Effectiveness of a Lifestyle Intervention in Patients with Type 2 Diabetes: The Physical Activity and Nutrition for Diabetes in Alberta (PANDA) Trial

Ghada Asaad, Diana C Soria-Contreras, Rhonda C Bell, Catherine B Chan, Ghada Asaad, Diana C Soria-Contreras, Rhonda C Bell, Catherine B Chan

Abstract

Type 2 diabetes (T2D) patients often find integrating a new dietary pattern into their lifestyle challenging; therefore, the PANDA (Physical Activity and Nutrition for Diabetes in Alberta) menu plan intervention was developed to help people incorporate the Canadian Diabetes Association (CDA) nutrition therapy guidelines into their daily lives. The menu plan focused on recipes and foods that were accessible, available and acceptable to Albertans. The objective was to evaluate the effectiveness of the intervention on blood glucose control and dietary adherence and quality among patients with T2D. Participants with T2D (n = 73) enrolled in a single-arm incorporating interactive education based on a four-week menu plan that incorporated the recommendations of the CDA nutrition therapy guidelines. Post-intervention follow-up was conducted at three and six months. After three months, there were beneficial changes in A1c (-0.7%), body mass index (BMI, -0.6 kg/m²), diastolic blood pressure (-4 mmHg), total cholesterol (-63 mg/dL), HDL- (+28 mg/dL) and LDL-cholesterol (-89 mg/dL), Healthy Eating Index (+2.1 score) and perceived dietary adherence (+8.5 score) (all p < 0.05). The significant improvements in A1c, BMI and lipids were maintained at six months. The PANDA menu plan intervention was effective in improving glycemic control and diet quality. The results suggest that a dietary intervention incorporating interactive education sessions focused on menu planning with familiar, accessible foods may be effective for diabetes management.

Keywords: diet quality; dietary adherence; glycemic control; intervention; menu plan; type 2 diabetes.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Participant recruitment and retention flow chart.
Figure 2
Figure 2
Intervention timeline.

