Role of Synchronized Lifestyle Modification Program on Diabetic Neuropathy Taking Oral Hypoglycemics
NCT ID: NCT04813146
Last Updated: 2024-11-20
Study Results
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Basic Information
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COMPLETED
NA
216 participants
INTERVENTIONAL
2021-02-05
2022-01-30
Brief Summary
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Detailed Description
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Diabetes has emerged as a great socioeconomic burden for the developing world. In 2017, globally, 451 million people were affected with diabetes. In Pakistan, the prevalence of type 2 diabetes is 16.98% which differs significantly with age, education, body mass index (BMI), obesity, family history and blood pressure. DM is classified into type 1 diabetes (T1D) and type 2 diabetes (T2D). T1D occurs due to an autoimmune pancreatic beta cell destruction with consequent insulin deficiency whereas T2D occurs due to predominantly insulin resistance with relative insulin deficiency or defective secretion. T2D cause serious and chronic microvascular and macrovascular complications. One of the most prevalent microvascular complication is diabetic peripheral neuropathy (DPN). DPN is defined as distal, symmetric sensorimotor polyneuropathy as a result of hyperglycemia and microangiopathy. It is a demyelinating disease of peripheral nerve fibers that manifests as parasthesias, impairment of sensations of vibration, proprioception, touch, pressure, pain and temperature.
Risk factors of DPN are age, duration of diabetes, HbA1c \>7.0%, increased BMI, hyperlipidemia and hyperglycemia. Treatment of T2D is targeted towards good glycemic control that includes life style modifications i.e. diet and exercise, oral hypoglycemic agents (OHAs) and subcutaneous insulin administration. In life style modification, variety of exercises are recommended that help to slow the progression of peripheral neuropathy.These include; aerobic training, weight-bearing, static and dynamic balance training and strength training exercises which improve the gait speed, stride length and nerve conduction velocities (NCVs) of sensory and motor nerves while flexibility exercises improve the range-of-motion in ankle, hip and shoulder joints and keep them flexible. Importance of dietary modification is enhanced if it is synchronized with the circadian rhythm of the body. Therefore, Synchronized Lifestyle Modification Program (SLP) is a personalized, homeostasis restoring, liver centric lifestyle modification program that works through the correction of body clock rhythm. Lifestyle medicine is defined as the discipline of studying how daily habits and practices impact both on the prevention and treatment of disease. Its key aspects are: regular physical activity, proper nutrition, weight management, avoiding tobacco and a sound mental health. Lifestyle modification in diabetics is believed to enhance the function of pancreatic islet cells and induce glucose-stimulated insulin release.Regarding pharmacological treatment, following OHAs are used which are; biguanides, insulin secretagogues, alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase-4 (DPP4) inhibitors and sodium glucose co-transporter-2 inhibitors. Now a days, an injectable agent i.e. Glucagon like peptide-1(GLP-1) receptor agonist is used with OHAs and is effective in decreasing blood glucose levels with a low risk of hypoglycemia in elderly patients.
Limited data is available which supports the combined effect of Synchronized Lifestyle modification Program (SLP) and Physiotherapy in the progression of DPN in T2D patients taking OHAs and GLP-1.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Synchronized Lifestyle Modification Program (SLP)
Synchronized Lifestyle Modification Program ( Synchronization of dietary intake with the natural circadian rhythm of the body)
SLP
Synchronization of dietary intake with circadian rhythm of the body
Synchronized Lifestyle Modification Program along with Physiotherapy
Synchronized Lifestyle Modification Program along with Physiotherapy (Synchronization of dietary intake and Physiotherapy including aerobic, resistance, flexibility and balance exercises)
SLP along with Physiotherapy
Synchronization of dietary intake along with Physiotherapy (aerobic, flexibility, resistance and balance exercises)
Physiotherapy
Physiotherapy (aerobics, resistance, flexibility and balance exercises)
Physiotherapy
Physiotherapy given only (aerobic, flexibility, resistance and balance exercises)
Control Group
No Intervention will be given to this group ( conventional medicine will be given to these patient )
No interventions assigned to this group
Interventions
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SLP
Synchronization of dietary intake with circadian rhythm of the body
SLP along with Physiotherapy
Synchronization of dietary intake along with Physiotherapy (aerobic, flexibility, resistance and balance exercises)
Physiotherapy
Physiotherapy given only (aerobic, flexibility, resistance and balance exercises)
Eligibility Criteria
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Inclusion Criteria
* Patients between age group 40-75 years
* Clinically diagnosed patients of Type 2 diabetes on OHAs and GLP-1 analogues
* Diabetic patients with symptomatic peripheral neuropathy (Severity of DPN is associated with a physical examination score \> 2.5 by using Michigan Neuropathy Screening Instrument (MNSI) with grades mild, moderate and severe)
Exclusion Criteria
* Age \< 40 years and \> 75 years
* Patients with any other co-morbidities (Heart, liver and kidney diseases)
* Patients with neuropathies due to any other disease
* Orthopaedic and surgical procedure of lower limbs
* Patients with foot ulcers
* Peripheral vascular diseases
* Patients receiving any structured supervised physiotherapy
* Pregnant females
40 Years
75 Years
ALL
No
Sponsors
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Riphah International University
OTHER
Responsible Party
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Principal Investigators
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Shazia Ali, PhD
Role: PRINCIPAL_INVESTIGATOR
Riphah International University
Locations
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Pakistan Railway Hospital
Islamabad, Federal, Pakistan
Countries
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References
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Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes. 2019 Nov 4;9(1):33. doi: 10.1038/s41387-019-0101-1.
