811. 26. Diabetes Care 2016;39:2065–2079 | DOI: 10.2337/dc16-1728 27. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985; 100: 126-131 [PMID: 3920711] 28. Majorie Amoroto Palermo, Santiago Sandoval, 2016, “Assessment of Physical Activity Level among Patients with Type 2 Diabetes Mellitus at the UP–Philippine General Hospital Diabetes Clinic 29. Sigal RJ, Kenny GP, Wasserman DH, et al.: Physical activity/exercise and type 2 diabetes. Diabetes Care, 2004, 27:2518–2539. [Medline] [CrossRef] 30. Wei M, Gibbons LW, Kampert JB, et al.: Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med, 2000, 132: 605–611. [Medline] [CrossRef] 31. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med, 2002, 346: 393–403. [Medline][CrossRef] 32. McAuley PA, Myers JN, Abella JP, et al.: Exercise capacity and body mass as predictors of mortality among male veterans with type 2 diabetes. Diabetes Care, 2007, 30: 1539–1543. [Medline] [CrossRef] 33. Thomas DE, Elliott EJ, Naughton GA: Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev, 2006, 3:CD002968. [Medline] 34. Colberg SR, Sigal RJ, Fernhall B, et al.: Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. 2010, 33: 2692–2696. 35. Boulé NG, Haddad E, Kenny GP, et al.: Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA, 2001, 286: 1218–1227. [Medline] [CrossRef] 36. Kaplan RM, Hartwell SL, Wilson DK, et al.: Effects of diet and exercise interventions on control and quality of life in non-insulin-dependent diabetes mellitus. J Gen Intern Med, 1987, 2: 220–228. [Medline] [CrossRef] 37. Kim DY, Seo BD, Kim DJ: Effect of walking exercise on changes in cardiorespiratory fitness, metabolic syndrome markers, and high-molecular-weight adiponectin in obese middle-aged women. J Phys Ther Sci, 2014, 26: 1723–1727.[Medline] [CrossRef] 38. J. Phys. Ther. Sci. 28: 142–147, 2016 39. Diabetes Care 33:e147– e167, 2010 40. Ware JE.SF-36 health survey update. Spine (Phila Pa 1976) 2000;25: 3130-3139 [PMID: 11124729] 41. Linu V. Koshy et al. Ijppr.Human, 2016; Vol. 6 (4): 601-639. 42. Mashima PA, Doarn CR (December 2008). "Overview of telehealth activities in speech-language pathology". Telemedicine Journal and E-Health. 14 (10): 1101–17. doi:10.1089/tmj.2008.0080 (https://doi.org/10.1089%2Ftmj.2008.0080). PMID 19119834 (https://www.ncbi.nlm.nih.gov/pubmed/19119834). 43. Kaur, et al.: Telephonic consultation and follow-up in diabetes; http://www.najms.org on Wednesday, September 28, 2016, IP: 44. Mugo MN, Stump CS, Rao PG, et al. Hypertension and diabetes mellitus. In: Black HR, Elliott WJ, editors. Hypertension: A Companion to Braunwald's Heart Disease. Elsevier; 2007. p. 409.