Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes: changes in health cognitions and glycemic control

Amutha Ramadas, Carina Ka Yee Chan, Brian Oldenburg, Zanariah Hussein, Kia Fatt Quek, Amutha Ramadas, Carina Ka Yee Chan, Brian Oldenburg, Zanariah Hussein, Kia Fatt Quek

Abstract

Background: Increasing prevalence and disease burden has led to an increasing demand of programs and studies focused on dietary and lifestyle habits, and chronic diseases such as type 2 diabetes mellitus (T2DM). We evaluated the effects of a 6-month web-based dietary intervention on Dietary Knowledge, Attitude and Behaviour (DKAB), Dietary Stages of Change (DSOC), fasting blood glucose (FBG) and glycosylated haemoglobin (HbA1c) in patients with uncontrolled HbA1c (> 7.0%) in a randomised-controlled trial (myDIDeA) in Malaysia.

Methods: The e-intervention group (n = 62) received a 6-month web-delivered intensive dietary intervention while the control group (n = 66) continued with their standard hospital care. Outcomes (DKAB and DSOC scores, FBG and HbA1c) were compared at baseline, post-intervention and follow-up.

Results: While both study groups showed improvement in total DKAB score, the margin of improvement in mean DKAB score in e-intervention group was larger than the control group at post-intervention (11.1 ± 0.9 vs. 6.5 ± 9.4,p < 0.001) and follow-up (19.8 ± 1.1 vs. 7.6 ± 0.7,p < 0.001), as compared to the baseline. Although there was no significant difference between intervention and control arms with respect to DSOC score and glycaemic control, the e-intervention group showed improved DSOC score (199.7 ± 18.2 vs193.3 ± 14.6,p = 0.046), FBG (7.9 ± 2.5 mmol/L vs. 8.9 ± 3.9 mmol/L,p = 0.015) and HbA1c (8.5 ± 1.8% vs. 9.1 ± 2.0%,p = 0.004) at follow-up compared to the baseline, whereas such improvement was not seen in the control group.

Conclusions: Most important impact of myDIDeA was on the overall DKAB score. This study is one of the first to demonstrate that an e-intervention can be a feasible method for implementing chronic disease management in developing countries. Concerns such as self-monitoring, length of intervention, intense and individualized intervention, adoption of other domains of Transtheoretical Model and health components, and barriers to change have to be taken into consideration in the development of future intervention programs.

Trial registration: ClinicalTrials.gov NCT01246687 .

Keywords: Diabetes mellitus, type 2; Diet therapy; Randomised-controlled trial; Telemedicine.

Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study. The study has obtained the ethical clearance from the Malaysian Ethics Research Committee (NMRR-09-303-3416) and Monash University’s Human Research Ethics Committee (CF09/1583–2,009,000,877).

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Changes in mean DKAB score and its sub-domains (a-d), (e) DSOC score, (f) FBG(mmol/L) and (g) HbA1c(%) across data collection points

