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Wang J, Mahe J, Huo Y, Huang W, Liu X, Zhao Y, Huang J, Shi F, Li Z, Jiang D, Li Y, Perceval G, Zhao L, Zhang L. Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis. J Med Internet Res 2024; 26:e58735. [PMID: 39190910 PMCID: PMC11387916 DOI: 10.2196/58735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.
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Affiliation(s)
- Jian Wang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Jinli Mahe
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yujia Huo
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Weiyuan Huang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Xinru Liu
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Feng Shi
- East China Aviation Personnel Medical Appraisal Center, Shanghai, China
| | - Zhihui Li
- Tsinghua Vanke School of Public Health, Tsinghua University, Shenzhen, China
| | - Dou Jiang
- School of Economics and Management, Southeast University, Nanjing, China
| | - Yilong Li
- School of Economics and Management, Southeast University, Nanjing, China
| | - Garon Perceval
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Lindu Zhao
- School of Economics and Management, Southeast University, Nanjing, China
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
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Gostoli S, Raimondi G, Popa AP, Giovannini M, Benasi G, Rafanelli C. Behavioral Lifestyle Interventions for Weight Loss in Overweight or Obese Patients with Type 2 Diabetes: A Systematic Review of the Literature. Curr Obes Rep 2024; 13:224-241. [PMID: 38436787 PMCID: PMC11150315 DOI: 10.1007/s13679-024-00552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE OF REVIEW Around 80-90% of patients with type 2 diabetes mellitus (T2DM) are overweight or obese, presenting a greater risk for serious health complications and mortality. Thus, weight loss represents a main goal for T2DM management. Although behavioral lifestyle interventions (BLIs) could help promoting weight loss in T2DM patients with overweight or obesity, their effectiveness is still controversial. This systematic review offers an updated and comprehensive picture of BLIs according to Michie's classification in T2DM patients with overweight or obesity and identifies possible factors (related to both patients and interventions) associated with weight loss. The PRISMA guidelines were followed. The literature search till March 2023 indicated 31 studies involving 42 different BLIs. RECENT FINDINGS Our findings suggest that structured BLIs, characterized by frequent feedback and support, can lead to a clinically meaningful 5% weight loss, regardless of specific behavioral, diet, and physical activity components. Further research should address methodological issues and heterogeneity of interventions, also considering the effect of pharmacological therapies on weight reduction. Lastly, more attention should be paid to the long-term effectiveness of behavioral lifestyle interventions and to the relationship between weight loss and diabetes.
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Affiliation(s)
- Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Giulia Raimondi
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Alexandra Paula Popa
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Micaela Giovannini
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Giada Benasi
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168th Street, 10032, New York, NY, United States
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
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Kalantari M, Hollywood A, Lim R, Hashemi M. Co-designing an intervention using the COM-B model to change an eating behaviour in people living with achalasia. Front Med (Lausanne) 2024; 11:1216209. [PMID: 38745739 PMCID: PMC11091317 DOI: 10.3389/fmed.2024.1216209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Background Achalasia is a rare motility disorder affecting the oesophagus, leading to difficulties with eating and drinking. Participants in previous studies reported that they needed more social, clinical and behavioural support in the long-term management of achalasia. This study, therefore aimed to 1) identify the most challenging eating behaviour for people living with achalasia and 2) co-design a behaviour change intervention to help address the challenges they experience. Methods This study used a qualitative approach involving online focus groups. The COM-B model was the theoretical framework, with behaviour change techniques (BCTs) as the active ingredients that target a mixture of capability, opportunity and/or motivation. Three focus groups were undertaken to obtain a range of input from different people living with achalasia. Participants in this study identified the target behaviour, prioritised the different BCTs which most resonated with them to design an intervention and decided on the mode of delivery. The research team analysed the techniques that helped participants with their eating behaviour using the COM-B model as a framework to create the intervention. Results The 24 participants in this study identified "eating in a social setting" as the target behaviour for the intervention. A workbook that can be personalised by the individual was the most suitable intervention. The workbook structure aligns with the constructs of the COM-B model. It includes reflection, activities and goal-setting sections based on what was indicated to be useful for the majority of the participants. Key techniques to overcome the challenges with eating in a social setting included social support, regulation to reduce negative emotions, goals and planning. Conclusion Using a focus group approach with the COM-B model as the theoretical framework, the participants in this study developed an intervention to support people living with achalasia. In order to achieve long-term behaviour change, engagement with a personalised workbook could facilitate eating in a social setting. Future work will need to pilot the workbook to ensure it can support people to improve their quality of life and complement the ongoing care they receive from health services.
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Affiliation(s)
- Melika Kalantari
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Amelia Hollywood
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Rosemary Lim
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Majid Hashemi
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Gal AM, Iatcu CO, Popa AD, Arhire LI, Mihalache L, Gherasim A, Nita O, Soimaru RM, Gheorghita R, Graur M, Covasa M. Understanding the Interplay of Dietary Intake and Eating Behavior in Type 2 Diabetes. Nutrients 2024; 16:771. [PMID: 38542683 PMCID: PMC10975878 DOI: 10.3390/nu16060771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 11/12/2024] Open
Abstract
Diet and eating behavior both play a crucial role in the prevention and management of type 2 diabetes mellitus (T2DM). The main objective of this study was to investigate the relationship between dietary intake and eating behavior in a population of patients with T2DM. A cross-sectional study was performed using 416 patients with T2DM and their dietary intake and eating behavior were assessed with validated questionnaires. Women scored significantly higher than men for emotional and restrained eating (p < 0.001). Correlation analyses showed that emotional eaters consumed significantly more calories (r = 0.120, p = 0.014) and fat (r = 0.101, p = 0.039), as well as non-alcoholic beverages for women (r = 0.193, p = 0.003) and alcohol for men (r = 0.154, p = 0.038). Also, individuals who ate based on external cues consumed significantly more calories (r = 0.188, p < 0.001) and fat (r = 0.139, p = 0.005). These results demonstrate that eating behavior influences dietary intake. Understanding this relationship could optimize diabetes management and allow for more individualized nutritional guidance.
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Affiliation(s)
- Ana Maria Gal
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Camelia Oana Iatcu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Alina Delia Popa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Lidia Iuliana Arhire
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Laura Mihalache
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Andreea Gherasim
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Otilia Nita
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
| | - Raluca Meda Soimaru
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.M.G.); (C.O.I.); (A.D.P.); (L.M.); (A.G.); (O.N.); (R.M.S.)
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Roxana Gheorghita
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Mariana Graur
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
| | - Mihai Covasa
- Department of Biomedical Sciences, Faculty of Medicine and Biological Sciences, Stefan cel Mare University, 720229 Suceava, Romania; (R.G.); (M.G.); (M.C.)
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Wang R, Liu Y, Thabane L, Olier I, Li L, Ortega-Martorell S, Lip GYH, Li G. Relationship between trajectories of dietary iron intake and risk of type 2 diabetes mellitus: evidence from a prospective cohort study. Nutr J 2024; 23:15. [PMID: 38302934 PMCID: PMC10835921 DOI: 10.1186/s12937-024-00925-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/30/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The association between dietary iron intake and the risk of type 2 diabetes mellitus (T2DM) remains inconsistent. In this study, we aimed to investigate the relationship between trajectories of dietary iron intake and risk of T2DM. METHODS This study comprised a total of 61,115 participants without a prior T2DM from the UK Biobank database. We used the group-based trajectory model (GBTM) to identify different dietary iron intake trajectories. Cox proportional hazards models were used to evaluate the relationship between trajectories of dietary iron intake and risk of T2DM. RESULTS During a mean follow-up of 4.8 years, a total of 677 T2DM events were observed. Four trajectory groups of dietary iron intake were characterized by the GBTM: trajectory group 1 (with a mean dietary iron intake of 10.9 mg/day), 2 (12.3 mg/day), 3 (14.1 mg/day) and 4 (17.6 mg/day). Trajectory group 3 was significantly associated with a 38% decreased risk of T2DM when compared with trajectory group 1 (hazard ratio [HR] = 0.62, 95% confidence interval [CI]: 0.49-0.79), while group 4 was significantly related with a 30% risk reduction (HR = 0.70, 95% CI: 0.54-0.91). Significant effect modifications by obesity (p = 0.04) and history of cardiovascular disease (p < 0.01) were found to the relationship between trajectories of dietary iron intake and the risk of T2DM. CONCLUSIONS We found that trajectories of dietary iron intake were significantly associated with the risk of T2DM, where the lowest T2DM risk was observed in trajectory group 3 with a mean iron intake of 14.1 mg/day. These findings may highlight the importance of adequate dietary iron intake to the T2DM prevention from a public health perspective. Further studies to assess the relationship between dietary iron intake and risk of T2DM are needed, as well as intervention studies to mitigate the risks of T2DM associated with dietary iron changes.
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Affiliation(s)
- Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Yingxin Liu
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada.
- Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
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McDiarmid S, Harvie M, Aglan A, Winterbottom H, Mubita W, Hulme A, Davies J, Yates J, Krizak S, Perry D, Issa BG. Manchester Intermittent and Daily diet Type 1 Diabetes App Study (MIDDAS-Type 1): protocol for a randomised feasibility trial of an intermittent and continuous low-energy diet in patients with type 1 diabetes and overweight and obesity. BMJ Open 2023; 13:e071395. [PMID: 37474169 PMCID: PMC10360425 DOI: 10.1136/bmjopen-2022-071395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Rising levels of overweight and obesity among people with type 1 diabetes (T1D) contribute to insulin resistance, dyslipidaemia, retinopathy, cardiometabolic complications and psychological morbidity. Continuous low-energy diets (CLED) providing approximately 800 kcal (3347 kJ)/day can produce significant weight loss in type 2 diabetes, and intermittent low-energy diets (ILED) may be an alternative. The Manchester Intermittent and Daily diet Type 1 Diabetes App Study (MIDDAS-Type 1) aims to assess the safety, acceptability and feasibility of remotely delivered ILED and CLED programmes for people with T1D and overweight and obesity. METHODS AND ANALYSIS Twelve participants with T1D and body mass index ≥27.5 kg/m2 (≥25 kg/m2 in high-risk ethnic minorities) recruited from an National Health Service (NHS) trust and research register in England will be randomised to a remotely delivered CLED (n=6) or ILED (n=6) for 12 weeks. The CLED includes a daily Optifast 850 kcal (3556 kJ) 75 g carbohydrate formula diet. The ILED includes 2 days/week of Optifast and 5 days of a portion-controlled Mediterranean diet (170-250 g carbohydrate/day). Both groups will receive matched high-frequency remote support from a dietitian, nurse and psychologist via telephone and/or the Oviva app. The primary outcome will assess safety (occurrence of severe hypoglycaemia, ketonaemia, ketoacidosis and time above and below target blood glucose). Secondary outcomes include study uptake, retention, dietary adherence, acceptability, intervention delivery fidelity and potential efficacy in relation to change in weight, insulin requirements, glycated haemoglobin, lipids, insulin resistance (estimated glucose disposal rate) and quality of life. Participants will be invited for optional repeat measurements at 52 weeks. ETHICS AND DISSEMINATION The trial protocol (V4.0/08.06.2022) was granted ethical approval by Cambridge East Research Ethics Committee (Ref: 21/EE/0014). The study will inform progression to a full-scale randomised controlled trial to test the efficacy of these programmes for patients with T1D and overweight and obesity. TRIAL REGISTRATION NUMBER NCT04674384; Pre-results.
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Affiliation(s)
- Sarah McDiarmid
- Research Dietitians, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit Research Dietitians, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azza Aglan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Hannah Winterbottom
- Research Dietitians, Manchester University NHS Foundation Trust, Manchester, UK
| | - Womba Mubita
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Amanda Hulme
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jane Davies
- Manchester University NHS Foundation Trust, Manchester, UK
| | - James Yates
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Suzanne Krizak
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Diane Perry
- Patient Representative, Manchester University NHS Foundation Trust, Manchester, UK
| | - Basil G Issa
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK
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Gawlik A, Nacak Y, Kleinert J, Konerding U, Vitinius F. Theoretical Derivation of a Telephone-Based Health Coaching Intervention for Promoting Physical Activity and Healthy Nutrition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6271. [PMID: 37444117 PMCID: PMC10341694 DOI: 10.3390/ijerph20136271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Present research regarding interventions to change behavior suffers from insufficient communication of their theoretical derivation. This insufficient communication is caused by the restrictions imposed by most of the relevant scientific journals. This impedes further intervention development. In this article, a telephone-based health coaching (TBHC) intervention is introduced using a format outside these restrictions. This intervention is seen as a combination of (1) the activities performed with the target persons, i.e., its core, and (2) measures to ensure the quality of the intervention. The theoretical derivation of the core is presented. The core is seen to consist of (1) the style of coach-patient interaction and (2) the contents of this interaction. The style of coach-patient interaction was derived from self-determination theory and was concretized using motivational interviewing techniques. The contents of the coach-patient interaction were derived from the health action process approach and were concretized using behavior-change techniques. The derivation led to (1) a set of 16 coaching tools referring to the different states in which a patient might be and containing state-specific recommendations for performing the coaching session, and (2) guidelines for selecting the appropriate coaching tool for each session. To ensure the quality of the intervention, a coach-training program before and supervision sessions during the TBHC were added.
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Affiliation(s)
- Angeli Gawlik
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany;
| | - Yeliz Nacak
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (Y.N.); (F.V.)
| | - Jens Kleinert
- Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany;
| | - Uwe Konerding
- Trimberg Research Academy, University of Bamberg, 96045 Bamberg, Germany;
- Department of Psychology and Psychotherapy, Witten/Herdecke University, 58455 Witten, Germany
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (Y.N.); (F.V.)
- Department of Psychosomatic Medicine, Robert-Bosch-Krankenhaus Stuttgart, 70376 Stuttgart, Germany
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Tanaka R. Nudge for Environmental Restructuring in Diabetes Self-Management: Comment on Existing Systematic Reviews. Health Serv Insights 2023; 16:11786329231174337. [PMID: 37215647 PMCID: PMC10196547 DOI: 10.1177/11786329231174337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/15/2023] [Indexed: 05/24/2023] Open
Abstract
Diabetes self-management education and support are necessary for all people living with diabetes, but its accessibility is limited worldwide. Nudge strategies have been proposed as an environmental outreach for diabetes management. This article provides further insights regarding environmental restructuring nudges into the cumulative evidence on diabetes self-management interventions from existing systematic reviews that classified primary trials using the behavior change technique taxonomy (BCTTv1). Among the 137 relevant articles searched through the bibliographic databases until 2022, three systematic reviews were scrutinized. Environmental restructuring nudges have been tested in interpersonal communications for diabetes self-management. Although nudge-based techniques were used with other types of behavior techniques in various trial contexts, the independent effects of social restructuring nudges were not denied in previous meta-analyses. Environmental restructuring nudges may be feasible in diabetes management, but they are still controversial with internal and external validation. Considering care accessibility for diabetes management, social restructuring nudges applied to healthcare providers are expected to complement healthcare systems. For future implementation, the rationale for the practice should be explicit in the conceptualization and evidence synthesis of diabetes-specific nudge interventions based on global sources.
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Affiliation(s)
- Rie Tanaka
- Institute of Medicine, University of Tsukuba, Tsukuba,
Ibaraki, Japan
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McKay RC, Giroux EE, Baxter KL, Casemore S, Clarke TY, McBride CB, Sweet SN, Gainforth HL. Investigating the peer Mentor-Mentee relationship: characterizing peer mentorship conversations between people with spinal cord injury. Disabil Rehabil 2023; 45:962-973. [PMID: 35343358 DOI: 10.1080/09638288.2022.2046184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to: (1) develop a coding manual to characterize topics discussed and conversation techniques used during peer mentorship conversations between people with spinal cord injury (SCI); (2) assess the reliability of the manual; and (3) apply the manual to characterize conversations. MATERIALS/METHODS The study was conducted in partnership with three Canadian provincial SCI organizations. Twenty-five phone conversations between SCI peer mentors and mentees were audio-recorded and transcribed verbatim. Ten transcripts were inductively analyzed to develop a coding manual identifying topics and techniques used during the conversations. Inductive technique codes were combined and deductively linked to motivational interviewing and behaviour change techniques. Two coders independently applied the coding manual to all transcripts. Code frequencies were calculated. RESULTS The coding manual included 14 topics and 31 techniques. The most frequently coded topics were personal information, recreational programs, and chronic health services for mentors and mentees. The most frequently coded techniques were giving personal information, social smoothers, and closed question for mentors; and giving personal information, social smoothers, and sharing perspective for mentees. CONCLUSION This research provides insights into topics and techniques used during real-world peer mentorship conversations. Findings may be valuable for understanding and improving SCI peer mentorship programs.Implications for RehabilitationSCI peer mentorship conversations address a wide range of rehabilitation topics ranging from acute care to living in the community.Identification of the topics discussed, and techniques used in SCI peer mentorship conversations can help to inform formalized efforts to train and educate acute and community-based rehabilitation professionals.Identifying commonly discussed topics in SCI peer mentorship conversation may help to ensure that peer mentors are equipped with the necessary knowledge and resources, or the development of those resources be prioritized.Developing a method to characterize the topics discussed and techniques used during SCI peer mentorship conversations may aid in designing methods to evaluate how rehabilitation professionals provide support to people with SCI.
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Affiliation(s)
- Rhyann C McKay
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Emily E Giroux
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Kristy L Baxter
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | | | | | | | - Shane N Sweet
- Department of Kinesiology & Physical Education, McGill University, Montréal, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
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10
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Vallis M. Behaviour Change to Promote Diabetes Outcomes: Getting More From What We Have Through Dissemination and Scalability. Can J Diabetes 2023; 47:85-89. [PMID: 36184369 DOI: 10.1016/j.jcjd.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 01/31/2023]
Abstract
The potential benefits of advanced medical treatments (pharmacotherapies) and technologies (diagnostics, devices and apps) are unrealized due to lack of sustained behaviour change in individuals living with type 2 diabetes. The lack of scale-up of effective health behaviour change interventions limits health improvement. Identification of mediators of behaviour change (adherence, self-efficacy, intrinsic motivation) can address this limitation by shifting the focus of behaviour change from input (which behaviour change strategy to choose) to output (what can the person adhere to and sustain). Technology and accessing the workplace environment to promote change offer scalable opportunities for facilitating health behaviour change in populations.
