DR.

YSR UNIVERSITY OF HEALTH SCIENCES

VIJAYAWADA, ANDHRA PRADESH.
PROFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION.
PART A

1 Name of the candidate Dr.SANKAR S

and address S/O SIVAKOLUNTHU S
49-b,Ganeshar street,madathupalayam road,
Avinashi,
Tiruppur district, TamilNadu, INDIA,641654.
2 Name of the APOLLO INSTITUTE OF MEDICAL SCIENCES AND
ins tu on RESEARCH-CHITTOOR.

3 Course of the study MD COMMUNITY MEDICINE

and subject

4 Date of admission in 30/11/2023

to the course

5 Title of the topic ASSESSEMENT OF DIETARY MODIFICATION AND

PHYSICAL ACTIVITY AMONG TYPE 2 DIABETIC
PATIENTS IN URBAN AREA CHITTOOR (A.P) A
COMMUNITY BASED INTERVENTIONAL STUDY.
6 INTRODUCTION

The global increase in the prevalence of diabetes seen in years has been a ributed mostly
to obesity, poor diet, and lack of physical ac vity. In 2019, diabetes was the
Direct cause of 1.5 million deaths and 48% of all death due to diabetes occurred before
the age of 70 years. Another 460000kidney disease death were caused by diabetes and
raised blood glucose cause around 20% of cardiovascular death.
As per the study in 2021 there were 101 million people in India with diabetes
and 136million with pre-diabetes.
The propor on of people with type 2 diabetes is on the rise and is a major
Cause of death worldwide. Type 2 diabetes is a major risk factor for vascular disease with
65% of all diabetes being due to cardiovascular disease.
Lifestyle characteris cs such as physical ac vity, diet, and stress are important
factors that influence development and prognosis of type 2 diabetes.
Changes in diet and increase in physical ac vity and exercise are the key
Components of the management of type 2 diabetes.

6.1 Need for study

For permanent change in the lifestyle regarding dietary pa ern and physical exercise.
To yield be er life for diabe c pa ents. For this con nuous mo va on and supervision is
needed which this study incorporates these key factors.

6.2 Aim
Assessment of improvement in diabe c pa ents by changing diet and physical ac vity.

Objec ve
 Study dietary pa ern and physical ac vity among diabe c pa ents.
 Study the awareness about weight reduc on and relevant exercise among
diabe c pa ents.
6.3 Review of Literature:
1.Gurmeet Kaur et la study done on Dietary and Lifestyle Modifica on among Diabe c
Pa ents at a Ter ary care Hospital in Delhi: A Cross-Sec onal Study found that Modern
lifestyle changes combined with urbaniza on has led to increased prevalence of diabetes. To
decrease the morbidity, mortality, and the complica ons of diabetes, comprehension of diet
and physical exercise is a must. The was conducted using a pretested ques onnaire among
100 type 2 diabe c pa ents a ending the medicine outpa ent department of a Ter ary care
Hospital Delhi, Baseline parameters of the study par cipants were expounded and their
awareness and prac ce regarding the lifestyle modifica on were assesses.

2.Reshmi Kundapur et la study done on Lifestyle, dietary and treatment adherence pa ern
of uncontrolled diabe cs in costal Karnataka, India; fond that Diabetes Mellitus shows a
rising trend in India, driven by a combina on factors like sedentary lifestyle, unhealthy diet
and tobacco use. This is part of larger study which was a community trial to reduce the burden
of Non communicable diseases in Karnataka. The inten on was to introduce lifestyle
modifica on and physical ac vity interven on and compare it controlled village. The
enrolment was done for all the pa ents, irrespec ve of all age, diagnosed with Type 2
Diabetes Mellitus who were on treatment but with HbA1c more than 7%, selected from a
baseline survey of 2 RBS readings (average was considered). Out of the 67 subjects, 32(47.8%)
had HbA1c between 7-9 whereas 35 (52.2%) had 10 and above. In this study, propor on of
females had poor glycemic control compared to male. The propor on of diabe cs who
performed exercise was low compared to people who was not physically ac ve.

