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Huttunen-Lenz M, Hansen S, Raben A, Westerterp-Plantenga M, Adam T, Macdonald I, Stratton G, Swindell N, Martinez JA, Navas-Carretero S, Handjieva-Darlenska T, Handjiev S, Poppitt SD, Silvestre MP, Larsen TM, Vestentoft PS, Fogelholm M, Jalo E, Brand-Miller J, Muirhead R, Schlicht W. Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms. J Prim Care Community Health 2024; 15:21501319241248223. [PMID: 38916158 DOI: 10.1177/21501319241248223] [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: 06/26/2024] Open
Abstract
BACKGROUND Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For interventions to be successful, it is important to influence "behavioral mechanisms" such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36 months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed. METHOD Participants (n = 962) with overweight and prediabetes who had achieved ≥8% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol. RESULTS There was no increase in the participants' self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions. CONCLUSIONS The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.
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Affiliation(s)
| | | | - Anne Raben
- University of Copenhagen, Frederiksberg, Denmark
- Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Tanja Adam
- Maastricht University, Maastricht, The Netherlands
| | - Ian Macdonald
- University of Nottingham, Nottingham, UK
- Nestle Research, Lausanne, Switzerland
| | | | | | - J Alfredo Martinez
- University of Navarra, Pamplona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
- IMDEAfood Madrid, Madrid, Spain
- IDISNA Navarra, Pamplona, Spain
| | - Santiago Navas-Carretero
- University of Navarra, Pamplona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | | | | | | | - Marta P Silvestre
- University of Auckland, Auckland, New Zealand
- NOVA University of Lisbon, Lisbon, Portugal
| | | | | | | | - Elli Jalo
- University of Helsinki, Helsinki, Finland
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Tripathi P, Kathrikolly TR. Lifestyle Intervention for Diabetes Remission: A Paradigm Shift inDiabetes Care and Management. Curr Diabetes Rev 2024; 20:e291123224009. [PMID: 38093443 DOI: 10.2174/0115733998272795231109034141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 08/06/2024]
Abstract
Remission is often considered the ultimate goal in T2D management and care. Although metabolic surgery is the conventional choice to achieve remission, substantial evidence suggests the possibility of T2D remission through lifestyle interventions. In this context, the current perspective explores recent scientific advancements in lifestyle intervention for diabetes remission and also emphasises its clinical applicability as a pragmatic approach to diabetes management. The perspective further provides additional evidence on remission from the authors' own research findings in the Indian population. We propose that a holistic lifestyle intervention approach - individualised diet plan, exercise protocol, and psychological intervention - may be a benchmark protocol to achieve T2D remission.
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Affiliation(s)
- Pramod Tripathi
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
| | - Thejas R Kathrikolly
- Department of Research, Freedom from Diabetes Research Foundation, Pune, Maharashtra, India
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Lake AJ, Williams A, Neven ACH, Boyle JA, Dunbar JA, Hendrieckx C, Morrison M, O’Reilly SL, Teede H, Speight J. Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1086186. [PMID: 36993822 PMCID: PMC10012118 DOI: 10.3389/fcdhc.2023.1086186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/12/2023] [Indexed: 03/02/2023]
Abstract
IntroductionWomen with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.Research design and methodsSemi-structured interviews with participants recruited via Australia’s National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify ‘important’ domains which we then mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model.ResultsNineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: ‘knowledge’, ‘memory, attention, and decision-making processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, ‘beliefs about consequences’, ‘social role and identity’, and ‘beliefs about capabilities’. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.ConclusionsThis study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM.
