How Does Diet Change with A Diagnosis of Diabetes? Protocol of the 3D Longitudinal Study

The prevalence of psychological distress in adults newly diagnosed with type 2 diabetes: Data from the Australian 3D case-series study

ISSUE ADDRESSED

This cross-sectional analysis of the Australian 3D study aimed to determine the prevalence of psychological distress and describe its associated characteristics in adults recently diagnosed with type 2 diabetes.

METHODS

Adults (aged 18 years and over) who were recently diagnosed with type 2 diabetes (<6 months prior) were recruited through the Australian National Diabetes Services Scheme in 2018-2019. Demographic and health data were collected via interview-administered telephone surveys. Hierarchical regression was used to analyse whether demographic, self-care and clinical characteristics were associated with psychological distress, as measured by the K10 questionnaire.

RESULTS

Of the participants (n = 223), 26.3% presented with psychological distress, with 8.4% reporting mild, 8.4% reporting moderate and 9.5% reporting severe psychological distress. Neither age, sex, body mass index or taking anti-depressant medications were associated with the presence of psychological distress (p > .05). Being a smoker, living situation, less physical activity and poorer healthy eating beliefs and intentions were significantly associated with psychological distress in those not taking anti-depressant medications (p < .05). Being female was significantly associated with psychological distress in those taking anti-depressant medications (p < .05).

CONCLUSION

The study found that psychological distress is highly prevalent in adults recently diagnosed with type 2 diabetes. Behavioural factors such as smoking and low physical activity, as well as psycho-social factors such as living situation, poor healthy eating beliefs and intentions were significantly associated with psychological distress. This has implications for the management of people with newly diagnosed type 2 diabetes. SO WHAT?: Psychological distress is highly prevalent in Australian adults newly diagnosed with type 2 diabetes, emphasising the urgent need for enhanced psychological care to support this group.

Exploring behaviour change in general practice consultations: A realist approach

OBJECTIVES

While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation.

METHODS

Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach.

RESULTS

Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP-patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations.

DISCUSSION

When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach.

Understanding dietary behaviour change after a diagnosis of diabetes: A qualitative investigation of adults with type 2 diabetes

Type 2 diabetes (T2D) is a major public health concern. Optimal management of T2D often requires individuals to make substantial changes to their dietary intake. This research employed a qualitative methodology to examine decision making processes underpinning dietary behaviour change. Semi-structured telephone interviews were conducted on a purposive sample of 21 Australian adults who had recently consulted a dietitian after being diagnosed with T2D. Data were analysed using theoretical thematic analysis and themes were matched deductively with constructs that underpin motivational, volitional, and implicit processes which exist in common models of behaviour change. Influences on motivation, such as a desire to improve health status and making use of valuable support networks featured in participant narratives. Volitional influences included knowing their limits, dealing with falling off the wagon, and learning how their body responds to food. The themes unlearning habits and limit the availability were identified as underpinning implicit influences on dietary change. Individual differences and emotions were constructs additional to the model that influenced dietary change. These findings contribute to a richer understanding of the subjective experiences of adults with T2D regarding dietary change and highlight the multiple processes that guide their decision making in this context.

Parental food consumption and diet quality and its association with children's food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study

OBJECTIVE

To examine the parental food consumption and diet quality and its associations with children's consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations.

DESIGN

Cross-sectional study using Feel4diabetes FFQ.

SETTING

Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children's food consumption after consideration of potential confounders.

PARTICIPANTS

2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6-8 years.

RESULTS

Parental food consumption was significantly associated with children's intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children's intake of 'fruit' (boys: β = 0·233, P < 0·001; girls: β = 0·134, P < 0·05) and 'vegetables' (boys: β = 0·177, P < 0·01; girls: β = 0·234, P < 0·001) and inversely associated with their 'snacks' consumption (boys: β = -0·143, P < 0·05; girls: β = -0·186, P < 0·01).

CONCLUSION

The present study suggests an association between parental food consumption and diet quality and children's food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.