3.Edward W. Gregg et la study done on Associa on of an Intensive Lifestyle Interven on

With Remission of Type 2 Diabetes; To examine the associa on of a long-term intensive
weight-loss interven on with the frequency if remission from type 2 diabetes to prediabetes
or normoglycemia. Ancillary observa onal analysis of a 4-year randomized controlled trial
Comparing an intensive lifestyle interven on (ILI) with a diabetes support and educa on
control condi on (DSE) among 4503 US adults with body mass index of 25 or higher and
type 2 diabetes. Par cipants were randomly assigned to receive ILI, which include weekly
group and individual counseling in the first 6 months followed by 3 sessions per month for
the second 6 months and twice-monthly contact and regular refresher group series and
campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group session per
year on diet, physical ac vity, and social support(n=2262).Intensive lifestyle interven on
par cipants lost significantly more weight than DSE par cipants at year 1 (net difference,-
7.9%;95% CI,-8.3% to-7.6%) and at year 4 (-3.9%;95% CI,-4.4% to -3.5%) and greater fitness
increases at year 1 (net difference, 15.4%; 95% CI, 13,7%-17.0%) and at year 4 (6.4%; 95%
CI, -4.7%-8.1%) (P<.001 for each).
4.Andreea Gheriasim et la Study done on Lifestyle Pa erns in Pa ents With Type 2 Diabetes;
Modern lifestyle has sedentary behavior, lower par cipa on in ac ve movement and physical
ac vity during leisure me, unhealthy diet, and increase exposure to stress. It is important to
examine the interac on of several lifestyle risk factors instead of focusing one alone. The
purpose of the study was to iden fy lifestyle pa erns in a group of pa ents with type 2
diabetes and the associa on of its components with certain metabolic parameters. Using
principal component analysis, We iden fied three dietary pa erns: the prudent (fat, oil,
cereals, potato, vegetables, fish, nuts, seeds and fruits), the Western pa ern (meat and meat
products, egg and so drinks) and the tradi onal pa ern (milk and its deriva ve, soups and
sauces, with low intake of sugar/snacks).In addi on using the same method of analysis, we
iden fied two lifestyle pa erns: the inadequate lifestyle pa ern (tradi onal dietary pa ern,
increased physical ac vity (PA) and non-smoking status). The inadequate lifestyle pa ern was
associated with younger age, hypertension and diabe c neuropathy. The tradi onal lifestyle
pa ern was related to lower postprandial blood glucose levels. Sedentary individuals were
more likely to be over 65 years old and to have higher glycated hemoglobin (HbA1c). Smokers
were also more likely to have inadequate glycemic and lipid profile control.

5.Yahaya Adil et la done study on The Effect of Lifestyle Interven on on Glycemic Control in
Type 2 Diabe c Pa ents In this the study involved a three month educa onal program
interven on in a two-group, randomized controlled trial. It include two group of subject, one
receiving educa onal program and other serving as a control group. Between November
2021 and February 2022, 100 pa ents with T2DM were recruited from Erbil, Iraq. Pa ents
with T2DM were randomly allocated to one of two groups: control (n=50) or interven on
(n=50). The interven on group received an educa onal program with publisher including,
diet instruc on, nutri onal supplements, and a exercise recommenda on as part of their
interven on. Data are presented as mean SD. A two-tailed unpaired t-test was employed for
comparison between groups. Means, standard devia ons, and percentages were provided as
crude values for descrip ve sta s cs. The three result of the study suggests that lifestyle
interven on and low-carbohydrate diet for three months are beneficial in improving glycemic
control in pa ents with type 2 diabetes when compared to control group.
7 Methodology

7.1 Study Design: A Community based Experimental study.

Study popula on: Known type 2 diabe c residing area of Chi oor
Sample Method: A community based interven onal study with control. To evaluate the
Effec veness of method of dietary interven on.

7.2 Data collec on procedure: Diabe c pa ents between 30-70 years in urban, Chi oor consent
is taken, and required ques ons are asked based on the predesigned valida on ques onnaire
suitable for the study.

Dura on of study: 12 months a er ge ng the ICE cer ficate.

7.3 Study se ng and Source of data:

A Experimental study in community in urban field prac ce area of Apollo ins tute of Medical
Sciences and Research, Chi oor.
The urban field prac ce area covered are:
 Panchalipuram
 Moraji Nagar
 Lenin Nagar
 Mangasamudram-1
 Mangasamudram-2

7.4 Sample size and its determina on:

Sample size: 126 pa ents

Sta s cal Analysis:
The Variables will be analysed using descrip ve sta s cs and mul variate analysis. The
hypothesis will be tested using repeated measures analysis of variance and will conducted on
the general characteris cs of the study subjects. For the condi on that the varia on cases
sa sfy the homogeneity of variance, paired t test and Mann Whitney U test will be
performed. The applicable for type 1, Level of significance 5% confidence level is 80% and
90%. The sample of two cases are 76 and 50 sample size 126 using SPSS (sta s cal Package
of Social Sciences) version 26 for window 10.
7.5 Sample Selec on Criteria:

Inclusion Criteria:
1. Both male and female aged between 30yrs-70yrs.
2. Pa ents with type 2 diabe c mellitus
3. Pa ents with known history of type 2 diabe c mellitus diagnosed minimum one
year back.
4. Subject giving their consent.

