Literature Review
The main purpose of the research is to investigate the influence of a healthy diet, exercising and metformin administration in preventing the development of type 2 diabetes from prediabetes in adults over the age of 40. The relevance of the research is assured by the statistics, which demonstrates that about 75% of adults in the United States are presupposed to suffer from obesity or excessive weight (Centers for Disease Control and Prevention, 2015). This evidence is critical because obesity and excessive weight are the main factors, which correlate with such diseases as type 2 diabetes and prediabetes. It is evident that one of the factors, which impacts on the development of diabetes is the increased consumption of sugars together with their decreased utilization because of insufficient exercising (Healthy People, 2013). As a result, people tend to be obese and gradually develop a prediabetic condition. At the same time, there is a specific scope of studies, which indicate that weight control, physical exercising, and a diet can reduce the factors, which allow prediabetes developing in diabetes (Ahmad & Crandall, 2010). Such researchers claim that in 58% of interventions, the prediabetic condition may be a prevented in case patients lose up to 10% of their body weight through diet and exercising (Diabetes Research & Wellness Foundation, n.d.). Therefore, the proposed experiment aims at increasing the utilization of blood sugars by exercising and metformin intake, together with a diet recommended for activation of metabolism.
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The literature review, discussing the core issues of the study, demonstrates that there are different factors, which have to be considered when performing the research. A study by Garnett et al. (2013) demonstrates that a structured diet can be one of the strategies, which allow teenagers to recover from obesity and prevent the development of diabetes. Moreover, the research suggests that the structure of diet should contain an increased or moderate amount of carbohydrates, together with increased amount of protein to be efficient. At the same time, scholars claim that a diet with a reduced level of carbohydrates and fats is not as efficient as it is expected; it is advised not be used for preventing type 2 diabetes (Garnett et al., 2013). At the same time, the important aspect of the study was that during its experimental stage, the researchers combined the influence of a diet with physical activity and metformin intake (Garnett et al., 2013). As a result, the interventions allowed not only decreasing the level of body fat, but improving the cardiometabolic profile and insulin sensitivity of subjects. Therefore, the selected interventions are expected to be efficient for adults, as well as they were for teenagers.
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Additionally, it is significant to note that the evaluated research discusses the influence of diet, exercising and metformin administration in teenagers, which present a different group from adults, aged over 40. In this sense, the age may be considered as one of the factors which create specific restrictions on diet and exercising. The aspects of diet’s connection with the age are important because adults have lower metabolism rate than the middle-aged people. Thus, scholars claim that human metabolism gradually slows down with the increase of the age (Son’kin & Tambovtseva, n.d.). Moreover, the study by Son’kin and Tambovtseva (n.d.) suggests considering the fact that muscle energy expenditure of an adult can sometimes be more, as opposed to children. The latter means that the programs of physical exercising should include activities, which use this aspect at its full rate, in order to assure the proper calorie loss. However, one more aspect of age is that middle-aged people may have specific restrictions of physical exercising. This factor is investigated by the study of Lee et al. (2013), who claim that mobility limitations are one of the most critical factors, which require consideration when creating programs of physical activities in adults. In this respect, scholars indicate that “compared with respondents with normoglycemia, respondents with prediabetes had higher odds of having functional limitations that affected mobility, the lower extremities, and the upper extremities” (Lee et al., 2013). Therefore, the prevalence of physic function limitations is prevalent among middle-aged individuals, which influences towards the scope of selected exercising interventions for preventing diabetes. At the same time, scholars claim that the rate of studies devoted to the research of the influence of physical exercising on preventing diabetes in adults is extremely low (Farni et al., 2014). This factor increases the validity of proposed research, as it considers the group of middle aged subjects with prediabetes.
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Furthermore, the library research considered the sources, which discuss the impact of metformin administration in individuals with prediabetes for preventing its progressing into diabetes. Thus, Hostalek, Gwilt, and Hildemann (2015) claim that the strategy of using metformin is effective in individuals, who have difficulties with maintaining the way of life that is required for reducing diabetes. It this sense, the scholars view metformin as a useful substance because of its ability for enhancing the action of insulin in liver and skeletal muscle. As a result, its general effect is the delay of or prevention of the onset of diabetes. Similarly, the researchers argue that numerous studies, including the Diabetes Prevention Program, approved the efficacy and safety of metformin, which is why they propose it a therapeutic use by patients with prediabetes (Hostalek, Gwilt, & Hildemann, 2015). Other studies support the view of efficacy of metformin administration, claiming that it reduces the incidence of diabetes by 21.5% in absolute terms (Devi, Singh, Kapoor, & Gandhi, 2015). The researchers obtained this result during the meta-analysis study done on three randomized clinical trials. The scholars argue that the effective dosage of metformin in conversing prediabetes from diabetes was 850 mg twice daily (Devi et al., 2015). At the same time, the research indicates that the strategy of administering metformin allows to boost the effect of lifestyle modification. Thus, only lifestyle modifications demonstrated a 20% decline of the development of diabetes (Devi et al., 2015). This information allows to predict that metformin administration would increase the efficacy of exercising and diet practiced by the experimental group of the research. Similarly, the researchers claim that the lifestyle modifications include more factors than exercising and diet. Among them, they also name reduction of sedentary work style and stress (Devi et al., 2015). However, the latter issues are not at the focus of current research. At the same time, certain investigations claim that the reduction of body weight is a factor, which may be irrelevant in adults, preventing the progress of diabetes by the means of lifestyle change (Sénéchal, Slaght, Bharti, & Bouchard, 2014). In this respect, scholars raise doubts about the ability of reduction of the body weight alone for the improvement of glycemic control. Consequently, they indicate that it is unclear whether weight loss may be a cornerstone in preventing diabetes, along with exercising and diet control (Sénéchal et al., 2014). Therefore, general practitioners must be reminded that the research has enough supporting evidence, validating its need and the range of the selected factors used for investigation. Thus, there is a need for exploring the impact of a structured diet, physical interventions and metformin administration on the prevention of diabetes in individuals aged about 40 and having prediabetes.