References

    1. Institute for Public Health . National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems. Putrajaya: Ministry of Health Malaysia; 2015.
    1. Rawal LB, Tapp RJ, Williams E, Chan CKY, Yasin S, Oldenburg B. Prevention of type 2 diabetes mellitus and its complications in developing countries: a review. Int J Behav Med. 2012;19:121–133. doi: 10.1007/s12529-011-9162-9.
    1. World Health Organisation . Diabetes Mellitus: Report of a WHO Expert Committee. Geneva: World Health Organisation; 1965.
    1. Oldenburg B, Absetz P, Chan CKY. Behavioral interventions for prevention and management of chronic disease. In: Steptoe K, Freeland JR, Jenning M, Lllabre S, Manuck SE, editors. Handbook of Behavioral Medicine: Methods and Applications. New York: Springer; 2010. pp. 969–988.
    1. Ramadas A, Quek KF, Chan CKY, Oldenburg B. Web-based interventions for the management of type 2 diabetes mellitus: a systematic review of recent evidence. Int J Med Inform. 2011;80(6):389–405. doi: 10.1016/j.ijmedinf.2011.02.002.
    1. Cotter AP, Durant N, Agne AA, Cherrington AL. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence. J Diabetes Complicat. 2014;28(2):243–251. doi: 10.1016/j.jdiacomp.2013.07.003.
    1. Long JD, Armstrong ML, Amos E, Shriver B, Roman-Shriver C, Feng D, Harrison L, Luker S, Nash A, Blevins MW. Pilot using world wide web to prevent diabetes in adolescents. Clin Nurs Res. 2006;15(1):67–79. doi: 10.1177/1054773805282446.
    1. McCoy MR, Couch D, Duncan ND, Lynch GS. Evaluating an internet weight loss program for diabetes prevention. Health Promot Int. 2005;20(3):221–228. doi: 10.1093/heapro/dai006.
    1. Tate DF, Jackvony EH, Wing RR. Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003;289(14):1833–1836. doi: 10.1001/jama.289.14.1833.
    1. Wolf AM, Conaway MR, Crowther JQ, Hazen KY, Nadler J L, Oneida B, Bovbjerg VE. Improving control with activity and nutrition (ICAN) study. Translating lifestyle intervention to practice in obese patients with type 2 diabetes: improving control with activity and nutrition (ICAN) study. Diabetes Care. 2004;27(7):1570–1576. doi: 10.2337/diacare.27.7.1570.
    1. Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The effectiveness of web-based vs. non-web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res. 2004;6(4):e40. doi: 10.2196/jmir.6.4.e40.
    1. Singh PM, Wight CA, Sercinoglu O, Wilson DC, Boytsov A, Raizada MN. Language preferences on websites and in Google searches for human health and food information. J Med Internet Res. 2007;9(2):e18. doi: 10.2196/jmir.9.2.e18.
    1. Woodall WG, Buller DB, Saba L, Zimmerman D, Waters E, Hines JM, et al. Effect of emailed messages on return use of a nutrition education website and subsequent changes in dietary behavior. J Med Internet Res. 2007;9(3):e27. doi: 10.2196/jmir.9.3.e27.
    1. Spencer L, Wharton C, Moyle S, Adams T. The transtheoretical model as applied to dietary behaviour and outcomes. Nutr Res Rev. 2007;20(1):46–73. doi: 10.1017/S0954422407747881.
    1. van Vugt M, de Wit M, Cleijne WHJJ, Snoek FJ. Use of behavioral change techniques in web-based self-management programs for type 2 diabetes patients: systematic review. J Med Internet Res. 2013;15(12):e279. doi: 10.2196/jmir.2800.
    1. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–395. doi: 10.1037/0022-006X.51.3.390.
    1. Barboza FC, Monteiro SM, Barradas SC, Sarmiento OL, Rios P, Ramirez A, et al. Physical activity, nutrition and behavior change in Latin America: a systematic review. Glob Health Promot. 2013;20(4 Suppl):65–81. doi: 10.1177/1757975913502240.
    1. DiClemente CC, rochaska J, Fairhurst S, Velicer W, Velasquez M, Rossi JS. The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol. 1991;59(2):295–304. doi: 10.1037/0022-006X.59.2.295.
    1. de Menezes CM, Bedeschi LB, Santos LC, Lopes AC. Interventions directed at eating habits and physical activity using the Transtheoretical model: a systematic review. Nutr Hosp. 2016;33(5):586.
    1. Spahn JM, Reeves RS, Keim KS, Laquatra I, Kellogg M, Jortberg B, et al. State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change. J Am Diet Assoc. 2010;110(6):879–891. doi: 10.1016/j.jada.2010.03.021.
    1. Lee JY, Park HA, Min YH. Transtheoretical model-based nursing intervention on lifestyle change: a review focused on intervention delivery methods. Asian Nurs Res. 2015;9(2):158–167. doi: 10.1016/j.anr.2015.05.001.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309. doi: 10.7326/0003-4819-148-4-200802190-00008.
    1. Ramadas A, Quek KF, Chan CK, Oldenburg B, Hussein Z. Randomised-controlled trial of a web-based dietary intervention for patients with type 2 diabetes mellitus: study protocol of myDIDeA. BMC Public Health. 2011;11:359. doi: 10.1186/1471-2458-11-359.
    1. Glasgow RE, Toobert DJ, Hampson SE, Strycker LA. Implementation, generalization and long-term results of the “choosing well” diabetes self-management intervention. Patient Educ Couns. 2002;48(2):115–122. doi: 10.1016/S0738-3991(02)00025-3.
    1. Ministry of Health & Academy of Medicine of Malaysia. Malaysian Clinical Practice Guidelines: Management of Type 2 Diabetes Mellitus (4th Edition). Putrajaya: Ministry of Health Malaysia; 2009.
    1. The Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr. 2000;54(4):353–356. doi: 10.1038/sj.ejcn.1600962.
