Improving diet, activity and wellness in adults at risk of diabetes: randomized controlled trial

Abstract

Objective:The purpose of this analysis is to examine the effect of an algorithm-driven online diabetes prevention program on changes in eating habits, physical activity and wellness/productivity factors.Methods:The intervention, Alive-PD, used small-step individually tailored goal setting and other features to promote changes in diet and physical activity. A 6-month randomized controlled trial was conducted among patients from a healthcare delivery system who had confirmed prediabetes (n =339). Change in weight and glycemic markers were measured in the clinic. Changes in physical activity, diet and wellness/productivity factors were self-reported. Mean age was 55 (s.d. 8.9) years, mean body mass index was 31 (s.d. 4.4) kg m−2, 68% were white and 69% were male.Results:The intervention group increased fruit/vegetable consumption by 3.71 (95% confidence interval (CI) 2.73, 4.70) times per week (effect size 0.62), and decreased refined carbohydrates by 3.77 (95% CI 3.10, 4.44) times per week both significantly (P<0.001) greater changes than in the control group. The intervention group also reported a significantly greater increase in physical activity than in the control group, effect size 0.49, P<0.001. In addition, the intervention group reported a significant increase in self-rated health, in confidence in ability to make dietary changes and in ability to accomplish tasks, and a decrease in fatigue, compared with the control group. These changes paralleled the significant treatment effects on glycemic markers and weight.Conclusions:In addition to promoting improvements in weight and glycemic markers, the Alive-PD program appears to improve eating habits and physical activity, behaviors important not just for diabetes prevention but for those with diagnosed diabetes or obesity. The improvements in wellness/productivity may derive from the diet and activity improvements, and from the satisfaction and self-efficacy of achieving goals.

Influences of added sugar consumption in adults with type 2 diabetes risk: A principle‐based concept analysis

“…This analysis found that several studies used added sugar proxies (eg, HFCS, SSB, sucrose) as a way to examine added sugar's impact on T2D risk . Other studies examining added sugars effect on T2D risk did not distinguish added sugar proxies as actual added sugar‐containing products (eg, sweets, HFCS) and alternatively referred to these products as simply, dietary sugars . Several review articles compared and contrasted sugar sources (eg, fructose sugars, total sugars, HFCS, sucrose, SSB) in the context of T2D risk, but did not refer to these sugars as “added” sugar sources limiting the conceptual clarity of the concept …”

“…The concept of added sugar and its relationship to the development of T2D risk is of interest and applicable to the field of nursing. Added sugar is reliably operationalized by use of dietary questionnaires like food diaries, food-frequency, beverage intake, and food habit questionnaires, or dietary interviews, daily collection records, or recalls, 12,14,25,28,29,32,40,41,43,44,46,[49][50][51][52] however, the validity of these methods varies by whether dietary intake is self-reported or calculated from controlled feeding trials. 11,38 Specifically, dietary self-report is associated with intentional misreporting; typically, under-reporting of dietary intake.…”

“…12,14,25,28,32,41,46,51 Other studies examining added sugars effect on T2D risk did not distinguish added sugar proxies as actual added sugar-containing products (eg, sweets, HFCS) and alternatively referred to these products as simply, dietary sugars. 29,44,49,50,52 Several review articles compared and contrasted sugar sources (eg, fructose sugars, total sugars, HFCS, sucrose, SSB) in the context of T2D risk, but did not refer to these sugars as "added" sugar sources limiting the conceptual clarity of the concept. 10,11,30,33,35,38,47 Researchers studying added sugar linked T2D risk with concepts like energy imbalance from dietary over-consumption and body weight.…”

Impact on dietary intake of a self-directed, gender-tailored diabetes prevention program in men

“…Miller et al[ 12 ] reported significant within group improvements in overall diet quality scores (+4.6, P < 0.01) measured using the Alternative Healthy Eating Index following a 4-mo group-based diabetes prevention program. In another study, Block et al[ 11 ] reported changes in food habits associated with higher diet quality, such as significant changes in the consumption frequency of fruits and vegetables (increases) and sweets and refined carbohydrate foods (decreases) found among those with prediabetes who received a 6-mo automated web-based diabetes prevention program.…”

“…Specific dietary changes following the diabetes prevention programs have included a reduction in total energy intake and favourable shifts in macronutrient composition ( e.g ., reduction in total and saturated fat intake)[ 9 ]. Only recently have changes in diet quality or amounts of foods (as opposed to energy or nutrients) been reported both immediately following completion of the intervention[ 11 , 12 ], as well as over the long-term for periods of 5-10 years later[ 13 , 14 ]. To date, no studies have reported the effect on diet of a diabetes prevention program tailored for men.…”