Plain language summary
There is an increasing prevalence of type 2 diabetes (T2D) in Malaysia, which has led to the adoption of the global trans-cultural diabetes nutrition algorithm (tDNA), to better manage patients with T2D. Eating self-efficacy is the confidence an individual has to perform specific tasks and attain certain goals in challenging situations. This secondary analysis of a randomised control trial of 230 obese or T2D patients, aimed to determine the changes in eating self-efficacy when on tDNA over 12 months. The results showed improved eating self-efficacy with tDNA, which was further improved if individuals received both tDNA and motivational counselling. There was also greater weight loss and improvements to measures of diabetes in individuals who had a higher eating self-efficacy. However, it should be noted that nearly 18% of people dropped out of the trial. It was concluded that eating self-efficacy was improved in patients who followed a structured lifestyle intervention, and this also translated into greater weight loss and better improvements to diabetes. Health care professionals could use this study to understand that eating self-efficacy is an important behavioural component to care of patients with T2D and that structured lifestyle interventions may be more effective.
Abstract
OBJECTIVE Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA). METHODS Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months' post-intervention. RESULTS There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p<0.001]. Compared to baseline, WEL scores improved in both the tDNA groups with significantly higher improvement in the tDNA-MI group compared to the tDNA-CC and UC groups at 6 months (tDNA-MI: 25.4±2.1 vs. tDNA-CC: 12.9±2.8 vs. UC: -6.9±1.9, p<0.001). At 12 months' follow-up, both the tDNA groups maintained improvement in the WEL scores, with significantly higher scores in the tDNA-MI group than tDNA-CC group, and the UC group had decreased WEL scores (tDNA-MI: 28.9±3.1 vs. tDNA-CC: 11.6±3.6 vs. UC: -13.2±2.1, p<0.001). Patients in the tDNA-MI group with greater weight loss and hemoglobin A1C reduction also had a higher eating self-efficacy, with a similar trend observed in comparative groups. CONCLUSION Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing. CLINICAL TRIAL This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.
Methodological quality
Jadad score
:
3
Allocation concealment
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No