    1. National Diabetes Institute . Dietary Management. Petaling Jaya: National Diabetes Institute Malaysi; 2009.
    1. Malaysian Dietitians’ Association, Ministry of Health. Malaysian medical nutrition therapy for type 2 diabetes. Putrajaya: Malaysian dietitians’ association; 2005.
    1. Moore H, Summerbell C, Hooper L, Cruickshank K, Vyas A, Johnstone P, et al. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev. 2004;(3):CD004097.
    1. Pegklidou K, Nicolaou I, Demopoulos VJ. Nutritional overview on the management of type 2 diabetes and the prevention of its complications. Curr Diabetes Rev. 2010;6(6):400–409. doi: 10.2174/157339910793499083.
    1. American Diabetes Association. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):S61–S78. doi: 10.2337/dc08-S061.
    1. Ramadas A, Chan CKY, Oldenburg B, Hussien Z, Quek KF. A web-based dietary intervention for people with type 2 diabetes: development, implementation, and evaluation. Int J Behav Med. 2015;22(3):365–373. doi: 10.1007/s12529-014-9445-z.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–1395. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Ramadas A, Chan CKY, Quek KF, Zanariah H, Oldenburg B. Validation of a knowledge, attitude, and behavior questionnaire for dietary education in Malaysian diabetic patients. Int J Behav Med. 2010;17(Suppl 1):154–155.
    1. Streiner D, Geddes J. Intention to treat analysis in clinical trials when there are missing data. Evid Based Ment Health. 2001;4(3):70–71. doi: 10.1136/ebmh.4.3.70.
    1. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Jr, Tudor-Locke C, et al. Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–1581. doi: 10.1249/MSS.0b013e31821ece12.
    1. Albarran NB, Ballesteros MN, Morales GG, Ortega MI. Dietary behavior and type 2 diabetes care. Patient Educ Couns. 2006;61(2):191–199. doi: 10.1016/j.pec.2005.03.008.
    1. Shamsi N, Shehab Z, Al-Nahash Z, Al-Muhanadi S, Al-Nasir F. Factors influencing dietary practice among type 2 diabetics. Bahrain Med Bull. 2013;35(3):1–14.
    1. Ishak NH, Mohd Yusoff SS, Rahman RA, Kadir RA. Diabetes self-care and its associated factors among elderly diabetes in primary care. J Taibah University Medical Sciences. 2017;12(6):504–511. doi: 10.1016/j.jtumed.2017.03.008.
    1. Savoca M, Miller C. Food selection and eating patterns: themes found among people with type 2 diabetes mellitus. J Nutr Educ. 2001;33(4):224–233. doi: 10.1016/S1499-4046(06)60035-3.
    1. Lim HM, Park JE, Choi YH, Huh YJ, Kim WY. Individualized diabetes nutrition education improves compliance with diet prescription. Nutr Res Pract. 2009;3(4):315–322. doi: 10.4162/nrp.2009.3.4.315.
    1. Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28(6):690–701. doi: 10.1037/a0016136.
    1. Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. J Acad Nutr Diet. 2017;117(12):1941–1962. doi: 10.1016/j.jand.2017.06.364.
    1. Azimah MN, Radzniwan R, Zuhra H, Khairini O. Have we done enough with diabetic education? A pilot study Malays Fam Physician. 2010;5(1):24–30.
    1. Møller G, Andersen HK, Snorgaard O. A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes. Am J Clin Nutr. 2017;106(6):1394–1400. doi: 10.3945/ajcn.116.139626.
    1. Kasila K, Poskiparta M, Karhila P, Kettunen T. Patients’ readiness for dietary change at the beginning of counselling: a Transtheoretical model-based assessment. J Hum Nutr Diet. 2003;16(3):159–166. doi: 10.1046/j.1365-277X.2003.00437.x.
    1. Kavookjian J, Berger BA, Grimley DM, Villaume WA, Anderson HM, Barker KN. Patient decision making: strategies for diabetes diet adherence intervention. Res Social Adm Pharm. 2005;1(3):389–407. doi: 10.1016/j.sapharm.2005.06.006.
    1. Hansel B, Giral P, Gambotti L, Lafourcade A, Peres G, Filipecki C, et al. A fully automated web-based program improves lifestyle habits and Hba1c in patients with type 2 diabetes and abdominal obesity: randomized trial of patient e-coaching nutritional support (the ANODE study) J Med Internet Res. 2017;19(11):e360. doi: 10.2196/jmir.7947.
    1. Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2:CD003417.
    1. Jackson CL, Bolen S, Brancati FL, Batts-Turner ML, Gary TL. A systematic review of interactive computer-assisted technology in diabetes care: interactive information technology in diabetes care. J Gen Intern Med. 2006;21(2):105–110.
    1. Kim CJ, Kang DH. Utility of a web-based intervention for individuals with type 2 diabetes: the impact on physical activity levels and glycemic control. Comput Inform Nurs. 2006;24(6):337–345. doi: 10.1097/00024665-200611000-00008.
    1. Bond GE, Burr R, Wolf FM, Price M, MCCurry SM, Teri L. The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial. Diabetes Technol Ther. 2007;9(1):52–59. doi: 10.1089/dia.2006.0057.
    1. Lee TI, Yeh YT, Liu CT, Chen PL. Development and evaluation of a patient-oriented education system for diabetes management. Int J Med Inform. 2007;76(9):655–663. doi: 10.1016/j.ijmedinf.2006.05.030.
    1. Chan CK, Oldenburg B, Viswanath K. Advancing the science of dissemination and implementation in behavioral medicine: evidence and progress. Int J Behav Med. 2015;22(3):277–282. doi: 10.1007/s12529-015-9490-2.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren