Diet Quality and Glycemic Control in Patients with Type 2 Diabetes

Antonio, Juliana Peçanha; Sarmento, Roberta Aguiar; Almeida, J. C.

doi:10.1016/j.jand.2018.11.006

Cited by 31 publications

(28 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the current study, those who did not improve their diet quality by 3 months were more likely to be current smokers than those who did improve their diet quality (p = 0.018). Similarly, a 2019 cross-sectional study of 229 people diagnosed with T2D in Brazil found that those with a lower diet quality (measured by the Healthy Eating Index score) were more likely to be current smokers than those with a higher diet quality 34 . These results suggest that individuals newly diagnosed with T2D who smoke may need extra support from healthcare professionals during patient education to improve diet quality.…”

Section: Discussionmentioning

confidence: 98%

Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study

et al. 2020

View full text Add to dashboard Cite

Background: Dietary intake impacts glycaemic control through its effect on weight and glucose-insulin homeostasis. Early glycaemic control is associated with improved outcomes and reduced mortality for people with type 2 diabetes (T2D). To date, the diet quality of people with T2D has only been studied cross-sectionally. The objective of this paper is to quantify short-term improvements in diet quality and to identify factors associated with improvements after T2D diagnosis among participants in the 3D study. Methods: This paper presents data from the 3D study of 225 Australian adults, newly diagnosed with T2D. Telephone interviews collected demographic, diet, physical and health data at baseline and 3 months. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) tool to examine short-term changes in diet quality after diagnosis. Participants were categorised into two groups: those who improved their diet quality by 3 months (increase in DASH score of 3 or more) and those who did not. Factors associated with change in DASH scores were clinically and statistically evaluated. Results: The 3D cohort was comparable to Australian cohorts with diabetes by gender and body mass index (BMI) but differed by age, remoteness and socioeconomic status. Mean (SD) baseline DASH score was 24.4 (4.7), in the midrange of possible scores between 8 and 40. One third of participants improved their DASH score by 3-months. This group had lower diet quality (p < 0.001), lower BMI (p = 0.045), higher physical activity levels (p = 0.028) and were less likely to smoke (p = 0.018) at baseline. Conclusions: Diet quality changes after diagnosis do not appear to be associated with demographic characteristics but were associated with lifestyle behaviours. Strategies targeted at better supporting smokers, those with low physical activity and higher BMI are required. Future research should investigate how the diet quality changes people make around time of diagnosis are related to long-term health outcomes.

show abstract

Section: Discussionmentioning

confidence: 98%

Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Over the longer-term, maintenance of a healthier dietary pattern can improve health and reduce diabetes-related healthcare expenditures [7][8][9][10][11][12][13][14][15]61].…”

Section: Discussionmentioning

confidence: 99%

“…The human toll on individuals and their families is also substantial in terms of reduced quality of life associated with managing the disease [5,6]. Many of these human and economic costs are avoidable, as adherence to a healthy diet within an overall diabetes management plan can yield clinically meaningful improvements in blood glucose levels, which can reduce diabetes complications over time [7][8][9][10][11][12][13][14][15]. Average blood glucose levels are most often quanti ed using the glycosylated hemoglobin level (A1C), which represents the average blood sugar level over the previous 3 months [16].…”

Section: Introductionmentioning

confidence: 99%

A Subsidized Healthy Food Prescription Program for Adults with type 2 Diabetes who are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial, Modelling and Implementation Studies