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Affiliation(s)
- Michael Vallis
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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11
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Sukartini T, Nursalam N, Pradipta RO, Ubudiyah M. Potential Methods to Improve Self-management in Those with Type 2 Diabetes: A Narrative Review. Int J Endocrinol Metab 2023; 21:e119698. [PMID: 37038539 PMCID: PMC10082325 DOI: 10.5812/ijem-119698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
CONTEXT The ability of self-manage was important for type 2 diabetes mellitus (T2DM) patients and it was supported and depend on the method used. We aimed to summarize the potential method of self-management to improve self-empowerment. EVIDENCE ACQUISITION To obtain the related data, 5 databases, including Scopus, Science Direct, ProQuest, CINAHL, and SAGE, were comprehensively searched. The search was done in advance using the Boolean operator. The full texts of articles presenting data on self-management methods were screened and retrieved. RESULTS A total of 22 studies were included in this review. Various self-management techniques were covered with primary and secondary outcomes. Primary outcomes included blood pressure, fasting blood glucose (FBG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Secondary outcomes included knowledge, self-efficacy, lifestyle habits, physical activity, diet, smoking, medical treatment, support, and health behavior. A goal-setting-oriented approach was effective in setting targets and gaining support from family members. A family-centered approach was effective in taking care of and taking good care of patients with T2DM. Strength training exercises provide patients with a choice of physical activity that can help them manage their blood sugar and blood pressure. Acceptance and commitment therapy (ACT) is a stress-reduction technique. The patient's acceptance of the disease and treatment for diabetes is aided by education. CONCLUSIONS A successful self-management method was one which balances and adapts to the patient's condition. Regardless of the age of the patients, the overall findings from the review suggest that self-management methods can help patients become healthier and improve their quality of life by controlling their hemoglobin A1c (HbA1c) level.
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Affiliation(s)
- Tintin Sukartini
- Departement of Advance Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
- Corresponding Author: Departement of Advance Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia.
| | - Nursalam Nursalam
- Departement of Advance Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Rifky Octavia Pradipta
- Departement of Fundamental Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Masunatul Ubudiyah
- Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Lamongan, East Java, Indonesia
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12
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Chawla R, Jaggi S, Gupta A, Bantwal G, Patil S. Clinical Utility of a Digital Therapeutic Intervention in Indian Patients With Type 2 Diabetes Mellitus: 12-Week Prospective Single-Arm Intervention Study. JMIR Diabetes 2022; 7:e41401. [PMID: 36226840 PMCID: PMC9664320 DOI: 10.2196/41401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/24/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background Patients with type 2 diabetes mellitus (T2DM) having elevated levels of blood glucose and glycated hemoglobin (HbA1c) are at higher risk of macro- and microvascular complications. Nonetheless, the goal of achieving glycemic control cannot be met with the use of pharmacotherapy alone. The recent emergence of digital therapeutic tools has shown the possibility of improving the modifiable risk factors and self-management of diabetes. Objective The aim of this study was to examine the clinical utility of a digital therapeutic intervention as an add-on therapy to achieve glycemic control in patients with T2DM. Methods This was a 12-week prospective, single-arm digital intervention study in patients with T2DM receiving regular antidiabetic treatment. The eligibility criteria included male and female patients with HbA1c≥6.5%, functional English literacy, and a mobile phone capable of running the intervention app. Outcome measures of the study were mean changes in HbA1c, fasting blood glucose (FBG), postprandial blood glucose (PPBG), BMI, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index at the end of 12 weeks. Results A total of 128 participants completed the study period of 12 weeks. There were 54.7% (70/128) men and 45.3% (58/128) women with a mean age of 48.48 years (SD 10.27). At the end of 12 weeks, the mean change in HbA1c, FBG, PPBG, and BMI for the overall study population was –0.84% (P<.001), –8.39 mg/dl (P=.02), –14.97 mg/dl (P<.001), and –0.24 kg/m2 (P=.06), respectively. Among the participants showing improvement in the HbA1c value at the end of 12 weeks (responders), the mean change in HbA1c, FBG, PPBG, and BMI was –1.24% (P<.001), –12.42 mg/dl (P=.003), –21.45 mg/dl (P<.001), and –0.34 kg/m2 (P=.007), respectively. There was an increase in HOMA-IR values for the overall study population (0.54, P=.29). HbA1c response showed a significant association with a baseline HbA1c level ≥7.5%, no prior history of smoking, and no prior COVID-19 infection, as well as with higher levels of program engagement. Conclusions A digital therapeutic intervention when used alongside standard medications significantly reduces HbA1c, FBG, and PPBG levels in patients with T2DM.
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Affiliation(s)
| | | | - Amit Gupta
- Center for Diabetes Care, Greater Noida, India
| | | | - Suhas Patil
- Terrals Technologies Private Ltd, Bangaluru, India
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13
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Lin H, Xu D, Yang M, Ma X, Yan N, Chen H, He S, Deng N. Behaviour change techniques that constitute effective planning interventions to improve physical activity and diet behaviour for people with chronic conditions: a systematic review. BMJ Open 2022; 12:e058229. [PMID: 35995541 PMCID: PMC9403139 DOI: 10.1136/bmjopen-2021-058229] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Action planning is a brief and effective behaviour change technique (BCT) to improve physical activity (PA) and diet behaviour (DB). This study aimed to identify critical BCTs and mechanisms of action (MoAs) to interpret the effectiveness of planning interventions based on the Health Action Process Approach (HAPA) model. DESIGN Systematic review. DATA SOURCES PubMed, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO), Psychology and Behavioural Sciences Collection (EBSCO), psyARTICLES and Medline were searched for studies from January 1990 to September 2021 published in English. ELIGIBILITY CRITERIA Experiment involving action planning intervention to improve PA or DB in community-dwelling adult patients with chronic conditions. DATA EXTRACTION AND SYNTHESIS Two reviewers independently coded the planning interventions into BCT combinations and MoA assemblies. Outcome was dichotomised according to the statistical power and Cohen's d. The Cochrane risk of bias assessment tool and the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool were used to assess the quality of randomised controlled trials (RCTs) and non-RCTs, respectively. RESULTS From the 52 included studies, 46 BCTs were identified and linked to 21 MoAs. Long-term facilitators for planning intervention included 'self-monitoring of behaviour', 'problem solving', 'instruction on how to perform the behaviour' and 'adding objects to the environments'. The three most frequently occurring MoAs were 'intention', 'behavioural regulation', 'beliefs about capabilities'. The effective intervention groups had higher MoA scores that corresponded to the HAPA model constructs than the ineffective groups. CONCLUSIONS The findings from this review may inform scientific and effective planning intervention designs for community-dwelling people with chronic conditions in the future. PROSPERO REGISTRATION NUMBER CRD42021241227.
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Affiliation(s)
- Hui Lin
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dongdong Xu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Min Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xueping Ma
- Cardiac Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Ning Yan
- Cardiac Centre, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Han Chen
- Department of Information, Medical Security Center, Hainan Hospital, PLA General Hospital, Sanya, China
| | - Shilin He
- Department of Information, Medical Security Center, Hainan Hospital, PLA General Hospital, Sanya, China
| | - Ning Deng
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
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14
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Clark DO, Keith NR, Ofner S, Hackett J, Li R, Agarwal N, Tu W. Environments and situations as correlates of eating and drinking among women living with obesity and urban poverty. Obes Sci Pract 2022; 8:153-163. [PMID: 35388340 PMCID: PMC8976545 DOI: 10.1002/osp4.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objective One path to improving weight management may be to lessen the self-control burden of physical activity and healthier food choices. Opportunities to lessen the self-control burden might be uncovered by assessing the spatiotemporal experiences of individuals in daily context. This report aims to describe the time, place, and social context of eating and drinking and 6-month weight change among 209 midlife women (n = 113 African-American) with obesity receiving safety-net primary care. Methods Participants completed baseline and 6-month weight measures, observations and interviews regarding obesogenic cues in the home environment, and up to 12 ecological momentary assessments (EMA) per day for 30 days inquiring about location, social context, and eating and drinking. Results Home was the most common location (62%) at times of EMA notifications. Participants reported "yes" to eating or drinking at the time of nearly one in three (31.1% ± 13.2%) EMA notifications. Regarding social situations, being alone was significantly associated with less frequent eating and drinking (OR = 0.75) unless at work in which case being alone was significantly associated with a greater frequency of eating or drinking (OR = 1.43). At work, eating was most common late at night, whereas at home eating was most frequent in the afternoon and evening hours. However, eating and drinking frequency was not associated with 6-month weight change. Conclusions Home and work locations, time of day, and whether alone may be important dimensions to consider in the pursuit of more effective weight loss interventions. Opportunities to personalize weight management interventions, whether digital or human, and lessen in-the-moment self-control burden might lie in identifying times and locations most associated with caloric consumption. Clinical trial registration: NCT03083964 in clinicaltrials.gov.