References

    1. International Diabetes Federation Diabetes Atlas, 6th ed. [(accessed on 21 May 2016)]. Available online: .
    1. Public Health Agency of Canada Diabetes in Canada: Facts and Figures from a Public Health Perspective. [(accessed on 21 May 2016)]. Available online: .
    1. Canadian Diabetes Association An Economic Tsunami: The Cost of Diabetes in Canada 2009. [(accessed on 21 May 2016)]. Available online: .
    1. Dworatzek P.D., Arcudi K., Gougeon R., Husein H., Sievenpiper J.L., Williams S.L. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Nutrition therapy. Can. J. Diabetes. 2013;37:S45–S55. doi: 10.1016/j.jcjd.2013.01.019.
    1. Nagelkerk J., Reick K., Meengs L. Perceived barriers and effective strategies to diabetes self-management. J. Adv. Nurs. 2006;54:151–158. doi: 10.1111/j.1365-2648.2006.03799.x.
    1. Assad G., Chan C.B. Relationship of diet quality to food security and nutrition knowledge in low-income, community-dwelling elders with type 2 diabetes mellitus: A pilot study. Can. J. Diabetes. 2012;36:310–313. doi: 10.1016/j.jcjd.2012.10.006.
    1. Jarvandi S., Gougeon R., Bader A., Dasgupta K. Differences in food intake among obese and nonobese women and men with type 2 diabetes. J. Am. Coll. Nutr. 2011;30:225–232. doi: 10.1080/07315724.2011.10719964.
    1. Munoz-Pareja M., Leon-Munoz L.M., Guallar-Castillon M., Graciani A., López-García E., Banegas J.R., Rodríguez-Artalejo F. The diet of diabetic patients in Spain in 2008–2010: Accordance with the main dietary recommendations: A cross-sectional study. PLoS ONE. 2012;7 doi: 10.1371/journal.pone.0039454.
    1. Berry T.R., Anders S., Chan C.B., Bell R.C. Communicating diabetes best practices to clients: A preliminary investigation of educator perspectives. Health Promot. Pract. 2012;3:388–394. doi: 10.1177/1524839911404225.
    1. Aitaoto N., Campo S., Snetselaar L.G., Janz K.F., Farris K.B., Parker E., Belyeu-Camacho T., Jimenez R.P. Formative research to inform nutrition interventions in Chuuk and the US Pacific. J. Acad. Nutr. Diet. 2015;6:947–953. doi: 10.1016/j.jand.2014.11.018.
    1. Deng F., Zhang A., Chan C. Acculturation, dietary acceptability, and diabetes management among Chinese in North America. Front. Endocrinol. 2013;4:1–7. doi: 10.3389/fendo.2013.00108.
    1. Berry T., Chan C., Bell R., Walker J. Collective knowledge: Using a consensus conference approach to develop recommendations for physical activity and nutrition programs for persons with type 2 diabetes. Front. Endocrinol. 2012;3:1–5. doi: 10.3389/fendo.2012.00161.
    1. US Aid Food Security Indicators and Framework for Use in the Monitoring and Evaluation of Food Aid Programs 1999. [(accessed on 21 May 2016)]; Available online: .
    1. Ross T., Geil P. Healthy eating on a lean budget: Diabetes meals for less. Diabetes Spectr. 2010;2:120–123. doi: 10.2337/diaspect.23.2.120.
    1. Cunningham C., Johnson S., Cowell B., Soroudi N., Isaacson S., Davis N., Wylie-Rosett J. Menu plans in a diabetes self-management weight loss program. J. Nutr. Educ. Behav. 2006;38:264–266. doi: 10.1016/j.jneb.2006.01.013.
    1. Bader A., Gougeon R., Joseph L., Da Costa D., Dasgupta K. Nutritional education through internet-delivered menu plans among adults with type 2 diabetes mellitus: Pilot study. JMIR Res. Protoc. 2013;2:e41–e46. doi: 10.2196/resprot.2525.
    1. Soria-Contreras D., Bell R., McCargar L., Chan C. Feasibility and efficacy of menu planning combined with individual counselling to improve health outcomes and dietary adherence in people with type 2 diabetes: A pilot study. Can. J. Diabetes. 2014;38:320–325. doi: 10.1016/j.jcjd.2014.03.009.
    1. Soria-Contreras D., Berry T.R., Chan C.B. Using focus group interviews to develop a menu plan to improve dietary adherence in type 2 diabetes. Unpublished Work.
    1. Toobert D.J., Hampson S.E., Glasgow R.E. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–950. doi: 10.2337/diacare.23.7.943.
    1. Storey K., McCargar L. Reliability and validity of Web-SPAN, a web-based method for assessing weight status, diet and physical activity in youth. J. Hum. Nutr. Diet. 2012;25:59–68. doi: 10.1111/j.1365-277X.2011.01181.x.
    1. Nutrition Research Division, Health Canada Canadian Nutrient File 2001b. [(accessed on 21 May 2016)]. Available online: .
    1. Willet W. Nutritional Epidemiology. 2nd ed. Oxford University Press; New York, NY, USA: 1998.
    1. Food and Nutrition Board, Institute of Medicine, National Academy of Sciences . Dietary Reference Intakes: Applications in Dietary Planning. National Academies Press; Washington, DC, USA: 2003.
    1. Tudor-Locke C., Bassett D.R., Jr. How many steps/day are enough? Preliminary pedometer indices for public health. Sport. Med. 2004;34:1–8. doi: 10.2165/00007256-200434010-00001.
    1. Black A.E. Critical evaluation of energy intake using the Goldberg cut-off for energy intake: Basal metabolic rate. A practical guide to its calculation, use and limitations. Int. J. Obes. 2000;24:1119–1130. doi: 10.1038/sj.ijo.0801376.
    1. Garriguet D. Diet quality in Canada. Health Rep. 2009;2:41–52.
    1. Asaad G., Sadegian M., Lau R., Xu Y., Soria-Contreras D.C., Bell R.C., Chan B.C. The reliability and validity of the perceived dietary adherence questionnaire for people with type 2 diabetes. Nutrtients. 2015;7:5484–5496. doi: 10.3390/nu7075231.
    1. Bandura A. Social Foundation of Thought and Action: A Social Cognitive Theory. Prentice Hall; Englewood Cliffs, NJ, USA: 1986.
    1. Health Canada Eating Well with Canada’s Food Guide. [(accessed on 21 May 2016)]. Available online: .
