Article

Behavioral strategies in diabetes prevention programs: A systematic review of randomized controlled trials

Boden Institute of Obesity, Nutrition and Exercise, Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.
Diabetes research and clinical practice (Impact Factor: 2.74). 01/2011; 91(1):1-12. DOI: 10.1016/j.diabres.2010.06.030
Source: PubMed

ABSTRACT The worldwide epidemic of type 2 diabetes (T2D) emphasizes the need for guidelines regarding community implementation of lifestyle modification prevention programs. An understanding of effective behavioral strategies is needed if evidence translation is to be realized. The aim of this paper is to systematically review the behavioral change strategies for lifestyle T2D prevention programs.
randomized controlled trials (RCTs) of lifestyle interventions for the prevention of T2D were reviewed with a systematic literature search. Data relating to the behavioral strategies and trial outcomes were extracted.
overall, lifestyle interventions were successful in reducing the incidence of T2D. The behavioral strategies utilized in these interventions were drawn from a variety of theoretical backgrounds. All RCTs utilized intensive modes of delivery and were associated with low dropout rates of 5.5-13.4%.
the available evidence shows that a robust behavioral change strategy is an essential part of an effective lifestyle modification program, as the absence of intensive individualized advice or "information only" more closely resembles the control group interventions used in these RCTs.

1 Bookmark
 · 
176 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study assessed the baseline knowledge, perceptions, attitudes and behaviors of prediabetes patients in order to tailor a new technology-enhanced primary care-based lifestyle modification intervention. Patients with a diagnosis of prediabetes were enrolled in a randomized, controlled pilot study, Avoiding Diabetes Thru Action Plan Targeting (ADAPT), a technology-based intervention to promote action plan discussions around patient-selected behavior change goals. A total of 54 adults (82% female) were enrolled in the pilot study. Most (89%) had comorbid conditions and mean BMI was 36. Participants exhibited high risk of diabetes knowledge (knowledge score 20 on a 32 point scale) and high levels of willingness to make changes to decrease diabetes risk. Number of daily steps was inversely correlated with perceived physical activity (r=-0.35082, p<0.001). Poorer scores on diet quality were inversely correlated with BMI. Participants in this sample demonstrated requisite levels of knowledge, self-efficacy, motivation and risk perception for effective behavior change. These data suggest that primary care-based prediabetes interventions can move beyond educational goals and focus on enhancing patients' ability to select, plan and enact action plans.
  • [Show abstract] [Hide abstract]
    ABSTRACT: A thorough understanding of the processes involved in lifestyle interventions is needed in order to close the gap between research and daily practice. This study explored the processes involved in the provision of a lifestyle intervention to patients with type 2 diabetes mellitus (T2DM) by health care professionals in primary care. Mixed methods. Health care professionals were asked to intensify lifestyle interventions for patients with T2DM in a routine care setting. Data were collected by serial interviews with health care professionals and patients, recorded consultations, an activity questionnaire and biomedical information. Qualitative data were analysed using a framework analysis with a phenomenological approach. The lifestyle intervention developed by the health care professionals included motivational interviewing, a nutrition and physical activity diary, and a multidisciplinary approach [physiotherapist, dietician, general practitioner and diabetes practice nurse (DPN)]. Participants and health care professionals were positive about the intervention, and patients were more active (P = 0.027), lost weight (P = 0.031) and had lower levels of glycated haemoglobin (P = 0.012). However, qualitative data showed that patients were passive during the consultation, and did not ask questions about ways to improve their lifestyle. DPNs did not use motivational interviewing optimally; provided patients with information that was difficult to understand; and were easily satisfied with the efforts of the patients. Lifestyle intervention for patients with T2DM is difficult in routine primary care. DPNs should adapt to the knowledge level of the patients, and patients must be stimulated to take an active role in their treatment. Patients and health care professionals should become equal partners in determining mutually agreeable treatment plans and goals. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
    Public Health 12/2014; 129(1). DOI:10.1016/j.puhe.2014.11.004 · 1.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Nutrition education (portion sizes, balanced meals) is a cornerstone of diabetes management; however, moving from information to behavior change is challenging. Through a single arm intervention study, we recently demonstrated that combining education with group-based meal preparation training has measureable effects on weight, eating behaviour, and glycemic control in adults with type 2 diabetes. In the present study, we conducted an in-depth examination of participants' perceptions of this strategy, through focus group discussion, to delineate effective elements of the strategy from participants' perspectives. Participants who had completed the nutrition education/meal preparation training program were invited to attend one of four focus group discussions. These were led by experienced facilitators and guided by questions addressing experiences during the intervention and their perceived impact. Audiotapes were transcribed and qualitative content analysis of transcripts was performed. We report herein themes that achieved saturation across the four discussions. Twenty-nine (80.6%, 29/36) attended a focus group discussion. The program elements perceived as effective by participants included the hands-on interactive learning approach to meal preparation, the grocery store tour, pedometer-based self-monitoring, experiencing the link between food consumption/physical activity and glucose changes during the program, and peer support. Discussants reported changes in eating and walking behaviour, greater confidence in ability to self-manage diabetes, reductions in glucose levels and/or need for glucose-lowering medications, and, in some cases, weight loss. Family members and friends were facilitators for some and barriers for others in terms of achieving health behavior changes. Among adults with type 2 diabetes, a group based program that included hands-on meal preparation and pedometer-based self-monitoring was perceived as effective in conveying information, developing skills, building confidence, and changing health behaviors.
    PLoS ONE 12/2014; 9(12):e114620. DOI:10.1371/journal.pone.0114620 · 3.53 Impact Factor

Full-text (3 Sources)

Download
42 Downloads
Available from
May 21, 2014