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Affiliation(s)
- Daniel O. Clark
- Indiana University Center for Aging ResearchIndianapolisIndianaUSA
- Regenstrief Institute, Inc.IndianapolisIndianaUSA
- Department of MedicineDivision of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - NiCole R. Keith
- Indiana University Center for Aging ResearchIndianapolisIndianaUSA
- Regenstrief Institute, Inc.IndianapolisIndianaUSA
| | - Susan Ofner
- Department of BiostatisticsIndiana University Richard M. Fairbanks School of Public HealthIndianapolisIndianaUSA
| | | | - Ruohong Li
- Department of BiostatisticsIndiana University Richard M. Fairbanks School of Public HealthIndianapolisIndianaUSA
| | - Neeta Agarwal
- Department of MedicineDivision of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Wanzhu Tu
- Regenstrief Institute, Inc.IndianapolisIndianaUSA
- Department of MedicineDivision of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisIndianaUSA
- Department of BiostatisticsIndiana University Richard M. Fairbanks School of Public HealthIndianapolisIndianaUSA
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15
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Chan J, McMahon E, Brimblecombe J. Point-of-sale nutrition information interventions in food retail stores to promote healthier food purchase and intake: A systematic review. Obes Rev 2021; 22:e13311. [PMID: 34254422 DOI: 10.1111/obr.13311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/01/2022]
Abstract
Providing simple information that identifies healthier/less healthy products at the point-of-sale has been increasingly recognized as a potential strategy for improving population diet. This review evaluated the effect on healthiness of food purchasing/intake of interventions that identify specific products as healthier/less healthy at the point-of-sale in food retail settings. Five databases were searched for peer-reviewed randomized controlled or quasi-experimental trials published 2000-2020. Effects on primary outcomes of the 26 eligible studies (322 stores and 19,002 participants) were positive (n = 14), promising (effective under certain conditions; n = 3), mixed (different effect across treatment arms/outcomes; n = 4), null (n = 3), negative (n = 1), or unclear (n = 1). Shelf-label studies (three studies of two rating systems across all products) were positive. Technology-delivered (mobile applications/podcast/kiosk) interventions were positive (n = 3/5) or promising/mixed (n = 2/5). In-store displays (n = 16) had mixed effectiveness. Interventions provided information on targeted healthier products only (n = 17), unhealthy products only (n = 1), both healthy and unhealthy (n = 2), and across all products (n = 5). No patterns were found between behavior change technique used and effectiveness. Study quality was mixed. These findings indicate that point-of-sale interventions identifying healthy/unhealthy options can lead to healthier customer purchasing behavior, particularly those delivered using shelf-labels or technology. Further research on discouraging unhealthy foods is needed.
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Affiliation(s)
- Jasmine Chan
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Global Obesity Centre, Deakin University, Burwood, Victoria, Australia
| | - Emma McMahon
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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16
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MacPherson MM, Cranston KD, Locke SR, Bourne JE, Jung ME. Using the behavior change wheel to develop text messages to promote diet and physical activity adherence following a diabetes prevention program. Transl Behav Med 2021; 11:1585-1595. [PMID: 34008852 PMCID: PMC8604265 DOI: 10.1093/tbm/ibab058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Improving diet and physical activity (PA) can reduce the risk of developing type 2 diabetes (T2D); however, long-term diet and PA adherence is poor. To impact population-level T2D risk, scalable interventions facilitating behavior change adherence are needed. Text messaging interventions supplementing behavior change interventions can positively influence health behaviors including diet and PA. The Behavior Change Wheel (BCW) provides structure to intervention design and has been used extensively in health behavior change interventions. Describe the development process of a bank of text messages targeting dietary and PA adherence following a diabetes prevention program using the BCW. The BCW was used to select the target behavior, barriers and facilitators to engaging in the behavior, and associated behavior change techniques (BCTs). Messages were written to map onto BCTs and were subsequently coded for BCT fidelity. The target behaviors were adherence to diet and PA recommendations. A total of 16 barriers/facilitators and 28 BCTs were selected for inclusion in the messages. One hundred and twenty-four messages were written based on selected BCTs. Following the fidelity check a total of 43 unique BCTs were present in the final bank of messages. This study demonstrates the application of the BCW to guide the development of a bank of text messages for individuals with prediabetes. Results underscore the potential utility of having independent coders for an unbiased expert evaluation of what active components are in use. Future research is needed to demonstrate the feasibility and effectiveness of resulting bank of messages.
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Affiliation(s)
- Megan M MacPherson
- School of Health and Exercise Sciences, Faculty of Health and Social
Development, University of British Columbia,
Kelowna, Canada
| | - Kaela D Cranston
- School of Health and Exercise Sciences, Faculty of Health and Social
Development, University of British Columbia,
Kelowna, Canada
| | - Sean R Locke
- Kinesiology, Faculty of Applied Health Sciences, Brock
University, St. Catharines, Ontario,
Canada
| | - Jessica E Bourne
- Centre for Exercise, Nutrition and Health Sciences, School of Policy
Studies, University of Bristol, Bristol,
UK
| | - Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social
Development, University of British Columbia,
Kelowna, Canada
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17
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Richardson KM, Cota Aguirre G, Weiss R, Cinar A, Liao Y, Marano K, Bedoya AR, Schembre S. Abbreviated Dietary Self-monitoring for Type 2 Diabetes Management: Mixed Methods Feasibility Study. JMIR Diabetes 2021; 6:e28930. [PMID: 34387551 PMCID: PMC8391728 DOI: 10.2196/28930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Diabetes Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. Although current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic stability among people with T2D, tracking all intake is burdensome and unsustainable. Thus, dietary self-monitoring approaches that are equally effective but are less burdensome should be explored. OBJECTIVE This study aims to examine the feasibility of an abbreviated dietary self-monitoring approach in patients with T2D, in which only carbohydrate-containing foods are recorded in a diet tracker. METHODS We used a mixed methods approach to quantitatively and qualitatively assess general and diet-related diabetes knowledge and the acceptability of reporting only carbohydrate-containing foods in 30 men and women with T2D. RESULTS The mean Diabetes Knowledge Test score was 83.9% (SD 14.2%). Only 20% (6/30) of participants correctly categorized 5 commonly consumed carbohydrate-containing foods and 5 noncarbohydrate-containing foods. The mean perceived difficulty of reporting only carbohydrate-containing foods was 5.3 on a 10-point scale. Approximately half of the participants (16/30, 53%) preferred to record all foods. A lack of knowledge about carbohydrate-containing foods was the primary cited barrier to acceptability (12/30, 40%). CONCLUSIONS Abbreviated dietary self-monitoring in which only carbohydrate-containing foods are reported is likely not feasible because of limited carbohydrate-specific knowledge and a preference of most participants to report all foods. Other approaches to reduce the burden of dietary self-monitoring for people with T2D that do not rely on food-specific knowledge could be more feasible.
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Affiliation(s)
- Kelli Marie Richardson
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Gloria Cota Aguirre
- Department of Public Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Rick Weiss
- Viocare Inc, Princeton, NJ, United States
| | - Ali Cinar
- Department of Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, IL, United States
| | - Yue Liao
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, United States
| | - Kari Marano
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Arianna R Bedoya
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Susan Schembre
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
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18
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Hannan M, Kringle E, Hwang CL, Laddu D. Behavioral Medicine for Sedentary Behavior, Daily Physical Activity, and Exercise to Prevent Cardiovascular Disease: A Review. Curr Atheroscler Rep 2021; 23:48. [PMID: 34226989 PMCID: PMC8257263 DOI: 10.1007/s11883-021-00948-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Behavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed. RECENT FINDINGS Behavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors. Behavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted.
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Affiliation(s)
- Mary Hannan
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Emily Kringle
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Cheuh-Lung Hwang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor Street (MC 898), Chicago, IL USA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor Street (MC 898), Chicago, IL USA
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19
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Prediction of type 2 diabetes mellitus based on nutrition data. J Nutr Sci 2021; 10:e46. [PMID: 34221364 PMCID: PMC8223171 DOI: 10.1017/jns.2021.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Numerous predictive models for the risk of type 2 diabetes mellitus (T2DM) exist, but a minority of them has implemented nutrition data so far, even though the significant effect of nutrition on the pathogenesis, prevention and management of T2DM has been established. Thus, in the present study, we aimed to build a predictive model for the risk of T2DM that incorporates nutrition data and calculates its predictive performance. We analysed cross-sectional data from 1591 individuals from the population-based Cooperative Health Research in the Region of Augsburg (KORA) FF4 study (2013–14) and used a bootstrap enhanced elastic net penalised multivariate regression method in order to build our predictive model and select among 193 food intake variables. After selecting the significant predictor variables, we built a logistic regression model with these variables as predictors and T2DM status as the outcome. The values of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of our predictive model were calculated. Eleven out of the 193 food intake variables were selected for inclusion in our model, which yielded a value of area under the ROC curve of 0⋅79 and a maximum PPV, NPV and accuracy of 0⋅37, 0⋅98 and 0⋅91, respectively. The present results suggest that nutrition data should be implemented in predictive models to predict the risk of T2DM, since they improve their performance and they are easy to assess.
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20
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El-Gayar O, Ofori M, Nawar N. On the efficacy of behavior change techniques in mHealth for self-management of diabetes: A meta-analysis. J Biomed Inform 2021; 119:103839. [PMID: 34139330 DOI: 10.1016/j.jbi.2021.103839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diabetes prevalence has become a global crisis. Due to the substantial rise in smartphone use, a variety of mobile interventions have been developed to help improve the clinical outcomes of diabetes patients. OBJECTIVES This study seeks to examine specific behavior change theories and techniques used in the design of self-management mobile app-based interventions aimed at achieving glycemic control in type 1 and type 2 diabetes. METHODS A meta-analysis of randomized control trials published in PubMed/Medline and Web of Science between January 2010 and October 2020 was conducted using studies that included diabetes patients, reported on well-described mobile app-based interventions, compared mHealth to usual care, and evaluated glycated hemoglobin (HbA1c) at baseline and follow-up. RESULTS We reported on 21 studies with a total of 1,920 diabetes patients. Our findings show that mHealth apps led to statistically significant clinical outcomes as compared to standard care for glycemic control (-0.38, 95% CI = -0.50 to -0.25, p < 0.0001) indicating that such interventions result in a reduction in HbA1c. Interventions that used behavior theory for developing mHealth apps were not statistically different from those that did not (p = 0.18). However, increased use of behavior change techniques (BCTs) may result in slightly higher HbA1c reduction. Among all BCTs, the most effective ones appear to be "Action planning" and "Self-monitoring of outcome(s) of behavior. CONCLUSIONS The current meta-analysis provides evidence that mHealth is likely to be beneficial for diabetes patients when the right behavior change techniques are applied to realize the full advantage of the intervention. Further investigation of the role of theory in the design of mHealth app-based interventions is warranted.
