Introduction

Objective To evaluate the impact of a worksite diabetes prevention intervention on secondary outcomes regarding the change in diet quality and components of the Health Action Process Approach (HAPA) theoretical framework Design Pretest-posttest control group design with 3-month follow-up Setting University worksite Participants Employees 18–65 years old with prediabetes (n=68) Intervention 16-week group-based intervention adapted from the Diabetes Prevention Program Main Outcome Measures Diet quality was assessed using the Alternative Healthy Eating Index (AHEI) 2010; HAPA components were assessed via written questionnaire Analysis Repeated measures analysis of variance compared the between- and within-group change in outcomes across time. Results Significant difference occurred between-groups for the change in consumption of nuts/legumes and red/processed meats post-intervention and for fruits at 3-month follow-up (all P<.05); a significant increase in total AHEI score occurred post-intervention in the experimental group (P=.002). The changes in action planning, action self-efficacy, and coping self-efficacy from HAPA were significantly different between groups following the intervention; the change in outcome expectancies was significantly different between groups at 3-month follow-up (all P<.05). Conclusions and Implications The worksite intervention facilitated improvement in diet quality and in planning and efficacious beliefs regarding diabetes prevention. Further research is needed to evaluate the long-term impact of the intervention.

Background People with prediabetes are at increased risk for developing type 2 diabetes. Weight reduction through lifestyle modification can significantly reduce diabetes risk. Yet, weight loss varies among individuals and some people do not achieve clinically meaningful weight loss following treatment. Objective Evaluate the timepoint and threshold for achieving ≥ 5% weight loss following completion of a 16-week worksite, lifestyle intervention for diabetes prevention. Design Weight change before and after the behavioral intervention among participants randomized to the experimental group was examined. Participants/setting Individuals with prediabetes aged 18–65 years with a body mass index of 25–50 kg/m2 at Ohio State University were eligible. Intervention The 16-week, group-based intervention, adapted from the Diabetes Prevention Program, was delivered to 32 participants in the experimental group. Main outcome measures Percent weight loss was assessed weekly during the intervention and at 4- and 7-month follow-up. Statistical analyses performed Linear regression modeled the relationship between percent weight loss during month 1 of the intervention and percent weight loss at 4 and 7 months. Logistic regression modeled failure to lose ≥ 5% weight loss at 4 and 7 months using weekly weight change during the first month of intervention. Results Percent weight loss at intervention week 5 was significantly associated with percent weight loss at 4 and 7 months (all P<0.001). Only 11.1% and 12.5% of participants who failed to achieve a 2.5% weight loss threshold during month 1 achieved ≥ 5% weight loss at months 4 and 7, respectively. Conclusions The first month of lifestyle treatment is a critical period for helping participants achieve weight loss. Otherwise, individuals who fail to achieve at least 2.5% weight loss may benefit from more intensive rescue efforts or stepped care interventions. Trial Registration ClinicalTrials.gov identifier: NCT01682954

Goal setting is an integral component of nutritional counseling. Lower glycemic index (GI) diets can improve outcomes among adults with type 2 diabetes mellitus. Intraindividual variability in intake occurs during goal pursuit and could be captured through mobile ecological momentary assessment (EMA) to develop algorithms for personalized medical nutrition therapy. EMA assessed goal progress toward a lower GI diet among adults with type 2 diabetes mellitus using an n-of-1 design. Mean (standard deviation) intake of low GI foods increased by 1.2 (0.1) servings for all participants combined. Three participants met or exceeded their GI goal repeatedly based on EMA reports. Mobile technology through EMA holds promise for the field of personalized medical nutrition therapy.

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