Olstad

Beall

Spackman

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: The high cost of many healthy foods poses a significant challenge to the maintenance of optimal blood glucose levels for adults with type 2 diabetes (T2DM) who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Subsidized healthy food prescription programs may help to reduce food insecurity by financially supporting patients to improve their diet quality, prevent diabetes complications and avoid acute care use. This study will use a type 2 hybrid effectiveness-implementation design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a subsidized healthy food prescription program for adults who are experiencing food insecurity and persistent hyperglycemia. A randomized controlled trial (RCT) will investigate program effectiveness via impact on blood glucose levels (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term program effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains, including reasons behind program successes and failures, fidelity, mechanisms of impact, contextual determinants of effective implementation and sustainability. Methods: 404 adults who are experiencing food insecurity and persistent hyperglycemia, including adults who identify as Indigenous, will be randomized to a subsidized healthy food prescription intervention (n=202) or a healthy food prescription comparison group (n=202). Both groups will receive a healthy food prescription. The intervention group will additionally receive $1.50/day/household member to purchase healthy foods in supermarkets for 6 months. The implementation process will follow the Quality Implementation Framework. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analyzed using mixed-effects linear and multinomial logistic/ordinal regression models. Longer-term outcomes will be modelled using the validated UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data and analyzed using descriptive statistics and theory-informed directed content analysis, respectively. Discussion: This research will provide a comprehensive body of data with high internal and external validity to assist policymakers and practitioners to effectively and rapidly translate the evidence generated into programs and policies to support patients with T2DM who are experiencing food insecurity. Trial registration: ClinicalTrials.gov NCT04725630 (January 25, 2021; https://www.clinicaltrials.gov/ct2/show/NCT04725630?term=Subsidized+Healthy+Food+Prescription+Program&cond=Diabetes+Mellitus%2C+Type+2&draw=2&rank=1).

show abstract

“…Process-based incentives focus on motivating near-term behaviors associated with optimal glycemic control, such as self-monitoring of blood glucose, with the underlying idea that incentivizing these behaviors can overcome people’s present bias [ 24 , 25 ]. However, the challenge with this approach is that individuals could engage in only a subset of behaviors such that overall glycemic control is not effectively improved [ 26 ]. An alternative approach is to focus on near-term health outcomes, such as having glucose readings within the acceptable range.…”

Section: Introductionmentioning

confidence: 99%

Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial

Bilger

Mitesh

Tan

et al. 2021

Patient

View full text Add to dashboard Cite

Background Sub-optimally controlled diabetes increases risks for adverse and costly complications. Self-management including glucose monitoring, medication adherence, and exercise are key for optimal glycemic control, yet, poor self-management remains common. Objective The main objective of the Trial to Incentivize Adherence for Diabetes (TRIAD) study was to determine the effectiveness of financial incentives in improving glycemic control among type 2 diabetes patients in Singapore, and to test whether process-based incentives tied to glucose monitoring, medication adherence, and physical activity are more effective than outcome-based incentives tied to achieving normal glucose readings. Methods TRIAD is a randomized, controlled, multi-center superiority trial. A total of 240 participants who had at least one recent glycated hemoglobin (HbA1c) being 8.0% or more and on oral diabetes medication were recruited from two polyclinics. They were block-randomized (blocking factor: current vs. new glucometer users) into the usual care plus (UC +) arm, process-based incentive arm, and outcome-based incentive arm in a 2:3:3 ratio. The primary outcome was the mean change in HbA1c at month 6 and was linearly regressed on binary variables indicating the intervention arms, baseline HbA1c levels, a binary variable indicating titration change, and other baseline characteristics.Results Our findings show that the combined incentive arms trended toward better HbA1c than UC + , but the difference is estimated with great uncertainty (difference − 0.31; 95% confidence interval [CI] − 0.67 to 0.06). Lending credibility to this result, the proportion of participants who reduced their HbA1c is higher in the combined incentive arms relative to UC + (0.18; 95% CI 0.04, 0.31). We found a small improvement in process-relative to outcome-based incentives, but this was again estimated with great uncertainty (difference − 0.05; 95% CI − 0.42 to 0.31). Consistent with this improvement, processbased incentives were more effective at improving weekly medication adherent days (0.64; 95% CI − 0.04 to 1.32), weekly physically active days (1.37; 95% CI 0.60-2.13), and quality of life (0.04; 95% CI 0.0-0.07) than outcome-based incentives. Conclusion This study suggests that both incentive types may be part of a successful self-management strategy. Processbased incentives can improve adherence to intermediary outcomes, while outcome-based incentives focus on glycemic control and are simpler to administer.

show abstract

Diet Quality and Glycemic Control in Patients with Type 2 Diabetes

Cited by 31 publications

References 24 publications

Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study

Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study

A Subsidized Healthy Food Prescription Program for Adults with type 2 Diabetes who are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial, Modelling and Implementation Studies

Process- and Outcome-Based Financial Incentives to Improve Self-Management and Glycemic Control in People with Type 2 Diabetes in Singapore: A Randomized Controlled Trial

Contact Info

Product

Resources

About