Diet Behavior Change Techniques in Type 2 Diabetes: A Systematic Review and Meta-analysis.

Kevin A Cradock, Gearóid ÓLaighin, Francis M Finucane, Rhyann McKay, Leo R Quinlan, Kathleen A Martin Ginis, Heather L Gainforth

Journal: Diabetes care 2018;40(12):1800-1810

PMID: 29162585

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Plain Language Summary

Dietary behaviour is intrinsically linked to type 2 diabetes. Dietary factors have been linked to the highest proportion of deaths in type 2 diabetes, stroke, and heart disease. Identifying effective ways to help suffers successfully change to more effective dietary behaviours may help condition management and reduce disease progression. The objective of the systemic review and meta-analysis was to identify dietary behaviour change techniques, intervention features, and specific diets associated with changes in blood glucose levels (HbA1c) and body weight in type 2 diabetes. It included 54 studies, all of whose participants have type 2 diabetes. High-protein diets and meal replacement programs produced the greatest reductions in blood glucose (measured by HbA1c). Behavioural change techniques including 'problem solving,' 'feedback on behaviour,' 'adding objects to the environment' and 'social comparison' as well as interventions that were build on behavioural change theory were associated with clinically significant reductions in blood glucose as measured by HbA1c (a reduction of ≥0.3% (3.3 mmol/mol). However, the findings show that changing or controlling (e.g. providing all food) dietary environmental factors may be more effective than strategies to change dietary behaviour to reduce blood glucose levels in adults with type 2 diabetes. The authors conclude that changing the dietary environment may be more important than focusing on dietary behaviour in type 2 diabetes treatment.

Abstract

OBJECTIVE

Dietary behavior is closely connected to type 2 diabetes. The purpose of this meta-analysis was to identify behavior change techniques (BCTs) and specific components of dietary interventions for patients with type 2 diabetes associated with changes in HbA and body weight.

RESEARCH DESIGN AND METHODS

The Cochrane Library, CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched. Reports of randomized controlled trials published during 1975-2017 that focused on changing dietary behavior were selected, and methodological rigor, use of BCTs, and fidelity and intervention features were evaluated.

RESULTS

In total, 54 studies were included, with 42 different BCTs applied and an average of 7 BCTs used per study. Four BCTs-"problem solving," "feedback on behavior," "adding objects to the environment," and "social comparison"-and the intervention feature "use of theory" were associated with >0.3% (3.3 mmol/mol) reduction in HbA. Meta-analysis revealed that studies that aimed to control or change the environment showed a greater reduction in HbA of 0.5% (5.5 mmol/mol) (95% CI -0.65, -0.34), compared with 0.32% (3.5 mmol/mol) (95% CI -0.40, -0.23) for studies that aimed to change behavior. Limitations of our study were the heterogeneity of dietary interventions and poor quality of reporting of BCTs.

CONCLUSIONS

This study provides evidence that changing the dietary environment may have more of an effect on HbA in adults with type 2 diabetes than changing dietary behavior. Diet interventions achieved clinically significant reductions in HbA, although initial reductions in body weight diminished over time. If appropriate BCTs and theory are applied, dietary interventions may result in better glucose control.

Address: Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland.; Electrical & Electronic Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.; Science Foundation of Ireland Centre for Research in Medical Devices (CÚRAM), Galway, Ireland.; Bariatric Medicine Service, Galway Diabetes Research Centre, Health Research Board Clinical Research Facility, Galway, Ireland.; School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada.; Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland [email protected].

DOI: 10.2337/dc17-0462