    1. The Comprehensive R Archive Network. [(accessed on 2 September 2016)]. Available online: .
    1. Schwingshackl L., Hoffmann G. Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension Score, and health outcomes: A systematic review and meta-analysis of cohort studies. J. Acad. Nutr. Diet. 2015;5:780–800. doi: 10.1016/j.jand.2014.12.009.
    1. Bell R.A., Summerson J.H., Konen J.C. Dietary intakes by levels of glycemic control for black and white adults with non-insulin dependent diabetes mellitus (NIDDM) J. Am. Coll. Nutr. 1995;14:144–151. doi: 10.1080/07315724.1995.10718486.
    1. Heilbronn L.K., Noakes M., Clifton P.M. Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Diabetes Care. 1999;22:889–895. doi: 10.2337/diacare.22.6.889.
    1. Davis N.J., Tomuta N., Schechter C., Isasi C.R., Segal-Isaacson C.J., Stein D., Zonszein J., Wylie-Rosett J. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care. 2009;7:1147–1152. doi: 10.2337/dc08-2108.
    1. Wang J., Olendzki B., Wedick N., Persuitte G., Culver A., Li W., Ma Y. Challenges in sodium intake reduction and meal consumption patterns among participants with metabolic syndrome in a dietary trial. Nutr. J. 2013;12:162–171. doi: 10.1186/1475-2891-12-163.
    1. Blumenthal J.A., Babyak M.A., Hinderliter A., Watkins L.L., Craighead L., Li P., Sherwood A. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: The ENCORE study. Arch. Intern. Med. 2010;170:126–135. doi: 10.1001/archinternmed.2009.470.
    1. Dasgupta K., Hajna S., Joseph L., Da Costa D., Christopoulos S., Gougeon R. Effects of meal preparation training on body weight, glycemia, and blood pressure: Results of a phase 2 trial in type 2 diabetes. Int. J. Behav. Nutr. Phys. Act. 2012;9:125–135. doi: 10.1186/1479-5868-9-125.
    1. Chen L., Pei J., Kuang J., Chen H., Chen Z., Li Z., Yang H. Effect of lifestyle intervention in patients with type 2 diabetes: A meta-analysis. Metab. Clin. Exp. 2015;64:338–347. doi: 10.1016/j.metabol.2014.10.018.
    1. The Diabetes Control and Complications Trial Research Group The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 1993;329:977–986.
    1. UK Prospective Diabetes Study Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet. 1998;352:837–853.
    1. Elfhag K., Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes. Rev. 2005;6:67–85. doi: 10.1111/j.1467-789X.2005.00170.x.
    1. Wing R., Lang W., Wadden T., Safford M., Knowler W., Bertoni A., Wagenknecht L. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–1486. doi: 10.2337/dc10-2415.
    1. Gallagher D., Heshka S., Kelley D.E., Thornton J., Boxt L., Pi-Sunyer F.X., Clark J.M. Changes in adipose tissue depots and metabolic markers following a 1-year diet and exercise intervention in overweight and obese patients with type 2 diabetes. Diabetes Care. 2014;37:3325–3332. doi: 10.2337/dc14-1585.
    1. Khan H. Clinical significance of HbA(1c) as a marker of circulating lipids in male and female type 2 diabetic patients. Acta Diabetol. 2007;4:193–200. doi: 10.1007/s00592-007-0003-x.
    1. Gatti A., Maranghi M., Bacci S., Carallo C., Gnasso A., Mandosi E., Filetti S. Poor glycemic control is an independent risk factor for low HDL cholesterol in patients with type 2 diabetes. Diabetes Care. 2009;8:1550–1552. doi: 10.2337/dc09-0256.
    1. Waldman B., Jenkins A.J., Davis T.E., Taskinen M., Scott R., O’Connell R.L., Keech A.C. HDL-C and HDL-C/ApoA-I predict long-term progression of glycemia in established type 2 diabetes. Diabetes Care. 2014;8:2351–2358. doi: 10.2337/dc13-2738.
    1. Lee H., Yim J., Kim Y., Choue R. Moderate diet-induced weight loss is associated with improved insulin sensitivity in middle-aged healthy obese Korean women. Nutr. Res. Pract. 2014;4:469–475. doi: 10.4162/nrp.2014.8.4.469.
    1. Rutti S., Ehses J., Sibler R., Prazak R., Rohrer L., Georgopoulos S., von Eckardstein A. Low- and high-density lipoproteins modulate function, apoptosis, and proliferation of primary human and murine pancreatic beta-cells. Endocrinology. 2009;10:4521–4530. doi: 10.1210/en.2009-0252.
    1. Dullaart R., Annema W., de Boer J., Tietge U. Pancreatic β-cell function relates positively to HDL functionality in well-controlled type 2 diabetes mellitus. Atherosclerosis. 2012;2:567–573. doi: 10.1016/j.atherosclerosis.2012.03.037.
    1. Drew B., Duffy S., Formosa M., Natoli A., Henstridge D., Penfold S., Kingwell B. High-density lipoprotein modulates glucose metabolism in patients with type 2 diabetes mellitus. Circulation. 2009;15:2103–2111. doi: 10.1161/CIRCULATIONAHA.108.843219.
    1. Waldman B., Jenkins A., Sullivan D., Ng M., Keechm A. HDL as a target for glycemic control. Curr. Drug Target. 2015;16 doi: 10.2174/1389450116666150727115544.
    1. Maahs D.M., Daniels S.R., De Ferranti S.D., Dichek H.L., Flynn J., Goldstein B.I., Urbina E. Cardiovascular disease risk factors in youth with diabetes mellitus: A scientific statement from the American Heart Association. Circulation. 2014;130:1532–1558. doi: 10.1161/CIR.0000000000000094.
    1. Chan C.B., Bell R.C. Food Accessibility. Unpublished Work.
    1. Asaad G., Bell R.C., Chan C.B. Outcomes of the PANDA-Nutrition Arm Trial Assessed Using Per-Protocol Criteria. Unpublished work.
    1. Hébert J.R., Frongillo E.A., Adams S.A., Turner-McGrievy G.M., Hurley T.G., Miller D.R., Ockene I.S. Perspective: Randomized controlled trials are not a panacea for diet-related research. Adv. Nutr. 2016;7:423–432. doi: 10.3945/an.115.011023.

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