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

Comparing the effects of time-restricted eating on glycaemic control in people with type 2 diabetes with standard dietetic practice: A randomised controlled trial

AIMS

To test the efficacy of time-restricted eating (TRE) in comparison to dietitian-led individualised dietary guidance to improve HbA1c in people with Type 2 diabetes mellitus.

METHODS

In a parallel groups design, 51 adults (35-65 y) with Type 2 diabetes mellitus and overweight/obesity (HbA1c ≥6.5% (48 mmol/mol), BMI ≥25-≤40 kg/m2) commenced a six-month intervention. Following baseline, participants were randomised to TRE (1000-1900 h) or DIET (individualised dietetic guidance) with four consultations over four months. Changes in HbA1c (primary), body composition, and self-reported adherence (secondary) were analysed using linear mixed models. A non-inferiority margin of 0.3% (4 mmol/mol) HbA1c was set a priori.

RESULTS

Forty-three participants (56 ± 8 y, BMI: 33 ± 5 kg/m2, HbA1c: 7.6 ± 0.8%) completed the intervention. HbA1c was reduced (P=0.002; TRE: -0.4% (-5 mmol/mol), DIET: -0.3% (-4 mmol/mol)) with no group or interaction effects; TRE was non-inferior to DIET (-0.11%, 95%CI: -0.50% to 0.28%). Body mass reduced in both groups (TRE: -1.7 kg; DIET: -1.2 kg) via ∼900 kJ/d spontaneous energy reduction (P<0.001). Self-reported adherence was higher in TRE versus DIET (P<0.001).

CONCLUSIONS

When individualised dietary guidance is not available, effective, and/or suitable, TRE may be an alternative dietary strategy to improve glycaemic control in people with Type 2 diabetes mellitus.

Exploring the thoughts, emotions, and behaviours related to the self-management practices of adults with type 2 diabetes

This qualitative research study explored the thoughts, emotions, and behaviours of adults aged between 35 and 45 who managed their type 2 diabetes effectively and adults who struggled with diabetes self-management in a South African setting. Semi-structured interviews were conducted with 17 adults who engaged in either successful self-management or who struggled with self-management. Effective management was characterised by an HbA1c level of 8% or lower. This group comprised of nine individuals. The participants who faced challenges with self-management had HbA1c levels ranging between 10% and 14%. This group consisted of eight participants. The data were analysed using inductive thematic analysis, and four main themes were identified: the emotional experience, prominent cognitions, practising acceptance and the mechanisms of behavioural change. These themes identified key determinants of individuals' self-management practices and can contribute to providing information for future cognitive behaviour therapy interventions to be developed that target specific components to improve self-management practices.

Qualitative evaluation of a Salutogenic Healthy Eating Programme for Dutch people with type 2 diabetes

The salutogenic model of health (SMH) is a health-promoting theory that focuses on resources, strengths, and coping capacities in everyday life as a way to improve health and wellbeing. The SMH was applied to develop a programme for enabling healthy eating practices among people with type 2 diabetes mellitus (T2DM): the SALUD programme. This study aims to gain insight in how participants with T2DM experienced the content and meaning of the SALUD programme. Three focus groups with participants (six to eight participants/group) that finished the SALUD programme were conducted. The focus groups were video-recorded, transcribed ad verbatim and thematically analysed. The SALUD programme was perceived by the participants as a positive, meaningful learning experience. Key factors why the participants described the programme as positive were that they felt a sense of social-belonging and (emotionally) safe (theme 1). The SALUD programme's positive encouraging approach presented by the coach invited participants to join an active learning process (theme 2). Performing trial-and-error experiments and weekly reflecting on goals is what characterized active learning. The meaningfulness of the learning process (theme 3) was derived from (i) positive self-confrontation; (ii) exploring mind-body connections and perceiving improved health and (iii) noticing positive changes in their social environment (theme 3). To conclude, the study uncovered that the SALUD programme incited a positive, meaningful learning process for healthy eating and the contextual factors important in this. Potential leads to further improve the SALUD programme are discussed in order to maximize the chance of inciting an inclusive, active learning process.