Abstract
BackgroundThe management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours.MethodsThis study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014–2016. Content analysis of the text and descriptive statistics were used to analyse the data.ResultsOne hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood.ConclusionsThe data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement.Trial registrationANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true
Highlights
The management of prediabetes in the community setting is a global priority
Prediabetes is a condition that indicates a sustained level of hyperglycaemia that is lower than the threshold for type 2 diabetes mellitus (T2DM)
Inclusion criteria were non-pregnant adults aged 70 years or less, newly diagnosed with prediabetes, classified as overweight or obese (≥25 kg/m2), able to communicate in English and not prescribed Metformin, an oral medication commonly used to lower blood sugar levels
Summary
The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. In New Zealand and the US where glycated haemoglobin (HbA1c) is used, the prevalence of prediabetes among the adult population is around 25% [1,2,3]. Of those with prediabetes, each year an estimated 5–10% develop T2DM [4, 5] with the majority eventually developing the condition, those who are overweight or obese [6]. The diagnosis of prediabetes presents an opportunity to make lifestyle changes, including weight loss, to achieve regression to normoglycaemia [7]. In addition to the issues of the provision of evidence-based nutritional advice are the multifaceted issues around behaviour change and the ability to uptake lifestyle advice
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