Abstract
BackgroundAlthough there are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking. This study aims to provide insight into the effective intervention pathways of the SLIMMER diabetes prevention intervention using mediation analyses.MethodsIn total, 240 participants at increased risk of T2DM were included in the analyses over 18 months. The intervention was a combined lifestyle intervention with a dietary and a physical activity (PA) component. The primary and secondary outcomes were change in fasting insulin (pmol/L) and change in body weight (kg) after 18 months, respectively. Firstly, in a multiple mediator model, we investigated whether significant changes in these outcomes were mediated by changes in dietary and PA behavior. Secondly, in multiple single mediator models, we investigated whether changes in dietary and PA behavior were mediated by changes in behavioral determinants and the participants’ psychological profile. The mediation analyses used linear regression models, where significance of indirect effects was calculated with bootstrapping.ResultsThe effect of the intervention on decreased fasting insulin was 40% mediated by change in dietary and PA behavior, where dietary behavior was an independent mediator of the association (34%). The effect of the intervention on decreased body weight was 20% mediated by change in dietary and PA behavior, where PA behavior was an independent mediator (17%). The intervention significantly changed intake of fruit, fat from bread spread, and fiber from bread. Change in fruit intake was mediated by change in action control (combination of consciousness, self-control, and effort), motivation, self-efficacy, intention, and skills. Change in fat intake was mediated by change in action control and psychological profile. No mediators could be identified for change in fiber intake. The change in PA behavior was mediated by change in action control, motivation, and psychological profile.ConclusionThe effect of the SLIMMER intervention on fasting insulin and body weight was mediated by changes in dietary and PA behavior, in distinct ways. These results indicate that changing dietary as well as PA behavior is important in T2DM prevention.
Highlights
There are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking
We firstly investigated whether the associations between the SLIM iMplementation Experience Region Noord- en Oost-Gelderland (SLIMMER) intervention and the outcomes were mediated by changes in dietary behavior and physical activity (PA) behavior
If mediation effects of dietary and/or PA behavior on fasting insulin could not be determined, we investigated whether these behavior changes showed an effect on decreased fasting insulin via decreased body weight
Summary
There are many effective lifestyle interventions for type 2 diabetes (T2DM) prevention, insight into effective intervention pathways, especially of long-term interventions, is often lacking. This study aims to provide insight into the effective intervention pathways of the SLIMMER diabetes prevention intervention using mediation analyses. Effective lifestyle interventions to prevent T2DM are available, little is known about the behaviors and determinants that mediate intervention effectiveness [2,3,4]. In order to identify effective targets for T2DM prevention programs that are promising in the long run, it is important to identify and report effective intervention pathways. Reviews and metaanalyses have resulted in an understanding that combined lifestyle interventions are often effective [5, 6], while mediation analyses can clarify causal pathways and determinants responsible for intervention success
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