Lifestyle factors predict likelihood of diet changes after type 2 diabetes diagnosis
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Adults with an improved diet-quality score 3 months after a type 2 diabetes diagnosis were more likely to be nonsmokers and have a lower BMI and higher physical activity level vs. those who did not improve their diet, study data show.
“Early, tight glycemic control is associated with improved outcomes and reduced mortality for people with type 2 diabetes, regardless of how the disease is managed in the future,” Emily Burch, a doctoral student, dietitian and researcher with the Menzies Health Institute Queensland at Griffith University, Australia, and colleagues wrote in the study background. “It is therefore important to understand the changes that people with type 2 diabetes make to improve diet quality immediately after diagnosis.”
Burch and colleagues analyzed data from 225 Australian adults diagnosed with type 2 diabetes during the 6 months before recruitment (56% men; mean age, 59 years; 10.3% current smokers). Researchers monitored the cohort through five interviewer-administered telephone surveys at baseline and 3, 6, 9 and 12 months. Researchers collected diet and 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 stratified into two groups: those who improved their diet quality by 3 months, defined as an increase in DASH score of 3 or more, and those who improved by 2 or fewer points, maintained or experienced a decrease in score.
“An increase of 3 points was deemed as the smallest clinically significant change based on findings from a 20-year longitudinal study of over 40,000 adults that showed an increase of at least 3 points to significantly influence long-term glycemic control as assessed by HbA1c,” the researchers wrote.
Researchers evaluated associations between baseline demographics, health and diet-related characteristics and change in DASH score at 3 months.
Within the cohort, mean baseline DASH score was 24.4, in the midrange of possible scores between 8 and 40.
Researchers found that at 3 months, one-third of participants improved their DASH score by at least 3 points (n = 63), with 29 participants improving their score by at least 5 points. Compared with participants who did not experience a change in diet score, those who improved their score by at least 3 points had a lower baseline diet quality (P < .001), lower baseline BMI (P = .045), higher baseline physical activity levels (7.1% vs. 19.7%; P = .028) and were less likely to smoke (12% vs. 6.6%; P = .018). There were no between-group differences based on baseline demographic characteristics, including age, sex, education level and income.
The researchers noted that it is possible some participants made changes immediately after receiving a diabetes diagnosis but before completing the baseline survey.
“The fact that those who did not improve started the study with a higher DASH score supports this supposition,” the researchers wrote.
The researchers wrote that strategies targeted at better supporting smokers, those with low physical activity and higher BMI are needed, and future research should investigate how the diet-quality changes people make around time of diagnosis are related to long-term health outcomes.
Perspective
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Tami Ross, RD, LD, CDCES, MLDE, FADCES
Given that the findings show those who improved their DASH score started with lower baseline diet quality, greater opportunities for dietary improvements exist up front, as compared with those who had higher baseline diet quality.
It is not clear from the study what if any medical nutrition therapy or diabetes care, education or support was provided to these individuals that may have affected the dietary changes. The findings of this study drive home the opportunity for referral to a diabetes care and education specialist to assess and provide education and support at the critical time of diagnosis as suggested by the Diabetes Self-Management Education and Support for Adults with Type 2 Diabetes Algorithm.
In addition to those factors explored in the study, one key factor not addressed is the individual’s psychological/coping status. In my experience working with people with type 2 diabetes for more than 25 years, some are motivated by the new diagnosis to learn all they can and start making lifestyle changes. Others, however, spend months moving between the stages of the grieving process — grieving the new diagnosis through denial, anger, bargaining and depression before finally coming to acceptance. That coping status dramatically affects ability or desire to make dietary or lifestyle changes.
While providing knowledge and education is important, supporting patients in making change means more than just education. Change comes about when it is actually more uncomfortable for the individual to stay the same than to make change. Something in their “world” has to occur that becomes a motivator for them to want to make change. When that something occurs, that is an opportunity to focus on what the individual is doing well; acknowledge and praise them for that, and then leverage those positive behaviors to identify solutions together. Maybe that person is trying to eat a non-starchy vegetable at dinner each night. How were they able to do that? How can they do that more often? Focus on small changes, small swaps, and small steps that can set the individual up for small successes to then build upon to realize future larger successes.
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