An approach that only incorporates a single intervention will work towards preventing some of the complications associated with Type II Diabetes but will fail to address the others. For example, evidence suggests that by lowering blood pressure and blood lipids will primarily reduce the risk of macrovascular complications, whereas it won’t have a significant effect on microvascular complications (Kirsh & Aron, 2011). In contrast, control of blood glucose levels significantly reduces the risk of microvascular complications more so then the macrovascular ones (Mitka, 2013; Neugebauer, Fireman, Roy, & O’Connor, 2013; Shahady, 2011; Yudkin et al., 2011). As both microvascular and macrovascular complications are leading causes to developing co-morbidities and the subsequent reduction in mortality, it is evident that any treatment should be an approach that aims to reduce both (Colagiuri, 2014; Gunton, Cheung, Davis, Zoungas, & Colagiuri, 2014; Ismail-Beigi, 2011). In addition to managing blood pressure and glucose is to also address blood lipid levels as these are shown to have an effect on both microvascular and macrovascular complications (Twigg & Wong, 2015).

 

Uncontrolled blood lipid levels and glucose levels give rise to a greater risk of conditions including vascular disease, nephropathy and retinopathy (Adnan, Shabbir, Ali, Ali, & Rahat, 2013; Fowler, 2011). A pathological process called artherosclerosis plays a central role in vascular disease as it is responsible for the narrowing of arterial walls and is promoted by elevated blood lipid levels (Dixon et al., 2014; Fowler, 2011). Similarly, high blood glucose levels, a condition called hyperglycemia, is strongly linked to inducing cell damage to organs such as the kidneys and eyes (Fowler, 2011). By targeting blood pressure alone, diabetic complications such as these would not be treated and would lead to such co-morbidities and in turn affect mortality.

 

In Australia, co-morbidities in relation to Type II diabetes account for 9% of deaths annually (Haji Ali Afzali, Gray, Beilby, Holton, & Karnon, 2013). Owing to the fact that not all patients suffer from hypertension, there is evidence to suggest that blood pressure lowering strategies alone are not effective in preventing co-morbidity and mortality in Type II diabetes, and that a range of lifestyle interventions in conjunction have the most positive effect (Aksnes, Skarn, & Kjeldsen, 2012; Gunton et al., 2014; Haji Ali Afzali et al., 2013; Sattar, 2014). 

Lifestyle interventions such as a nutritionally balanced diet and increased physical activity have shown to effectively reduce co-morbidities such as metabolic parameters, and blood pressure levels in relation to Type II Diabetes (Deedwania, 2011; Unger, Hinnen, Schreiber, & Parkin, 2013; Hordern et al., 2012). An individualised patient focused plan with an emphasis on an increase in physical activity and dietary modification has shown to have lasting effect in decreasing the incidence of a range of co-morbidities and risk factors such as kidney disease, hypertension, and micro and macrovascular complications, due to the focus on overall health (Schellenberg, Dryden, Vandermeer, Ha, & Korownyk, 2013). The broad spectrum of co-morbidities decreased with this treatment plan could not be achieved with a sole blood pressure lowering strategy due to the sole focus on one health concern, and therefore this strategy does not have the most positive impact (Tuomilehto, Schwarz, & Lindstrom, 2011; Zheng et al., 2012).

It is evident that focus on blood pressure lowering strategies alone would lead to serious contributing factors such as obesity and poor nutrition going untreated, thus leading to the development of significant co-morbidities, and mortality (Hordern et al., 2012; Schwarz, Greaves, Lindstrom, Yates, & Davies, 2012). In comparison, a lifestyle intervention program has proven to take into account the prevention of modifiable risk factors including hypertension, as well as successfully showing a long lasting decrease in the incidence of additional co-morbidities, and in the long term, mortality (Johnson et al., 2015; Kahn, Cooper, & Del Prato, 2014).