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Guerreiro MP, Strawbridge J, Cavaco AM, Félix IB, Marques MM, Cadogan C. Development of a European competency framework for health and other professionals to support behaviour change in persons self-managing chronic disease. BMC MEDICAL EDUCATION 2021; 21:287. [PMID: 34016108 PMCID: PMC8136137 DOI: 10.1186/s12909-021-02720-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/29/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Healthcare and other professionals are expected to support behaviour change in people living with chronic disease. However, effective behaviour change interventions are largely absent in routine encounters. The Train4Health project, a European strategic partnership for higher education, sought to address this problem. The primary aim of this study, which is part of an early work package, was to develop an interprofessional competency framework for health and other professions to support behaviour change for the self-management of chronic disease at a European level. A secondary aim was to derive a set of behaviour change techniques (BCTs) from an established taxonomy to link with framework competencies. METHODS The study comprised two interlinked parts. Part 1 involved a two-round e-Delphi study with an interprofessional panel of 48 experts across 12 European countries to develop the behaviour change competency framework. Preparatory work included drafting a list of competency statements based on seven existing frameworks. Part 2 involved an expert panel of six behavioural psychologists deriving a set of BCTs to link with framework competencies. Their feedback was based on preparatory work, which focused on seven high priority chronic diseases for self-management, identified through European projects on self-management and identifying five relevant target behaviours from key clinical guidelines. A literature search yielded 29 effective BCTs for the target behaviours in the selected chronic diseases. RESULTS Twenty-seven competency statements, were presented in Round 1 to the Delphi panel. Consensus was achieved for all statements. Based on comments, two statements were removed, one was added, and 14 were modified. All 15 statements subjected to Round 2 were consensus-approved, yielding a total of 12 foundational competencies for behaviour change in self-management of chronic disease and 14 behaviour change competencies. Four behaviour change competencies related to BCTs. Behavioural psychologists' feedback led to a core set of 21 BCTs deemed applicable to the five target behaviours across the seven chronic diseases. CONCLUSIONS A behaviour change competency framework comprising 26 statements for European health and other professionals to support self-management of chronic disease was developed, linked with a core set of 21 BCTs from an established taxonomy.
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Affiliation(s)
- Mara Pereira Guerreiro
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal.
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal.
| | - Judith Strawbridge
- Royal College of Surgeons in Ireland, School of Pharmacy and Biomolecular Sciences, Dublin, Ireland
| | | | - Isa Brito Félix
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
| | - Marta Moreira Marques
- ADAPT SFI Research Centre & Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin, Dublin, Ireland
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
| | - Cathal Cadogan
- Trinity College Dublin, School of Pharmacy and Pharmaceutical Sciences, Dublin, Ireland
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McDiarmid S, Harvie M, Johnson R, Vyas A, Aglan A, Moran J, Ruane H, Hulme A, Sellers K, Issa B. Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e21116. [PMID: 33739297 PMCID: PMC8088860 DOI: 10.2196/21116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence. OBJECTIVE This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D. METHODS A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention. RESULTS A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021. CONCLUSIONS The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21116.
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Affiliation(s)
- Sarah McDiarmid
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Rhona Johnson
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Avni Vyas
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Azza Aglan
- Greater Manchester Mental Health Foundation Trust, Manchester, United Kingdom
| | - Jacqui Moran
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Amanda Hulme
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Katharine Sellers
- The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Basil Issa
- Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Cradock KA, Quinlan LR, Finucane FM, Gainforth HL, Martin Ginis KA, de Barros AC, Sanders EBN, ÓLaighin G. Identifying Barriers and Facilitators to Diet and Physical Activity Behaviour Change in Type 2 Diabetes Using a Design Probe Methodology. J Pers Med 2021; 11:jpm11020072. [PMID: 33530618 PMCID: PMC7911111 DOI: 10.3390/jpm11020072] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
Treatment of Type 2 Diabetes (T2D) typically involves pharmacological methods and adjunct behavioural modifications, focused on changing diet and physical activity (PA) behaviours. Changing diet and physical activity behaviours is complex and any behavioural intervention in T2D, to be successful, must use an appropriate suite of behaviour change techniques (BCTs). In this study, we sought to understand the perceived barriers and facilitators to diet and PA behaviour change in persons with T2D, with a view to creating artefacts to facilitate the required behaviour changes. The Design Probe was chosen as the most appropriate design research instrument to capture the required data, as it enabled participants to reflect and self-document, over an extended period of time, on their daily lived experiences and, following this reflection, to identify their barriers and facilitators to diet and PA behaviour change. Design Probes were sent to 21 participants and 13 were fully completed. A reflective thematic analysis was carried out on the data, which identified themes of food environment, mental health, work schedule, planning, social support, cravings, economic circumstances and energy associated with diet behaviour. Similar themes were identified for PA as well as themes of physical health, weather, motivation and the physical environment.
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Affiliation(s)
- Kevin A. Cradock
- Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland;
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland;
| | - Leo R. Quinlan
- Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland;
- Centre for Research in Medical Devices (CÚRAM), Science Foundation of Ireland, Galway, Ireland
- Correspondence: ; Tel.: +353-91-524411 (ext. 3710)
| | - Francis M. Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, Health Research Board Clinical Research Facility, Galway, Ireland;
| | - Heather L. Gainforth
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada; (H.L.G.); (K.A.M.G.)
| | - Kathleen A. Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada; (H.L.G.); (K.A.M.G.)
| | - Ana Correia de Barros
- Fraunhofer Portugal AICOS (Fraunhofer Center for Assistive Information and Communication Solutions), Rua Alfredo Allen, 455/461, 4200-135 Porto, Portugal;
| | - Elizabeth B. N. Sanders
- Department of Design, The Ohio State University, 100 Hayes Hall, 108 North Oval Mall, Columbus, OH 43210, USA;
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland;
- Centre for Research in Medical Devices (CÚRAM), Science Foundation of Ireland, Galway, Ireland
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MacPherson MM, Dineen TE, Cranston KD, Jung ME. Identifying Behaviour Change Techniques and Motivational Interviewing Techniques in Small Steps for Big Changes: A Community-Based Program for Adults at Risk for Type 2 Diabetes. Can J Diabetes 2020; 44:719-726. [DOI: 10.1016/j.jcjd.2020.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
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Katsaridis S, Grammatikopoulou MG, Gkiouras K, Tzimos C, Papageorgiou ST, Markaki AG, Exiara T, Goulis DG, Papamitsou T. Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care. Nutrients 2020; 12:nu12113516. [PMID: 33203138 PMCID: PMC7696891 DOI: 10.3390/nu12113516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.
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Affiliation(s)
- Savvas Katsaridis
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Sindos, GR-57400 Thessaloniki, Greece; (S.K.); (M.G.G.)
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Sindos, GR-57400 Thessaloniki, Greece; (S.K.); (M.G.G.)
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Laboratory of Clinical Pharmacology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str, GR-54646 Thessaloniki, Greece;
| | - Stefanos T. Papageorgiou
- Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Anastasia G. Markaki
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hellenic Mediterranean University, PO Box 8556, Trypitos, GR-72300 Sitia, Greece;
| | - Triada Exiara
- Department of Internal Medicine, Sismanoglio General Hospital, 45 Sismanogliou Str, GR-69133 Komotini, Greece;
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
- Correspondence: (D.G.G.); (T.P.)
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
- Correspondence: (D.G.G.); (T.P.)
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Design for Sustained Wellbeing through Positive Activities—A Multi-Stage Framework. MULTIMODAL TECHNOLOGIES AND INTERACTION 2020. [DOI: 10.3390/mti4040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
In this paper, we introduce a framework that conceptualizes a multi-stage process through which technology can promote sustained wellbeing. Intentional wellbeing-enhancing activities form the centerpiece linking direct product interaction to, ultimately, wellbeing. The framework was developed following a bottom-up–top-down approach by integrating theoretical knowledge from positive psychology, behavioral science and human–computer interaction (HCI)/design with empirical insights. We outline (a) the framework, (b) its five main stages including their multidisciplinary theoretical foundations, (c) relations between these stages and (d) specific elements that further describe each stage. The paper illustrates how the framework was developed and elaborates three major areas of application: (design) research, design strategies and measurement approaches. With this work, we aim to provide actionable guidance for researchers and IT practitioners to understand and design technologies that foster sustained wellbeing.
