Abstract
BackgroundThere is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes.MethodsADDITION-Plus was a randomised controlled trial of a behaviour change intervention among 478 patients (40–69 years). Physical activity and diet were measured objectively (physical activity at 1 year) and by self-report at baseline and one year. Associations between baseline predictors and behaviour change were quantified using multivariable linear regression.ResultsParticipants increased their plasma vitamin C and fruit intake, reduced energy and fat intake from baseline to follow-up. Younger age, male sex, a smaller waist circumference, and a lower systolic blood pressure at baseline were associated with higher levels of objectively measured physical activity at one year. Greater increases in plasma vitamin C were observed in women (beta-coefficient [95% CI]: beta = −5.52 [−9.81, -1.22]) and in those with screen-detected diabetes (beta = 6.09 [1.74, 10.43]). Younger age predicted a greater reduction in fat (beta = −0.43 [−0.72, -0.13]) and energy intake (beta = −6.62 [−13.2, -0.05]). Patients with screen-detected diabetes (beta = 74.2 [27.92, 120.41]) reported a greater increase in fruit intake. There were no significant predictors of change in self-reported physical activity. Beliefs about behaviour change and diabetes did not predict behaviour change.ConclusionsOlder patients, men and those with a longer duration of diabetes may need more intensive support for dietary change. We recommend that future studies use objective measurement of health behaviours and that researchers add predictors beyond the individual level. Our results support a focus on establishing healthy lifestyle changes early in the diabetes disease trajectory.
Highlights
There is limited evidence about predictors of health behaviour change in people with type 2 diabetes
The diagnosis may have acted as a cue to adopt healthier behaviours over the year of our study, whereas patients with clinically diagnosed diabetes may have faced challenges to maintain any changes in behaviour made soon after diagnosis
Our results suggest that the Theory of Planned Behaviour (TPB) might not be a useful framework for predicting changes in health-related behaviours in individuals with recently diagnosed diabetes
Summary
There is limited evidence about predictors of health behaviour change in people with type 2 diabetes. The aim of this study was to assess change in health behaviours over one year and to identify predictors of behaviour change among adults with screen-detected and recently clinically diagnosed diabetes. There may be a window of opportunity to facilitate health behaviour change soon after diagnosis This may vary according to the time elapsed since diagnosis and whether patients are detected through screening or diagnosed in routine clinical practice [10]. Results from an RCT examining a brief self-management intervention to support patients with recently diagnosed diabetes (n = 180) to achieve sustained improvements in their exercise and diet showed that participants with a higher proactive competence (e.g. initiating health behaviours, dealing with potential barriers to goal-maintenance) at baseline reported greater self-management and improvement in exercise and diet at 12 months [11].
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