Abstract
Background and Aims: An appropriate diet is an essential component of the management of Type 2 Diabetes Mellitus (T2DM). However, for many people with T2DM, self-management is difficult. Therefore, the Beyond Good Intentions (BGI) education program was developed based on self-regulation and proactive coping theories to enhance people's capabilities for self-management. The aim of this study was to determine the effectiveness of the BGI program on improving dietary quality among a preselected group of people with T2DM after two-and-a-half years follow-up.Methods: In this randomized controlled trial, 108 people with T2DM were randomized (1:1) to the intervention (n = 56) (BGI-program) or control group (n = 52) (care as usual). Linear regression analyses were used to determine the effect of the BGI program on change in dietary quality between baseline and two-and-a-half years follow-up. In addition, potential effect modification by having a nutritional goal at baseline was evaluated. Multiple imputation (n = 15 imputations) was performed to account for potential bias due to missing data.Results: According to intention-to-treat analysis, participants in the intervention group showed greater improvements in dietary quality score than participants in the control group (β = 0.71; 95%CI: 0.09; 1.33) after follow-up. Having a nutritional goal at baseline had a moderating effect on the effectiveness of the BGI program on dietary quality (p-interaction = 0.01), and stratified results showed that the favorable effect of the intervention on dietary quality was stronger for participants without a nutritional goal at baseline (no nutritional goal: β = 1.46; 95%CI: 0.65; 2.27 vs. nutritional goal: β = −0.24; 95%CI: −1.17; 0.69).Conclusions: The BGI program was significantly effective in improving dietary quality among preselected people with T2DM compared to care as usual. This effect was stronger among participants without a nutritional goal at baseline. A possible explanation for this finding is that persons with a nutritional goal at baseline already started improving their dietary intake before the start of the BGI program. Future studies are needed to elucidate the moderating role of goalsetting on the effectiveness of the BGI program.
Highlights
Type 2 Diabetes Mellitus (T2DM) and its complications largely contribute to the global disease burden, making T2DM one of the leading causes of global deaths [1]
The dietary quality score (DQS) at baseline was comparable between the intervention and control group [intervention: 12.8 (± 1.7); control: 12.9 (± 2.0)]
The control group had a larger percentage of participants that were male, married, and currently employed
Summary
Type 2 Diabetes Mellitus (T2DM) and its complications largely contribute to the global disease burden, making T2DM one of the leading causes of global deaths [1]. The main drivers in the global T2DM epidemic are lifestyle related factors, including obesity, a sedentary lifestyle, and an unfavorable diet [1]. This highlights the importance of managing T2DM and prevent or delay complications, which can be achieved through good cardiometabolic control [3]. Good cardiometabolic control in T2DM can be accomplished by pharmacological treatment and/or lifestyle modification, with improving physical activity levels and dietary quality as main components [3]. An important element in achieving good cardiometabolic control is the self-management of people with T2DM [6]. The aim of this study was to determine the effectiveness of the BGI program on improving dietary quality among a preselected group of people with T2DM after two-and-a-half years follow-up
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