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Sommer J, Dyczmons J, Grobosch S, Gontscharuk V, Vomhof M, Roden M, Icks A. Preferences of people with type 2 diabetes for telemedical lifestyle programmes in Germany: protocol of a discrete choice experiment. BMJ Open 2020; 10:e036995. [PMID: 32907900 PMCID: PMC7482475 DOI: 10.1136/bmjopen-2020-036995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/25/2020] [Accepted: 08/15/2020] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Telemedical lifestyle programmes for people with type 2 diabetes mellitus (T2DM) provide an opportunity to develop a healthier lifestyle and consequently to improve health outcomes. When implementing new programmes into standard care, considering patients' preferences may increase the success of the participants. This study aims to examine the preferences of people with T2DM with respect to telemedical lifestyle programmes, to analyse whether these preferences predict programme success and to explore the changes that may occur during a telemedical lifestyle intervention. METHODS AND ANALYSIS We outline the protocol of the development and assessment of a discrete choice experiment (DCE) to examine patient preferences in a telemedical lifestyle programme with regard to the functions of the online portal, communication, responsibilities, group activities and time requirements. To develop the design of the DCE, we conducted pilot work involving healthcare experts and in particular people with T2DM using cognitive pretesting. The final DCE is being implemented within a randomised controlled trial for investigating whether participation in a telemedical lifestyle intervention programme sustainably improves the HbA1c values in 850 members of a large German statutory health insurance with T2DM. Preferences are being assessed before and after participants complete the programme. The DCE data will be analysed using regression and latent class analyses. ETHICS AND DISSEMINATION The DCE study has been approved by the ethics committee of the medical faculty of the Heinrich Heine University Duesseldorf, registration number 2018-242-ProspDEuA, registered on 6 December 2018. The TeLIPro trial is registered at the US National Library of Medicine, registration number NCT03675919, registered on 15 September 2018. We aim to disseminate our results in peer-reviewed journals, at national and international conferences and among interested patient groups and the public.
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Affiliation(s)
- Jana Sommer
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jan Dyczmons
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Sandra Grobosch
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Division of Endocrinology and Diabetology, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at the Heinrich Heine University, Duesseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Dening J, Islam SMS, George E, Maddison R. Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2020; 22:e16437. [PMID: 32857059 PMCID: PMC7486668 DOI: 10.2196/16437] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is among the most prevalent noncommunicable health conditions worldwide, affecting over 500 million people globally. Diet is a key aspect of T2DM management with dietary modification shown to elicit clinically meaningful outcomes such as improved glycemic control, and reductions in weight and cardiovascular disease risk factors. Web-based interventions provide a potentially convenient and accessible method for delivering dietary education, but its effects on dietary behavior in people with T2DM are unknown. Objective The objective of this review was to determine the effectiveness of web-based interventions on dietary behavior change and glycemic control in people with T2DM. Methods Per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, systematic literature searches were performed using Medline, Embase, The Cochrane Library, and CINAHL to retrieve papers from January 2013 to May 2019. Randomized controlled trials of web-based interventions in adults with T2DM with reported dietary assessment were included. Population and intervention characteristics, dietary guidelines and assessments, and significant clinical outcomes were extracted. Differences between groups and within groups were assessed for dietary behavior and clinical outcomes. Results There were 714 records screened, and five studies comprising 1056 adults were included. Studies measured dietary changes by assessing overall diet quality, changes in specific dietary components, or dietary knowledge scores. Significant improvements in dietary behavior were reported in four out of the five studies, representing healthier food choices, improvements in eating habits, reductions in carbohydrates, added sugar, sodium, saturated fat and overall fat intake, and/or increases in dietary knowledge. Three studies found significant mean reductions for hemoglobin A1c ranging from –0.3% to –0.8%, and/or weight ranging from –2.3 kg to –12.7 kg, fasting blood glucose (–1 mmol/L), waist circumference (–1 cm), and triglycerides (–60.1 mg/dL). These studies provided varied dietary recommendations from standard dietary guidelines, national health program guidelines, and a very low carbohydrate ketogenic diet. Conclusions This review provided evidence that web-based interventions may be an effective way to support dietary behavior change in people with T2DM, potentially leading to changes in glycemic control and other clinical outcomes. However, the evidence should be viewed as preliminary as there were only five studies included with considerable heterogeneity in terms of the diets recommended, the dietary assessment measures used, the complexity of the interventions, and the modes and methods of delivery.
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Elena George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Mattei J, Alfonso C. Strategies for Healthy Eating Promotion and Behavioral Change Perceived as Effective by Nutrition Professionals: A Mixed-Methods Study. Front Nutr 2020; 7:114. [PMID: 32923451 PMCID: PMC7457058 DOI: 10.3389/fnut.2020.00114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 01/16/2023] Open
Abstract
Nutrition professionals may recognize ways to improve diet among their clients/patients. This study aimed to survey strategies and foods that nutrition professionals in Puerto Rico perceive as most effective for healthy eating promotion and behavioral change. The study was a cross-sectional online mixed-methods survey conducted among registered members of the College of Nutritionists and Dietitians of Puerto Rico. Using close-ended questions, nutrition professionals identified foods that they considered as easy to include or difficult to control in the diet of their clients/patients, and strategies that may work best for healthy eating. Frequencies of responses were analyzed. Open-ended questions were qualitatively analyzed in NVivo v11. The response rate was 33.2% (n = 414). The foods deemed as easy to include in the diet were root vegetables (66%), fruit (66%), legumes (57%), water (38%), and yogurt/dairy (37%). The foods deemed as more difficult to control were sugary beverages (63%), sweets and desserts (57%), fats and fried foods (56%), salt (50%), and white rice (44%). The strategies for healthy eating deemed effective were personalized orientation (79%), setting short-term goals (61%), making gradual dietary changes (53%), and setting health-oriented (41%), and personal (37%) goals. Emerging themes from qualitative analysis included the intuited key role of nutrition professionals, the need for policy changes, emphasizing prevention, cultural sensitivity, and practical issues. Respondents suggested potential strategies across levels of the socioecological model. In conclusion, healthy eating strategies and foods perceived by nutrition professionals as effective may shape optimal nutritional counseling and population-wide approaches to improve healthy eating in Puerto Rico.
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Affiliation(s)
- Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Charmaine Alfonso
- College of Nutritionists and Dietitians of Puerto Rico, San Juan, PR, United States
- School of Health Sciences, Ana G. Méndez University, Gurabo Campus, Gurabo, PR, United States
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Romero-Sánchez JM, Brito-Brito PR, Martínez-Alberto CE, Martín-García Á, Rodríguez-Álvaro M, Group CR, Paloma-Castro O. A New Instrument for Measuring Dietary Knowledge in Patients With Diabetes: Psychometric Testing of the CoNOCidiet-Diabetes. Int J Nurs Knowl 2020; 32:20-28. [PMID: 32472981 DOI: 10.1111/2047-3095.12288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To determine the psychometric properties of the CoNOCidiet-Diabetes, a new instrument based on nursing outcome "Knowledge: prescribed diet." METHODS Methodological design. The participant were 359 patients diagnosed with diabetes visiting 27 primary healthcare centers in Spain. Reliability (internal consistency and test-retest), validity (convergent criterion validity, concurrent content validity and known-groups validity), and sensitivity to change was tested. FINDINGS CoNOCidiet-Diabetes has shown evidence of acceptable psychometric properties as instrument but some items should be revised. CONCLUSIONS This research provides a new instrument developed to specifically measure dietary knowledge in individuals with diabetes. IMPLICATIONS For nursing practice: The literalness of the CoNOCidiet-Diabetes with the nursing outcome "Knowledge: prescribed diet" facilitate its measurement using the patient's statements.
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Affiliation(s)
- José Manuel Romero-Sánchez
- Research Group under the Andalusian Research, Development, and Innovation Scheme CTS-1019, University of Cádiz, Cádiz, Spain
| | - Pedro Ruymán Brito-Brito
- Primary Care Management of Tenerife, The Canary Islands Health Service, University of La Laguna., San Cristóbal de La Laguna, Spain
| | | | - Ángel Martín-García
- Health Care Directorate (Southern District), Primary Care Management, Madrid, Spain
| | - Martín Rodríguez-Álvaro
- University of La Laguna, San Cristóbal de La Laguna; Research Nurse at the Primary Care Management of La Palma, The Canary Islands Health Service, Santa Cruz de La Palma, Spain
| | - CoNocidiet-Research Group
- Members of the CoNOCidiet-Diabetes Research Group: Mercedes Fraile-Bravo, Cristina Oter-Quintana, Juan Carlos Paramio-Cuevas, Rubén Martín-Payo, Gonzalo Duarte-Clíments, and Héctor De la Rosa-Merino
| | - Olga Paloma-Castro
- Department of Nursing and Physical Therapy, Faculty of Nursing, Development, and Innovation Scheme CTS-1019. University of Cádiz, University of Cádiz at Algeciras, and Head of the Research Group under the Andalusian Research, Cádiz, Spain
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31
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Rigby RR, Mitchell LJ, Hamilton K, Williams LT. The Use of Behavior Change Theories in Dietetics Practice in Primary Health Care: A Systematic Review of Randomized Controlled Trials. J Acad Nutr Diet 2020; 120:1172-1197. [PMID: 32444328 DOI: 10.1016/j.jand.2020.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/24/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Behavior change theories frameworks provide the theoretical underpinning for effective health care. The extent to which they are applied in contemporary dietetics interventions has not been explored. OBJECTIVE To systematically review the evidence of behavior change theory-based interventions delivered by credentialed nutrition and dietetics practitioners in primary health care settings. METHODS Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, and Cochrane databases were searched for English language, randomized controlled trials before August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Eligible interventions included adults (aged ≥18 years) receiving face-to-face dietetics care underpinned by behavior change theories in primary health care settings with outcome measures targeting changes in health behaviors or health outcomes. Screening was conducted independently in duplicate and data were extracted using predefined categories. The quality of each study was assessed using the Cochrane Risk of Bias tool. The body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual Conclusion Grading Table. RESULTS Thirty articles reporting on 19 randomized controlled trials met the eligibility criteria, representing 5,172 adults. Thirteen studies (68%) showed significant improvements for the primary outcome measured. Social cognitive theory was the behavior change theory most commonly applied in interventions (n=15) with 11 finding significant intervention effects. Goal setting, problem solving, social support, and self-monitoring were the most commonly reported techniques (n=15, n=14, n=11, and n=11, respectively). Most studies had a high (n=11) or unclear (n=8) risk of bias. There was fair evidence (Grade II) supporting the use of behavior change theories to inform development of dietetics interventions. CONCLUSIONS Interventions delivered by credentialed nutrition and dietetics practitioners that were underpinned by behavior change theories and utilizing various behavior change techniques were found to have potential to be more effective at improving patient health outcomes than dietary interventions without theoretical underpinnings. Findings from this review should inform future primary health care research in the area of dietary behavior change. In addition, findings from this review highlight the need for stronger documentation of use of behavior change theory and techniques that map on to the theory within dietetics practice.