Exclusion Criteria:
1. Diabe c below 30years of age
2. Pa ents with type 1 diabe c mellitus.
3. Pa ents with known history of type 2 diabe c mellitus less than one year.
4. Subject not willing to give consent.

7.6 Brief descrip on:

Diabetic patients between 30-70 years in urban field practice areas of Apollo
Institute of Medical Sciences, Chittoor will be selected randomly from the household
survey register. After obtaining the written consent form, socio demographic details
which contains Name, Age, Sex, Education, Religion, socio economic status,
Address, Contact number and other required information is taken. After that
validated questionnaire which consist of the questions about socio-demographic
information, information about knowledge, attitude and practices about diet and
physical activity of patients who have given their consent and the data is collected.

8 DESCRIPTION OF METERIALS USED:

The developed ques onnaire ,validated and pre tested Ques onnaire which is designed
based on which the ques ons about the socio-demographic informa on, BMI,informa on
about knowledge ,a tude,and prac ces regarding diet and physical ac vity among diabe c
pa ents 30-70years of age group who have given their consent , the data is collected
through interview method . The informa on is collected and analyzed

Anticipated Risks (Adverse events, Lethal or sublethal injury) to the study participants and
efforts taken to minimize them : NIL
9

DETAILS OF COLLABORATION, IF ANY (INCLUDE ANNEXURE) :NIL

10

DETAILS OF ETHICAL CLERANCE OBTAINED:

11 ICE Cer ficate and Reference Number (included Annexure)

List of references:
12
1. Edward W. Gregg, Lynne E. Wagenknecht, Jeanne M. Clark, Linda M. Delahanty, John
Bantle, Henry J. Pownall, et la Associa on of an intensive Lifestyle interven on with
Remission of Type 2 Diabetes.
2. Liang Chen, Jian-Hao Pei, Jian Kuang, Hong-Mei Chen, Zhong-Wen Li, Hua-Zhong
Yang. Effect of Lifestyle Interven on in Pa ents with type 2 diabetes: A meta-
analysis.
3. Xiao-Li Huang, Jian-Hua Pan, Dan Chen, Jing Chen, Fang Chen, Tao-Tao Hu. Efficacy of
Lifestyle interven ons in pa ents with type 2 diabetes: A systema c review and
meta-analysis.
4. Steven S Coughlin, Christos Hatzigeorgiou, Judith Anglin, Ding Xie et la. Healthy
Lifestyle interven on for adult clinic pa ents with type 2 diabetes mellitus.
5. Eva S Vadstrup, Anne Frolich, Hans Perrild, Evaa Borg, Michael Roder. Lifestyle
interven on for diabetes pa ents- trial protocol of The Copenhagen Type 2 Diabetes
Rehabilita on Project.
6. Reshmi Kundapur et la study done on Lifestyle, dietary and treatment adherence
pa ern of uncontrolled diabe cs in costal Karnataka, India
7. Gurmeet Kaur et la study done on Dietary and Lifestyle Modifica on among Diabe c
Pa ents at a Ter ary care Hospital in Delhi: A Cross-Sec onal Study.
8. Edward W. Gregg et la study done on Associa on of an Intensive Lifestyle
Interven on With Remission of Type 2 Diabetes.
9. Andreea Gheriasim et la Study done on Lifestyle Pa erns in Pa ents With Type 2
Diabetes.
10. Yahaya Adil et la done study on The Effect of Lifestyle Interven on on Glycemic
Control in Type 2 Diabe c Pa ents.
11. Nathan DM. Long-term complica ons of diabetes mellitus. N Engl J Med. 1993;
328(23):16761685. [PubMed: 8487827].
 12. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance
and type 2 diabetes. Nature. 2006; 444(7121):840–846. [PubMed: 17167471].

13 List of Annexures:

a)Consent form in English and Local language

b) Study profoma and ques onnaire

c) Le er of Collabora on

d) Work plan/ study dura on and Timeline

e) Esimated Budget

f) IEC Certificate
14 Signature of the Candidate

15 Remark of the Guide

16 Name and Designa on of the Guide Dr.Y.Bharani Krishna

Professor, Department of Community Medicine

Signature

17 Co-Guide

Signature

18 Head of the Department Dr. B.G Ranganath

Professor and HOD
Department of Community Medicine
Signature and Seal

19
Signature of the dean with seal Dr. Alfred J Augustein
Professor of General Surgery
Dean