The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study

Abstract

BackgroundPrimary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes.MethodsThis study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Māori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m2 and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2–3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used.ResultsOne hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Māori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses.ConclusionsStudy findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation.Trial RegistrationANZCTR ACTRN12615000806561. Registered 3 August 2015 (Retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0671-8) contains supplementary material, which is available to authorized users.

Making dietary changes following a diagnosis of prediabetes: a qualitative exploration of barriers and facilitators

“…This paper reports research in New Zealand that examined making dietary changes among people with recently diagnosed prediabetes who had participated in a six‐month primary care‐based dietary intervention pilot study, the Prediabetes Intervention Package (PIP) . In brief, the purpose of the intervention was to provide participants and their whānau (family group) with an understanding of the principles of healthy eating to empower them to make healthy dietary choices.…”

“…However, research on factors affecting the ability to adopt protective dietary behaviours following lifestyle advice to prevent disease progression among those with prediabetes is limited, and a gap exists in understanding the barriers to making positive dietary changes among this group [5,6]. This paper reports research in New Zealand that examined making dietary changes among people with recently diagnosed prediabetes who had participated in a six-month primary care-based dietary intervention pilot study, the Prediabetes Intervention Package (PIP) [7]. In brief, the purpose of the intervention was to provide participants and their wh anau (family group) with an understanding of the principles of healthy eating to empower them to make healthy dietary choices.…”

What predicts regression from pre-diabetes to normal glucose regulation following a primary care nurse-delivered dietary intervention? A study protocol for a prospective cohort study

“…The PIP was designed in collaboration with the Health Hawke’s Bay PHO 48. The intervention was first pre-tested with members of the public, then primary care nurses reviewed and contributed to the implementation and research protocols at a meeting.…”

“…The primary care-based Pre-diabetes Intervention Package (PIP) is a feasible primary care nurse-delivered 6-month pre-diabetes lifestyle intervention with a focus on diet, sociocultural context and goal setting, for overweight and obese patients with pre-diabetes 48. In this pragmatic mixed-methods non-randomised pilot study conducted in the Hawke’s Bay region, New Zealand (NZ), intervention implementation fidelity was high and after adjustment, the intervention group lost a mean 1.3 kg more than the control group (p<0.0.001).…”

A multifaceted approach for management of prediabetes and its associated cardiovascular risk

“…Patient education and counselling on the importance of therapeutic lifestyle changes and long‐term adherence is paramount. In a pilot study, primary care nurse‐led interventions based on improving lifestyle choices resulted in significant weight loss and modest improvement in HbA1c 13 . Wearable devices that prompt users to become more physically active or track their food intake may also have a role in reducing the incidence of prediabetes 14 .…”