Type 2 diabetes mellitus (T2DM) is one of the most prevalent non-communicable diseases (NCDs) in developed as well as developing countries.1
It is associated with significant morbidity, mortality and increased healthcare cost.2
In 2010, about one-third of people with diabetes were over 60 years of age.4
The greatest increase in the prevalence is expected to occur in Asia and Africa due to the joint trends of urbanisation and lifestyle changes.1
Regular physical activity in the management of T2DM is effective in improving glucose homeostasis and reducing risk of diabetes complications and mortality.5–8
Recommendations suggest that the elderly, especially with NCDs, benefit from regular physical activity.9–12
However, 52–80% of the elderly were inactive,13–15
especially with T2DM.16
Interventions to promote physical activity in people with T2DM are many but few specifically focussed on elderly as most studies included participants aged ≥40 years and did not examine age effects.17–22
Feedback to promote behavioural change is one of the frequently used interventions. Motion sensor devices (accelerometer or pedometer) and exercise log were used as feedbacks to increase physical activity.17–22
They served as motivational tools and allow self-monitoring of the intended behaviour change, hence empowering patients to self-care. These studies reported improvements in daily step counts, metabolic controls,19
and reductions in anthropometric measurements.21
Self-management is an important aspect in the multidimensional management of T2DM. Patients need to address various health behaviours such as physical activity, healthy eating and blood sugar monitoring to manage their condition. In T2DM, healthcare professionals often provide self-management education; however, the effect on health status often is short term.23
The lack of ongoing educational support and attention to behaviour change principles are often contributing factors to the short-term positive changes in health status. The increasing number of attendees to primary care clinics and shortage of healthcare professionals trained in self-management approaches also contribute to these suboptimal approaches to T2DM management.
Peer support has emerged as a relatively low-cost approach that can be used in conjunction with healthcare professional support to assist in the management of T2DM. Ongoing support through peer mentors empowers patients with T2DM to self-manage their condition.25–27
Peer mentors are people ‘… who successfully coped with the same condition and can be a positive role model’ (ref. 28
, p i26). Interventions incorporating peer mentors improved glycaemic control,19
and self-care behaviour.20
However, the role of peer support for elderly with T2DM in promoting physical activity is not well documented in the literature especially in South East Asia.
In 2010, Malaysia was ranked among the top 10 countries in the world for diabetes prevalence, with 11.6% of the 17 million people aged 20–79 years with diabetes.1
The prevalence of diabetes in Malaysia increased from 8.2% in 1996 to 14.9% in 2006.29
The highest prevalence is among people aged 60–64 years at 26.1%. Furthermore, elderly with T2DM have low levels of physical activity than younger patients (41.5% vs 25.3%).30
Those who are less active have poorer glycaemic control.
Malaysia is a multiethnic population comprising the Malay (50.7%), Chinese (23.1%), Indian (6.9%) and other Bumiputera (11%) people (indigenous people) as the major groups within the total population of 28 million. Malay people have the second-highest prevalence of T2DM at 11.9%,29
and had worse glycaemic and cardiometabolic controls.31
Moreover, they have the lowest prevalence of recommended adequate exercise than the other ethnic groups.32
The rapid increased in the incidence of T2DM and a shift towards an ageing population over the last decade33
warrants the need for an intervention program to promote physical activity and improve the health status of elderly with T2DM in Malaysia. With the limited healthcare resources, peer support and feedback about physical activity behaviour in the management of T2DM may prove to be a cost-effective approach. Furthermore, targeting elderly Malays is appropriate in view of the low prevalence of adequate exercise and poorer glycaemic control in this group in Malaysia. Hence, the objective of this trial is to evaluate the relative effectiveness of personalised feedback about physical activity patterns alone and in combination with peer support to promote and maintain physical activity compared to usual care.