Global Journal of Medical Research, F: Diseases, Volume 23 Issue 2

Table 8: ANCOVA Summary of the effect of Intervention on Waist circumference of T2DM patients Parameter Effect of Intervention on the Waist Circumference F P-value Effect Size ⴄ 2 Initial Visit 3 Months 6 Months Mean ± SD Mean ± SD Mean ± SD Waist Circumference 88.75 ± 6.47 82.98 ± 5.73 80.02 ± 6.74 7.435 0 .001* 0.147 *Statistically Significant at P ≤ 0.05 IV. D iscussion Even with a large number of T2DM medications being available on the market, non-adherence to therapy, side effects, cost, and poor health seeking behaviors are a major drawback for effective glycaemic control. (Jaja et al., 2016; Sokiprim et al., 2022; Siminialayi and Eme-Chioma, 2006) This occasionally makes it difficult for patients with T2DM to follow through to their treatment. An unhealthy diet like non-vegetarian with processed red meat, excess fats were even reported to have a 3.8times chance of having diabetes linked to their cause of death irrespective of age and sex. (Snowden 1985). Although this study considered age, sex and dietary patterns, it did not the health seeking behaviours and occupations of the participant. It showed a mean age of 54.74±11.29 years for intervention group with gender equally matched (see Table1). The principles of prevention and management in T2DM include frequent blood glucose monitoring, reduction in calories etc. Blood glucose monitoring before and after meal will enable early recognition of glucose abnormalities and allow prompt action to prevent several diabetic complications. Particpants in this study had blood sugar monitored daily on self- assessment of daily glycaemic control. Tonstadetal. (2013) showed that appropriate diet was associated with weight reduction in patients at risk for T2DM when BMI was adjusted. The intervention group were on 1,200kcal per day in this present study. A UK study demonstrates that a weight loss program can result in type 2 diabetes remission even in those with a normal body mass index (BMI) by reducing body fat, notably in the liver and pancreas. Twenty participants with type 2 diabetes with a BMI of 27 kg/m2 or less participated in the ReTUNE (Reversal of Type 2 Diabetes Upon Normalisation of Energy Intake in Non-obese People) experiment. Participants had shed 9% of their body weight after a year. They observed reductions in liver fat, total triglycerides, and pancreatic fat, and their body fat considerably dropped, reaching the same level as individuals without type 2 diabetes. This was also shown to be associated by increases in insulin production and decreases in A1c and fasting plasma glucose levels, Furthermore, the study showed that T2DM has the same etiology and pathogenesis whether BMI is normal or elevated. This knowledge ought to have a significant impact on the recommendations doctors give to their patients. Encourage patients to lose weight is not very pleasant to a patient with T2DM however, this is one of the dramatic aspects about dealing with people in this group. The improvements in T2DM are seen with systematic intervention programs that result in considerable weight reduction (Katula et al., 2013; Mohammed et al., 2012). For the prevention and treatment of diabetes, targeted lifestyle interventions have been demonstrated to be both clinically and financially successful (Shurney 2012; Herman, 2015). The study showed a steady drop of parameter means from the initial visit to six months in the intervention group. The fasting blood sugar dropped from a group mean of 7.97 on the initial visit to a mean of 5.35 after six months with and effect size of 0.13. (see Table 6). Furthermore, the study showed that twice the number of study participants in the intervention group had a drop in Fasting blood glucose (well controlled) throughout the study period compared to the control group in a ratio of almost 2:1. It is safe to document that the intervention had more efficacy at glycaemic control (see Table 4). Lim et al 2011 found normalized in the diabetic group (from 9.2±0.4mmol/L to 5.9±0.4 mmol/l, p=0.003). This finding were similar to finding in Pories et al. (1987), affirmed in 2017 by Schauer et al.; reaffirmed by the Diabetes Remission Clinical Trial (DiRECT) study and currently by Sokiprim et al (2022) using wholly Nigerian diet to achieve remission in T2DM patients. Similarly, the result showed substantive weight loss after six months of Intervention. This is revealed in the waist circumference mean which fell from 88.82cm to 80.0cm after six months, and BMI that dropped from 26.670 to 22.857kg/m 2 after six months (Table 3). The very small effect size of 0.16 for BMI shows no interference with the control (Table 7). This study has provided proof that a healthy diet may help maintain good glycaemic control and restore patients' health to normal. A calorie reduction over a period of weeks or months may cause weight loss with a decline in leptin synthesis, a reduction in fatty acid infiltration into liver and muscle cells, and the potential for a legacy effect. This may be the cause of the outcome seen with the decrease in HbA1c after weight loss (see table 5). All of them cause weight reduction, a decrease in inflammatory mediators, and an increase in insulin sensitivity. Dysbiosis is brought on by the disturbance of the microbiome caused by the Western 52 Year 2023 Global Journal of Medical Research Volume XXIII Issue II Version I ( D ) F © 2023 Global Journals Type 2 Diabetes Mellitus Remission in Patients with Ideal BMI in Rivers State, Nigeria