Aamir AH, Ul-Haq Z, Mahar SA, Qureshi FM, Ahmad I, Jawa A, Sheikh A, Raza A, Fazid S, Jadoon Z, Ishtiaq O, Safdar N, Afridi H, Heald AH. Diabetes Prevalence Survey of Pakistan (DPS-PAK): prevalence of type 2 diabetes mellitus and prediabetes using HbA1c: a population-based survey from Pakistan. BMJ Open. 2019 Feb 21;9(2):e025300. doi: 10.1136/bmjopen-2018-025300.
Diabetes Canada Clinical Practice Guidelines Expert Committee; Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018 Apr;42 Suppl 1:S10-S15. doi: 10.1016/j.jcjd.2017.10.003. No abstract available.
Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson DJ, Lim J, Malik RA, Alam U. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther. 2018 Jun;40(6):828-849. doi: 10.1016/j.clinthera.2018.04.001. Epub 2018 Apr 30.
Cancelliere P. A Review of the Pathophysiology and Clinical Sequelae of Diabetic Polyneuropathy in the Feet. J Diabetes, Metab Disord Control. 2016;3(2):21-4.
Liu X, Xu Y, An M, Zeng Q. The risk factors for diabetic peripheral neuropathy: A meta-analysis. PLoS One. 2019 Feb 20;14(2):e0212574. doi: 10.1371/journal.pone.0212574. eCollection 2019.
Qaseem A, Barry MJ, Humphrey LL, Forciea MA; Clinical Guidelines Committee of the American College of Physicians; Fitterman N, Horwitch C, Kansagara D, McLean RM, Wilt TJ. Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017 Feb 21;166(4):279-290. doi: 10.7326/M16-1860. Epub 2017 Jan 3.
Gholami F, Nikookheslat S, Salekzamani Y, Boule N, Jafari A. Effect of aerobic training on nerve conduction in men with type 2 diabetes and peripheral neuropathy: A randomized controlled trial. Neurophysiol Clin. 2018 Sep;48(4):195-202. doi: 10.1016/j.neucli.2018.03.001. Epub 2018 Mar 30.
Majeedkutty NA, Jabbar MA, Sreenivasulu S. Physical therapy for diabetic peripheral neuropathy: A narrative review. Disabil CBR Incl Dev. 2019;30(1):112-25.
Bae SA, Fang MZ, Rustgi V, Zarbl H, Androulakis IP. At the Interface of Lifestyle, Behavior, and Circadian Rhythms: Metabolic Implications. Front Nutr. 2019 Aug 28;6:132. doi: 10.3389/fnut.2019.00132. eCollection 2019.
Parr EB, Heilbronn LK, Hawley JA. A Time to Eat and a Time to Exercise. Exerc Sport Sci Rev. 2020 Jan;48(1):4-10. doi: 10.1249/JES.0000000000000207.
Rippe JM. Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices. Am J Lifestyle Med. 2018 Jul 20;12(6):499-512. doi: 10.1177/1559827618785554. eCollection 2018 Nov-Dec.
Marin-Penalver JJ, Martin-Timon I, Sevillano-Collantes C, Del Canizo-Gomez FJ. Update on the treatment of type 2 diabetes mellitus. World J Diabetes. 2016 Sep 15;7(17):354-95. doi: 10.4239/wjd.v7.i17.354.
Other Identifiers
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IRC/20/234 Rubab Rameez
Identifier Type: -
Identifier Source: org_study_id
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