Behaviour change for type 2 diabetes: perspectives of general practitioners, primary care academics, and behaviour change experts on the use of the 5As framework

BACKGROUND

The 5As framework is a recognized underpinning of behaviour change guidelines, teaching, and research in primary care. Supporting patients to improve their lifestyle behaviours, including diet and physical activity, is a common aspect of type 2 diabetes mellitus (T2DM) management. The 5As framework often informs behaviour change for patients with T2DM.

OBJECTIVE

To explore the experience and perspectives of general practitioners (GPs) and primary care academics and behaviour change experts regarding using the 5As framework when caring for patients with T2DM to better understand how and why the 5As are effective in practice.

METHODS

We recruited 20 practising GPs, primary care academics, and behaviour change experts for an individual semistructured interview and analysed the data using a realist evaluation approach.

RESULTS

There were diverse accounts of how GPs use the 5As in practice and few of the participants could name each "A." The 5As were commonly regarded as a framework best suited to beginners and although GPs expressed they followed the broad direction of the 5As, they did not consciously follow the framework in an instructive manner. Elements that could enhance the 5As included more emphasis on motivational interviewing, changing how "Ask" is included in the consultation, and increased person-centredness.

CONCLUSION

Although it is a ubiquitous framework in primary care, the 5As are understood in diverse ways and applied variably in practice. There is room to enhance how the 5As support behaviour change consultations to optimize outcomes in primary care.

Food purchases in households with and without diabetes based on consumer purchase data

OBJECTIVES

Dietary recommendations for individuals with diabetes are easy to provide, but adherence is difficult to monitor. The objective of this study was to investigate whether there was a difference in grocery purchases between households with and without diabetes.

STUDY DESIGN

Cohort study.

METHODS

Consumer purchase data in 2019 was collected from 6662 households donating their supermarket receipts via a receipt collecting service. Of these households, 718 included at least one individual with diabetes. The monetary percentages spent on specific food groups were used to characterize households using all purchases in 2019. A probability index model was used to compare households with diabetes to households without diabetes.

RESULTS

We included 405,264 shopping trips in 2019 attributed to 6662 households. Both households with and without diabetes spent the highest monetary percentage on sweets (with diabetes: 9.3%, without diabetes: 8.8%), with no statistically significant difference detected. However, compared to households without diabetes, households with diabetes had a significantly higher probability of spending a higher monetary percentage on butter, oil and dressings; non-sugary drinks; processed red meat and ready meals as well as a significantly lower probability of spending a higher monetary percentage on accessory compounds; alcoholic beverages; eggs; grains; rice and pasta, and raw vegetables.

CONCLUSIONS

Households with diabetes spent a relatively higher monetary value on several unhealthy foods and less on several healthy groceries compared to households without diabetes. There is a need for more diabetes self-management education focused on including more healthy dietary choices in their household grocery purchases.

Analyzing Dietary Behaviors Self-reported by People With Diabetes Using a Behavior Change Technique Taxonomy

OBJECTIVE

We aimed to explore both the dietary-related behavior change techniques (BCTs) adults with type 2 diabetes (T2D) described to enact themselves and the BCTs they perceived their dietitians to enact within consultations.

DESIGN

Qualitative study involving semistructured telephone interviews with adults who consulted with a dietitian after their T2D diagnosis. Participants shared their experience of dietary behavior change and interactions with dietitians.

SETTING

Telephone-based interviews from an Australian university setting.

PARTICIPANTS

Twenty-one adults (12 females and 9 males) aged 36-75 years were self-selected and invited by email.

PHENOMENON OF INTEREST

Dietary behavior changes reportedly enacted after a T2D diagnosis by participants and their dietitians.

ANALYSIS

Transcripts were analyzed through thematic content analysis according to the BCT taxonomy.

RESULTS

Participants described several BCTs such as problem-solving and self-monitoring (behavior), which helped their dietary behavior change. Participants perceived their dietitians to use BCTs, including goal setting (outcome), self-monitoring (behavior), and instruction on how to perform the behavior. These participants who had consulted with a dietitian reported additional techniques than those prescribed in the consultation process.

