Abstract
BackgroundChanging diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c and body weight.MethodsWe performed a systematic review of papers published between 1975–2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA1c and body weight were meta-analysed and examined in relation to use of BCTs.ResultsThirteen RCTs were identified. Meta-analyses revealed reductions in HbA1c at 3, 6, 12 and 24 months of -1.11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall reduction of -0.53 % (6 mmol/mol [95 % CI -0.74 to -0.32, P < 0.00001]) in intervention groups compared to control groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, P = 0.002).Four of 46 BCTs identified were associated with >0.3 % reduction in HbA1c: ‘instruction on how to perform a behaviour’, ‘behavioural practice/rehearsal’, ‘demonstration of the behaviour’ and ‘action planning’, as were intervention features ‘supervised physical activity’, ‘group sessions’, ‘contact with an exercise physiologist’, ‘contact with an exercise physiologist and a dietitian’, ‘baseline HbA1c >8 %’ and interventions of greater frequency and intensity.ConclusionsDiet and physical activity interventions achieved clinically significant reductions in HbA1c at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes.
Highlights
Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging
Type 2 diabetes is diagnosed based on a fasting plasma glucose (FPG ≥126 mg/dL [7 mmol/L]) or the two hour plasma glucose value following a 75 g oral glucose tolerance test (>200 mg/DL [11.0 mmol/L]) or having a HbA1c of ≥ 6.5 % according to the American Diabetes Association (ADA) [4]
Body weight was reported as a secondary outcome
Summary
Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c and body weight. Glycosylated haemoglobin A1c (HbA1c haemoglobin to which glucose is bound, is tested to determine average blood glucose level over the past two to three months) [1] is widely regarded as an accurate measurement for diabetes assessment and the ADA recommend that HbA1c testing be performed on all patients with diabetes at initial diagnosis and as part of continuing treatment [4]. HbA1c was selected as the primary outcome for this review as it represents the most widely used measure of type 2 diabetes control and treatment efficacy
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