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Affiliation(s)
- Amelia J. Lake
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Amelia J. Lake,
| | - Amelia Williams
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Adriana C. H. Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jacqueline A. Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
- Monash Department of Obstetrics and Gynecology, Monash Health, Clayton, VIC, Australia
| | - James A. Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Sharleen L. O’Reilly
- School of Exercise & Nutrition Science, Deakin University, Burwood, VIC, Australia
- UCD Institute of Food and Health, College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
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Almulhim AN, Hartley H, Norman P, Caton SJ, Doğru OC, Goyder E. Behavioural Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis. BMC Public Health 2023; 23:95. [PMID: 36639632 PMCID: PMC9837922 DOI: 10.1186/s12889-022-14874-3] [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: 08/16/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Given the high rates globally of Type 2 Diabetes Mellitus (T2DM), there is a clear need to target health behaviours through person-centred interventions. Health coaching is one strategy that has been widely recognised as a tool to foster positive behaviour change. However, it has been used inconsistently and has produced mixed results. This systematic review sought to explore the use of behaviour change techniques (BCTs) in health coaching interventions and identify which BCTs are linked with increased effectiveness in relation to HbA1C reductions. METHODS In line with the PICO framework, the review focused on people with T2DM, who received health coaching and were compared with a usual care or active control group on HbA1c levels. Studies were systematically identified through different databases including Medline, Web of science, and PsycINFO searches for relevant randomised controlled trials (RCTs) in papers published between January 1950 and April 2022. The Cochrane collaboration tool was used to evaluate the quality of the studies. Included papers were screened on the reported use of BCTs based on the BCT taxonomy. The effect sizes obtained in included interventions were assessed by using Cohen's d and meta-analysis was used to estimate sample-weighted average effect sizes (Hedges' g). RESULTS Twenty RCTs with a total sample size of 3222 were identified. Random effects meta-analysis estimated a small-sized statistically significant effect of health coaching interventions on HbA1c reduction (g+ = 0.29, 95% CI: 0.18 to 0.40). A clinically significant HbA1c decrease of ≥5 mmol/mol was seen in eight studies. Twenty-three unique BCTs were identified in the reported interventions, with a mean of 4.5 (SD = 2.4) BCTs used in each study. Of these, Goal setting (behaviour) and Problem solving were the most frequently identified BCTs. The number of BCTs used was not related to intervention effectiveness. In addition, there was little evidence to link the use of specific BCTs to larger reductions in HbA1c across the studies included in the review; instead, the use of Credible source and Social reward in interventions were associated with smaller reductions in HbA1c. CONCLUSION A relatively small number of BCTs have been used in RCTs of health coaching interventions for T2DM. Inadequate, imprecise descriptions of interventions and the lack of theory were the main limitations of the studies included in this review. Moreover, other possible BCTs directly related to the theoretical underpinnings of health coaching were absent. It is recommended that key BCTs are identified at an early stage of intervention development, although further research is needed to examine the most effective BCTs to use in health coaching interventions. TRIAL REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228567 .
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Affiliation(s)
- Abdullah N. Almulhim
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA UK ,grid.449598.d0000 0004 4659 9645Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, 13316 Saudi Arabia
| | - Hannah Hartley
- grid.418447.a0000 0004 0391 9047Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, BD9 6RJ UK
| | - Paul Norman
- grid.11835.3e0000 0004 1936 9262Department of Psychology, The University of Sheffield, Cathedral Court, The University of Sheffield, Vicar Ln, Sheffield, S1 2LT UK
| | - Samantha J. Caton
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA UK
| | - Onur Cem Doğru
- grid.411108.d0000 0001 0740 4815Department of Psychology, Afyon Kocatepe University, Gazlıgöl St, 03200 Afyonkarahisar, Turkey
| | - Elizabeth Goyder
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA UK
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Huber C, Montreuil C, Christie D, Forbes A. Integrating Self-Management Education and Support in Routine Care of People With Type 2 Diabetes Mellitus: A Conceptional Model Based on Critical Interpretive Synthesis and A Consensus-Building Participatory Consultation. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:845547. [PMID: 36992783 PMCID: PMC10012123 DOI: 10.3389/fcdhc.2022.845547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
The integration of self-management education and support into the routine diabetes care is essential in preventing complications. Currently, however, there is no consensus on how to conceptualise integration in relation to self-management education and support. Therefore, this synthesis presents a framework conceptualising integration and self-management.MethodsSeven electronic databases (Medline, HMIC, PsycINFO, CINAHL, ERIC, Scopus and Web of Science) were searched. Twenty-one articles met the inclusion criteria. Data were synthesised using principles of critical interpretive synthesis to build the conceptual framework. The framework was presented to 49 diabetes specialist nurses working at different levels of care during a multilingual workshop.ResultsA conceptual framework is proposed in which integration is influenced by five interacting components: the programme ethos of the diabetes self-management education and support intervention (content and delivery), care system organisation (the framework in which such interventions are delivered), adapting to context (the aspects of the people receiving and delivering the interventions), interpersonal relationship (the interactions between the deliverer and receiver of the intervention), and shared learning (what deliverer and receiver gain from the interactions). The critical inputs from the workshop participants related to the different priorities given to the components according to their sociolinguistic and educational experiences, Overall, they agreed with the conceptualisation of the components and their content specific to diabetes self-management education and support.DiscussionIntegration was conceptualised in terms of the relational, ethical, learning, contextual adapting, and systemic organisational aspects of the intervention. It remains uncertain which prioritised interactions of components and to what extent these may moderate the integration of self-management education and support into routine care; in turn, the level of integration observed in each of the components may moderate the impact of these interventions, which may also apply to the impact of the professional training.ConclusionThis synthesis provides a theoretical framework that conceptualises integration in the context of diabetes self-management education and support in routine care. More research is required to evaluate how the components identified in the framework can be addressed in clinical practice to assess whether improvements in self-management education and support can be effectively realised in this population.
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Affiliation(s)
- Claudia Huber
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, London, United Kingdom
- *Correspondence: Claudia Huber,
| | - Chantal Montreuil
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Derek Christie
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, London, United Kingdom
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