ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In Patients With Type 2 Diabetes, Lifestyle Change Is Very Effective In Reducing Cardiovascular Disease
Clinical Question In patients with Type 2 Diabetes, how effective is lifestyle change in reducing cardiovascular disease?
Clinical Bottom Line For patients with Type 2 Diabetes, lifestyle change is effective in reducing cardiovascular disease. A systematic review and two randomized controlled trials prove that the risk of cardiovascular disease and the markers of cardiovascular disease decreases with increasing exercise and fitness.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22399699Balducci/2012606 Italian patients with Type 2 DiabetesRCT
Key resultsHbA(1c), hs-CRP, and CHD risk score all improved with increasing fitness.
#2) 21525503Chudyk/2011Patients with Type 2 DiabetesMeta Analysis
Key resultsHbA(1c) was significantly improved by -0.6% and -0.67% by aerobic exercise alone and aerobic exercise combined with resistance training (RT), respectively. The 95% confidence interval went from -0.98 to -0.27 and -0.93 to -0.40, respectively. The confidence intervals for systolic blood pressure and triglycerides (clinical markers for CV) were as follows “systolic blood pressure (SBP) -6.08 and -3.59 mmHg, respectively (95% CI -10.79 to -1.36 and -6.93 to -0.24, respectively), and triglycerides -0.3 mmol/L (95% CI -0.48 to -0.11 and -0.57 to -0.02, respectively)”.
#3) 19614943Johnson/200941 patients with Type 2 DiabetesRCT
Key resultsAfter 12 weeks of using a pedometer to increase the daily steps, BMI, weight, and systolic and diastolic blood pressure improved (p<0.01 for all). After 24 weeks, patients assigned to basic lifestyle programme (BLP) had a higher PR (78 +/- 12 b.p.m.) than patients assigned to an enhanced lifestyle programme (EPL) with a PR of 71+/- 12 b.p.m. The adjusted p was 0.03.
Evidence Search (("Diabetes Mellitus, Type 2"[Mesh]) AND "Exercise"[Mesh]) AND "Cardiovascular Diseases"[Mesh]
Comments on
The Evidence
Validity: The first article was a randomized controlled trial with groups similar at the start. The groups were treated the same, and it was not disclosed if there was a greater than 80% completion rate. There was adequate follow-up and adequate compliance. Recall bias was unlikely, and there were no disclosed competing interests. It was not disclosed if the study was double blind. The second article is a systematic review of randomized controlled trials, with a comprehensive, detailed search for relevant trials. The 34 articles were assessed for validity using specific inclusion criteria. A meta-analysis was not performed, and the number of patients was not disclosed. The third article was a randomized controlled trial with groups similar at the start. The groups were treated the same, and was a greater than 80% completion rate. There was adequate follow-up and adequate compliance. Recall bias was unlikely, and there were no disclosed competing interests. It was not disclosed if the study was double blind.
Applicability The results of these studies will aid the dentist in counseling patients with Type 2 Diabetes.
Specialty/Discipline (General Dentistry)
Keywords Type 2 Diabetes Mellitus AND cardiovascular disease
ID# 2404
Date of submission: 02/27/2013spacer
E-mail allinsonelizabeth@gmail.com
Author Elizabeth Allinson
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana S. Gross, MPH
Faculty mentor/Co-author e-mail grossg@uthscsa.edu
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