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Locke SR, Dix G, Te Hiwi B, Oelke ND, Rush KL, Berg S, Dinwoodie M, Jung ME, Martin Ginis KA. Improving Diabetes Care in the British Columbia Southern Interior: Developing Community‒University Initiatives to Address Service Gaps. Can J Diabetes 2020; 45:5-14.e2. [PMID: 32800448 DOI: 10.1016/j.jcjd.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Diabetes rates in the British Columbia (BC) interior are rising more rapidly compared with the rest of Canada, whereas diabetes service provision is limited within this region. The purposes of this article were: 1) to identify characteristics of diabetes service delivery; and 2) to co-develop community‒university diabetes research projects to address service barriers and gaps in the BC southern interior across urban, rural and Indigenous populations. METHODS A 3-step approach was used. In step 1, a web search was conducted to identify diabetes-related services. In step 2, 10 community members working or volunteering in diabetes organizations participated in semistructured telephone interviews pertaining to diabetes service access, priorities, barriers, benefits and gaps. In step 3, a meeting of researchers and community members (n=25) was held to foster collaboration and co-develop research projects. RESULTS Seventy-eight urban, rural and Indigenous diabetes-related services were identified in the BC southern interior. Provision of care to those with new type 1 diabetes and gestational diabetes diagnoses was identified in the interviews as a key priority; the needs of these groups contribute to a deficiency of resources to deliver prediabetes programs. The meeting produced plans for 2 collaborative projects: (1) the development of a diabetes patient journey map, and (2) development of a diabetes service hub with navigators for patients. CONCLUSIONS Together, community members and researchers have identified service gaps and formulated research projects to improve diabetes management for urban, rural and Indigenous peoples living in the BC southern interior.
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Affiliation(s)
- Sean R Locke
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada.
| | - Gabriel Dix
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada
| | - Braden Te Hiwi
- Community, Culture, and Global Studies, Irving K. Barber School of Arts and Sciences, University of British Columbia, British Columbia, Canada
| | - Nelly D Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada
| | - Kathy L Rush
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada
| | - Stephen Berg
- Okanagan School of Education, Faculty of Education, University of British Columbia, British Columbia, Canada
| | - Miranda Dinwoodie
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, British Columbia, Canada
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33
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Guidance for behavioural interventions aiming to support family support providers of people with spinal cord injury: A scoping review. Soc Sci Med 2020; 246:112456. [DOI: 10.1016/j.socscimed.2019.112456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 06/17/2019] [Accepted: 07/28/2019] [Indexed: 01/07/2023]
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Zhang L, He X, Shen Y, Yu H, Pan J, Zhu W, Zhou J, Bao Y. Effectiveness of Smartphone App-Based Interactive Management on Glycemic Control in Chinese Patients With Poorly Controlled Diabetes: Randomized Controlled Trial. J Med Internet Res 2019; 21:e15401. [PMID: 31815677 PMCID: PMC6928697 DOI: 10.2196/15401] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In recent years, the rapid development of mobile medical technology has provided multiple ways for the long-term management of chronic diseases, especially diabetes. As a new type of management model, smartphone apps are global, convenient, cheap, and interactive. Although apps were proved to be more effective at glycemic control, compared with traditional computer- and Web-based telemedicine technologies, how to gain a further and sustained improvement is still being explored. OBJECTIVE The objective of this study was to investigate the effectiveness of an app-based interactive management model by a professional health care team on glycemic control in Chinese patients with poorly controlled diabetes. METHODS This study was a 6-month long, single-center, prospective randomized controlled trial. A total of 276 type 1 or type 2 diabetes patients were enrolled and randomized to the control group (group A), app self-management group (group B), and app interactive management group (group C) in a 1:1:1 ratio. The primary outcome was the change in glycated hemoglobin (HbA1c) level. Missing data were handled by multiple imputation. RESULTS At months 3 and 6, all 3 groups showed significant decreases in HbA1c levels (all P<.05). Patients in the app interactive management group had a significantly lower HbA1clevel than those in the app self-management group at 6 months (P=.04). The average HbA1c reduction in the app interactive management group was larger than that in the app self-management and control groups at both months 3 and 6 (all P<.05). However, no differences in HbA1c reduction were observed between the app self-management and control groups at both months 3 and 6 (both P>.05). Multivariate line regression analyses also showed that the app interactive management group was associated with the larger reduction of HbA1c compared with groups A and B at both months 3 and 6 (all P>.05). In addition, the app interactive management group had better control of triglyceride and high-density lipoprotein cholesterol levels at both months 3 and 6 compared with baseline (both P<.05). CONCLUSIONS In Chinese patients with poorly controlled diabetes, it was difficult to achieve long-term effective glucose improvement by using app self-management alone, but combining it with interactive management can help achieve rapid and sustained glycemic control. TRIAL REGISTRATION ClinicalTrials.gov NCT02589730; https://clinicaltrials.gov/ct2/show/NCT02589730.
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Affiliation(s)
- Lei Zhang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xingxing He
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiemin Pan
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Schwarz PEH, Timpel P, Harst L, Greaves CJ, Ali MK, Lambert J, Weber MB, Almedawar MM, Morawietz H. Reprint of: Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series. J Am Coll Cardiol 2019; 72:3071-3086. [PMID: 30522637 DOI: 10.1016/j.jacc.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 02/08/2023]
Abstract
The primary objective of this study was to analyze the most up-to-date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review. Three separate, systematic literature searches identified 2,343 papers in total. Overall, 44 studies were included for data extraction and analysis. The included systematic reviews and meta-analyses published between January 1, 2016, and December 31, 2017, were of good to very good quality (median Overview Quality Assessment Questionnaire score = 17). Identified evidence suggests that cardiovascular disease (CVD) prevention services should consider regulation of blood glucose as a key target for intervention. Furthermore, the recommendations for effective intervention and service development/training described here for prevention of CVD should be adopted into evidence-based practice guidelines. Multidisciplinary teams should be formed to deliver multicomponent interventions in community-based settings. There may be substantial opportunities for integrating CVD and diabetes prevention services.
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Affiliation(s)
- Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Colin J Greaves
- School for Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, United Kingdom
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey Lambert
- The Institute of Health Research, Primary Care, University of Exeter Medical School, Exeter, United Kingdom
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohamad M Almedawar
- Dresden International Graduate School for Biomedicine and Bioengineering, Technische Universität Dresden, Dresden, Germany; Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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36
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Schwarz PEH, Timpel P, Harst L, Greaves CJ, Ali MK, Lambert J, Weber MB, Almedawar MM, Morawietz H. Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series. J Am Coll Cardiol 2019; 72:1829-1844. [PMID: 30286928 DOI: 10.1016/j.jacc.2018.07.081] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
The primary objective of this study was to analyze the most up-to-date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review. Three separate, systematic literature searches identified 2,343 papers in total. Overall, 44 studies were included for data extraction and analysis. The included systematic reviews and meta-analyses published between January 1, 2016, and December 31, 2017, were of good to very good quality (median Overview Quality Assessment Questionnaire score = 17). Identified evidence suggests that cardiovascular disease (CVD) prevention services should consider regulation of blood glucose as a key target for intervention. Furthermore, the recommendations for effective intervention and service development/training described here for prevention of CVD should be adopted into evidence-based practice guidelines. Multidisciplinary teams should be formed to deliver multicomponent interventions in community-based settings. There may be substantial opportunities for integrating CVD and diabetes prevention services.
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Affiliation(s)
- Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Colin J Greaves
- School for Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, United Kingdom
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jeffrey Lambert
- The Institute of Health Research, Primary Care, University of Exeter Medical School, Exeter, United Kingdom
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohamad M Almedawar
- Dresden International Graduate School for Biomedicine and Bioengineering, Technische Universität Dresden, Dresden, Germany; Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Al-Hamdan R, Avery A, Salter A, Al-Disi D, Al-Daghri NM, McCullough F. Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes. Nutrients 2019; 11:nu11051113. [PMID: 31109110 PMCID: PMC6566809 DOI: 10.3390/nu11051113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022] Open
Abstract
Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18–55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m2) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m2)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.