CONCLUSIONS AND IMPLICATIONS

Adults with T2D undertake a variety of BCTs to support dietary behavior change. Dietitians can draw on behavior change taxonomies to support behavior change in clients.

What happens to diet quality in people newly diagnosed with type 2 diabetes? The 3D case-series study

BACKGROUND

Diet quality plays an important role in the prevention of diabetes-related complications in people with type 2 diabetes mellitus (T2DM). However, evidence is scarce on how diet quality typically changes over time after diagnosis. The present study aimed to describe how the diet quality of individuals newly diagnosed with T2DM changes over a 12-month period and to identify factors associated with diet quality changes.

METHODS

A 12-month prospective, observational case-series study was undertaken. Two-hundred and twenty-five Australian adults (56% men) newly diagnosed with T2DM were recruited from the Diabetes Australia national database. Participants completed five interviewer-administered surveys over 12 months: baseline, 3, 6, 9 and 12 months. Demographic, physical and health characteristics, and dietary intake data were collected at each timepoint. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) scoring tool. To assess changes in DASH, energy, fruit and vegetable intake over time, repeated measure analyses of variance were used. Multivariate repeated measures models investigated characteristics associated with these dietary changes.

RESULTS

The mean DASH score of the sample remained stable at 24.0 across the 12 months. Very few participants (6.8%) improved diet quality consistently across the study period. No associations between DASH, energy, fruit or vegetable intake over time and characteristics were observed.

CONCLUSIONS

This observational study suggests that without dedicated interventions (the natural course), most people newly diagnosed with T2DM will not achieve meaningful diet quality change. The development of cost-effective interventions to achieve sustained diet quality change early after diagnosis are warranted.

AGP und Ernährung – Mit CGM postprandiale Glukoseverläufe analysieren

Ernährungstherapien zählen zu den Grundlagen eines effektiven Diabetesmanagements bei Menschen sowohl mit Typ-1-, als auch mit Typ-2-Diabetes. Auch für Menschen mit Prädiabetes oder Adipositas sind Lebensstilinterventionen, einschließlich Ernährungsempfehlungen, Bestandteil der grundlegenden Therapie. Es wird empfohlen, die Ernährung individuell an die persönlichen Umstände, Präferenzen und metabolischen Ziele anzupassen. Im Zeitalter der Digitalisierung finden mHealth-Interventionen, beispielsweise in Form von kontinuierlich Glukose messenden Systemen (CGM), vermehrt Einzug in die Ernährungstherapie. Das ambulante Glukoseprofil (AGP) zeigt eine strukturierte und grafische Zusammenstellung der durch CGM gewonnenen Daten. Nach einer Bewertung der glykämischen Situation (Hypoglykämien, Variabilität und Stabilität der Glukosewerte) kann das AGP auch als Unterstützung bezüglich einer Ernährungsanpassung dienen. Ziel dieser Publikation ist es, eine allgemeine Übersicht über die Ernährungsempfehlungen, speziell in Deutschland, zu ermöglichen und den Nutzen kontinuierlicher Glukosemessungen in Bezug auf Ernährung zu beschreiben.

AGP and Nutrition - Analysing postprandial glucose courses with CGM

Nutritional therapies are one of the fundamentals of effective management of diabetes type 1 and type 2. Lifestyle interventions, including nutritional recommendations, are also part of the basic therapy for people with prediabetes or obesity. It is recommended that the diet should be individually adapted to personal circumstances, preferences and metabolic goals. In the age of digitalisation, mHealth interventions, like continuous glucose monitoring systems (CGM), are increasingly finding their way into nutrition therapy. The ambulatory glucose profile (AGP), a structured and graphical compilation of the obtained CGM data, can also be used as a support for dietary adjustment. After assessment of the glycaemic situation (hypoglycaemia, variability and stability of glucose levels). This publication aims to provide a general overview of nutritional recommendations, especially in Germany, and to describe the benefits of CGM measurements with regard to nutrition.

A spotlight on the surfacing of self-management of employees with diabetes seen by professional nurses in selected occupational health clinics in Cape Town

Background

Diabetes is considered one of the largest global health challenges of this century and one of the top 10 causes of death across the world. Studies indicate an increased economic burden in relation to diabetes, not only on government revenue but also within private industries. Exploring the perceptions of employees with diabetes mellitus as related to their self-management practices could assist in encouraging behaviours that are associated with positive management outcomes.

Aim

The purpose of this study was to explore and describe the perceptions of employees with diabetes mellitus, seen by professional nurses in selected occupational health clinics, about the self-management of their disease.

Methods

A qualitative, exploratory, descriptive contextual design was followed through 17 individual interviews with 17 employees working in various industries in Cape Town, using a semi-structured interview schedule. Open coding of the data followed, and four themes emerged. Measures to ensure trustworthiness were also adhered to in the study, and approval for the study was granted.

Results

The study findings gave insight into the manner in which employees perceived their behaviour changes in terms of their self-management practices. Various emotions were expressed by employees relating to the disease as well as the lifestyle adaptations required for self-management thereof. Employees noted that knowledge acquisition and greater understanding of the motivators for lifestyle changes could improve aspects of their day-to-day living as well as the disease outcomes.

Conclusion

Employees expressed an awareness of the changes and lifestyle adaptations needed but found aspects thereof to be an ongoing challenge. The areas of challenge varied amongst employees. A consciousness of the possible consequences of poor self-management practices and self-modification behavior to address these was observed.

Dietary intake of adults with and without diabetes: results from NHANES 2013-2016

INTRODUCTION

Diet is a critical aspect of the management of adults with diabetes. This paper aims to compare dietary intakes of key macronutrients and micronutrients of US adults with and without diabetes and across the spectrum of diabetes.

RESEARCH DESIGN AND METHODS

We compared absolute and energy-adjusted dietary intake of major macronutrients and micronutrients among those with and without diabetes and across the spectrum of glycemic control using a 24-hour dietary recall from a cross-sectional, nationally representative sample of 9939 US adults, 20+ years old (National Health and Nutrition Examination Survey 2013-2016). Diabetes was defined as an glycohemoglobin A1c (HbA1c)≥6.5%, fasting glucose ≥126 mg/dL, serum glucose at 2 hours following a 75 g glucose load (oral glucose tolerance test) ≥200 mg/dL, any diagnosis of diabetes or use of diabetes medication (self-reported).

RESULTS

Percent of calories from macronutrients was similar for those with and without diabetes (p>0.05, energy adjusted and adjusted for age, race, and sex). In both groups, sugar accounted for about 20% of calories. Those with diabetes consumed about 7% more calcium (p=0.033), about 5% more sodium (p=0.026), and had lower diet quality (Healthy Eating Index-2015, p=0.021) than those without diabetes. Among those with diabetes, those with an HbA1c>9.0% consumed about 4% less magnesium (p-analysis of variance=0.007) than those with an HbA1c<6.5%. Results were similar within strata of age, race, and sex. Macronutrient intake did not vary consistently by HbA1c level.

CONCLUSIONS

In this nationally representative sample, there were no substantial or consistent differences in the dietary intake of macronutrients or micronutrients between US adults with and without diabetes. Improving the diets of those with diabetes will likely require enhanced targeted efforts to improve the dietary intake of persons with diabetes, as well as broad efforts to improve the dietary intake of the general population.

'I could have made those changes years earlier': experiences and characteristics associated with receiving a prediabetes diagnosis among individuals recently diagnosed with type 2 diabetes

BACKGROUND

Prediabetes increases the risk of developing type 2 diabetes (T2D). Improving diet quality is key in preventing this progression, yet little is known about the characteristics of individuals with prediabetes or the nutrition care they receive.

OBJECTIVES

This study aims to identify characteristics and experiences associated with receiving a prediabetes diagnosis prior to developing T2D.

METHODS

A mixed methods study encompassed a quantitative subanalysis of participants with newly diagnosed T2D from The 3D Study, and semi-structured telephone interviews with a subsample of participants who were previously diagnosed with prediabetes. Interviews were thematically analysed and survey data synthesized using SPSS statistical software.