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Affiliation(s)
- Rasha Al-Hamdan
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Amanda Avery
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Andrew Salter
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Dara Al-Disi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Fiona McCullough
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham NG7 2RD, UK.
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Yoshikawa F, Kumashiro N, Shigiyama F, Uchino H, Ando Y, Yoshino H, Miyagi M, Ikehara K, Hirose T. Efficacy of intermittent empagliflozin supplementation on dietary self-management and glycaemic control in patients with poorly controlled type 2 diabetes: A 24-week randomized controlled trial. Diabetes Obes Metab 2019; 21:303-311. [PMID: 30187632 DOI: 10.1111/dom.13524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/21/2018] [Accepted: 09/01/2018] [Indexed: 02/06/2023]
Abstract
AIMS To explore the effects of intermittent use of empagliflozin, a sodium-glucose co-transporter-2 inhibitor, on dietary self-management and glycaemic control in patients with inadequately controlled type 2 diabetes. MATERIALS AND METHODS We conducted a prospective, randomized, open-label, blinded-endpoint, parallel-group, comparative clinical trial of 50 patients with type 2 diabetes, treated with no more than three oral antidiabetic drugs (glycated haemoglobin [HbA1c] ≥52 mmol/mol but <86 mmol/mol). The participants were randomized to take 10 mg/d empagliflozin either every day (regular group, n = 25) or on the day on which they considered they had overeaten (intermittent group, n = 25) for 24 weeks. We limited empagliflozin prescription to half of the required period in the intermittent group. The primary endpoint was change in HbA1c at the end of the 24-week treatment period relative to baseline. The secondary outcomes included changes in body weight, daily energy intake and diabetes treatment-related quality of life (QoL). Energy intake was assessed using a diet-specific validated questionnaire rather than actual assessments of food intake. RESULTS The intake rate of empagliflozin was 96.7 ± 7.2% for the regular group and 45.7 ± 7.0% for the intermittent group. Interestingly, ΔHbA1c was identical in the two groups (-0.64 ± 0.19% and - 0.65 ± 0.17%, respectively). Body weight decreased (-2.72 ± 0.52 and - 1.50 ± 0.45 kg, respectively) and diabetes treatment-related QoL increased significantly from baseline in both groups. Energy intake, however, decreased significantly only in the intermittent group (-221.0 ± 108.3 kcal/d). CONCLUSIONS Intermittent empagliflozin supplementation is a useful therapeutic option that empowers dietary self-management, improves glycaemic control and is accompanied by body weight loss and an increase in diabetes treatment-related QoL in patients with inadequately controlled type 2 diabetes.
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Affiliation(s)
- Fukumi Yoshikawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Fumika Shigiyama
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Yasuyo Ando
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Yoshino
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masahiko Miyagi
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kayoko Ikehara
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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Carter S, Clifton PM, Keogh JB. Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open 2018; 1:e180756. [PMID: 30646030 PMCID: PMC6324303 DOI: 10.1001/jamanetworkopen.2018.0756] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Intermittent energy restriction is an alternative weight loss method that is becoming popular; however, to date, there are no long-term clinical trials of intermittent energy restriction in patients with type 2 diabetes. OBJECTIVE To compare the effects of intermittent energy restriction (2 days per week) with those of continuous energy restriction on glycemic control and weight loss in patients with type 2 diabetes during a 12-month period. DESIGN, SETTING, AND PARTICIPANTS Adult participants (N = 137) with type 2 diabetes were randomized 1:1 to parallel diet groups (intermittent energy restriction [n = 70] or continuous energy restriction [n = 67]) between April 7, 2015, and September 7, 2017, at the University of South Australia. Medications likely to cause hypoglycemia were reduced at baseline according to the medication management protocol. INTERVENTIONS An intermittent energy restriction diet (500-600 kcal/d) followed for 2 nonconsecutive days per week (participants followed their usual diet for the other 5 days) or a continuous energy restriction diet (1200-1500 kcal/d) followed for 7 days per week for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was change in hemoglobin A1c (HbA1c) level, with equivalence prespecified by a 90% CI margin of ±0.5%. The secondary outcome was weight loss with equivalence set at ±2.5 kg (±1.75 kg for fat mass loss and ±0.75 kg for fat-free mass loss). All other outcomes were tested for superiority. RESULTS Of the 137 randomized participants (77 women and 60 men; mean [SD] age, 61.0 [9.1] years; mean [SD] body mass index, 36.0 [5.8] [calculated as weight in kilograms divided by height in meters squared]; and mean [SD] HbA1c level, 7.3% [1.3%]), 97 completed the trial. Intention-to-treat analysis showed similar reductions in mean (SEM) HbA1c level between the continuous and intermittent energy restriction groups (-0.5% [0.2%] vs -0.3% [0.1%]; P = .65), with a between-group difference of 0.2% (90% CI, -0.2% to 0.5%) meeting the criteria for equivalence. Mean (SEM) weight change was similar between the continuous and intermittent energy restriction groups (-5.0 [0.8] kg vs -6.8 [0.8] kg; P = .25), but the between-group difference did not meet the criteria for equivalence (-1.8 kg; 90% CI, -3.7 to 0.07 kg), nor did the between-group difference in fat mass (-1.3 kg; 90% CI, -2.8 to 0.2 kg) or fat-free mass (-0.5 kg; 90% CI, -1.4 to 0.4 kg). There were no significant differences between groups in final step count, fasting glucose levels, lipid levels, or total medication effect score at 12 months. Effects did not differ using completers analysis. Hypoglycemic or hyperglycemic events in the first 2 weeks of treatment were similar between the continuous and intermittent energy restriction groups (mean number [SEM] of events, 3.2 [0.7] vs 4.9 [1.4]; P = .28), affecting 35% of participants (16 of 46) using sulfonylureas and/or insulin. CONCLUSIONS AND RELEVANCE Intermittent energy restriction is an effective alternative diet strategy for the reduction of HbA1c and is comparable with continuous energy restriction in patients with type 2 diabetes. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12615000383561.
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Affiliation(s)
- Sharayah Carter
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Peter M. Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Jennifer B. Keogh
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
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Berman MA, Guthrie NL, Edwards KL, Appelbaum KJ, Njike VY, Eisenberg DM, Katz DL. Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study. JMIR Diabetes 2018; 3:e4. [PMID: 30291074 PMCID: PMC6238888 DOI: 10.2196/diabetes.9591] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Intensive lifestyle change can treat and even reverse type 2 diabetes. Digital therapeutics have the potential to deliver lifestyle as medicine for diabetes at scale. OBJECTIVE This 12-week study investigates the effects of a novel digital therapeutic, FareWell, on hemoglobin A1c (HbA1c) and diabetes medication use. METHODS Adults with type 2 diabetes and a mobile phone were recruited throughout the United States using Facebook advertisements. The intervention aim was to effect a sustainable shift to a plant-based dietary pattern and regular exercise by advancing culinary literacy and lifestyle skill acquisition. The intervention was delivered by an app paired with specialized human support, also delivered digitally. Health coaching was provided every 2 weeks by telephone, and a clinical team was available for participants requiring additional support. Participants self-reported current medications and HbA1c at the beginning and end of the 12-week program. Self-efficacy related to managing diabetes and maintaining dietary changes was assessed via survey. Engagement was recorded automatically through the app. RESULTS We enrolled 118 participants with a baseline HbA1c >6.5%. Participants were 81.4% female (96/118) and resided in 38 US states with a mean age of 50.7 (SD 9.4) years, baseline body mass index of 38.1 (SD 8.8) kg/m2, and baseline HbA1c of 8.1% (SD 1.6). At 12 weeks, 86.2% (94/109) of participants were still using the app. Mean change in HbA1c was -0.8% (97/101, SD 1.3, P<.001) for those reporting end-study data. For participants with a baseline HbA1c >7.0% who did not change medications midstudy, HbA1c change was -1.1% (67/69, SD 1.4, P<.001). The proportion of participants with an end-study HbA1c <6.5% was 28% (22/97). After completion of the intervention, 17% (16/97) of participants reported a decrease in diabetic medication while 8% (8/97) reported an increase. A total of 57% (55/97) of participants achieved a composite outcome of reducing HbA1c, reducing diabetic medication use, or both; 92% (90/98) reported greater confidence in their ability to manage their diabetes compared to before the program, and 91% (89/98) reported greater confidence in their ability to maintain a healthy dietary pattern. Participants engaged with the app an average of 4.3 times per day. We observed a significantly greater decrease in HbA1c among participants in the highest tertile of app engagement compared to those in the lowest tertile of app engagement (P=.03). CONCLUSIONS Clinically meaningful reductions in HbA1c were observed with use of the FareWell digital therapeutic. Greater glycemic control was observed with increasing app engagement. Engagement and retention were both high in this widely distributed sample.
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Affiliation(s)
- Mark A Berman
- Better Therapeutics LLC, San Francisco, CA, United States
| | | | | | | | - Valentine Y Njike
- Prevention Research Center, Griffin Hospital, Yale University, Derby, CT, United States
| | - David M Eisenberg
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - David L Katz
- Better Therapeutics LLC, San Francisco, CA, United States.,Prevention Research Center, Griffin Hospital, Yale University, Derby, CT, United States
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