RESULTS

Of the 225 study participants, 100 individuals were previously diagnosed with prediabetes and 120 participants were not. Those with prediabetes were less likely to be smokers (P = 0.022) and more likely to be satisfied with seeing a dietitian (P = 0.031) than those without a previous prediabetes diagnosis. A total of 20 participants completed semi-structured interviews. Thematic analysis revealed three themes: (i) experiencing a prediabetes diagnosis; (ii) receiving nutrition care during prediabetes and (iii) reflecting on the experience of receiving care for prediabetes versus T2D.

CONCLUSIONS

There are gaps in the current management of prediabetes in Australia. Low rates of prediabetes diagnosis and an ambiguous experience of receiving this diagnosis suggest an area of health service improvement. With no difference in diet quality between individuals with and without a previous prediabetes diagnosis, the nutrition care during prediabetes may be more important than the diagnosis itself in delaying the onset of T2D.

Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study

Background

Dietary intake impacts glycaemic control through its effect on weight and glucose-insulin homeostasis. Early glycaemic control is associated with improved outcomes and reduced mortality for people with type 2 diabetes (T2D). To date, the diet quality of people with T2D has only been studied cross-sectionally. The objective of this paper is to quantify short-term improvements in diet quality and to identify factors associated with improvements after T2D diagnosis among participants in the 3D study.

Methods

This paper presents data from the 3D study of 225 Australian adults, newly diagnosed with T2D. Telephone interviews collected demographic, diet, physical and health data at baseline and 3 months. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) tool to examine short-term changes in diet quality after diagnosis. Participants were categorised into two groups: those who improved their diet quality by 3 months (increase in DASH score of 3 or more) and those who did not. Factors associated with change in DASH scores were clinically and statistically evaluated.

Results

The 3D cohort was comparable to Australian cohorts with diabetes by gender and body mass index (BMI) but differed by age, remoteness and socioeconomic status. Mean (SD) baseline DASH score was 24.4 (4.7), in the midrange of possible scores between 8 and 40. One third of participants improved their DASH score by 3-months. This group had lower diet quality (p < 0.001), lower BMI (p = 0.045), higher physical activity levels (p = 0.028) and were less likely to smoke (p = 0.018) at baseline.

Conclusions

Diet quality changes after diagnosis do not appear to be associated with demographic characteristics but were associated with lifestyle behaviours. Strategies targeted at better supporting smokers, those with low physical activity and higher BMI are required. Future research should investigate how the diet quality changes people make around time of diagnosis are related to long-term health outcomes.

Dietary Intake and Type 2 Diabetes

This editorial aims to examine the risk factors associated with type 2 diabetes and to discuss the evidence relating to dietary strategies for managing people with this condition. It is clear from the evidence presented that a range of dietary interventions can provide useful approaches for managing people with type 2 diabetes, including the regulation of blood glucose and lipid parameters, and for reducing the risks of acute and chronic diabetic complications.

Microbial Population Changes and Their Relationship with Human Health and Disease

Specific microbial profiles and changes in intestinal microbiota have been widely demonstrated to be associated with the pathogenesis of a number of extra-intestinal (obesity and metabolic syndrome) and intestinal (inflammatory bowel disease) diseases as well as other metabolic disorders, such as non-alcoholic fatty liver disease and type 2 diabetes. Thus, maintaining a healthy gut ecosystem could aid in avoiding the early onset and development of these diseases. Furthermore, it is mandatory to evaluate the alterations in the microbiota associated with pathophysiological conditions and how to counteract them to restore intestinal homeostasis. This review highlights and critically discusses recent literature focused on identifying changes in and developing gut microbiota-targeted interventions (probiotics, prebiotics, diet, and fecal microbiota transplantation, among others) for the above-mentioned pathologies. We also discuss future directions and promising approaches to counteract unhealthy alterations in the gut microbiota. Altogether, we conclude that research in this field is currently in its infancy, which may be due to the large number of factors that can elicit such alterations, the variety of related pathologies, and the heterogeneity of the population involved. Further research on the effects of probiotics, prebiotics, or fecal transplantations on the composition of the human gut microbiome is necessary.