The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclusion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardiovascular diseases and being overweight, not diabetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, diastolic blood pressure, health status and well-being. The existing data are insufficient for drawing conclusions on the benefits of the transtheoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing separately on education interventions for patients and providers.

BackgroundIncreased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals’ perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes.MethodsOpportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis.Results74% of men (n = 2 577) and 76% of women (n = 4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants’ perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants.ConclusionsSubjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.

OBJECTIVETo investigate the proportion of individuals at high risk of type 2 diabetes who perceive the need for lifestyle counseling, factors associated with this perception, and whether the perceived need is associated with subsequent attendance in lifestyle intervention.RESEARCH DESIGN AND METHODSBaseline and intervention data were obtained from 10,149 participants in a Finnish National Diabetes Prevention Project.RESULTSIn total, 36% of men and 52% of women perceived the need for counseling. Most of the risk factors did not increase the perceived need for counseling. Those agreeing to attend supervised lifestyle intervention were more likely to report a perceived need than those who agreed on a self-initiated lifestyle change or those who refused to attend lifestyle intervention. The perceived need was associated with actual attendance in the lifestyle intervention only among women.CONCLUSIONSIt will be vital to find additional means to support lifestyle change.

Objectives To improve understanding of how individuals at high risk of type 2 diabetes experience the risk of diabetes and how these experiences relate to the adoption of physical activity as a protective behaviour. Design A qualitative study using semi‐structured interview with individuals identified by screening as at high risk of type 2 diabetes. Methods Fourteen individuals, aged 40–64, were interviewed twice, with a 2‐year interval between. Participants' experiences of their risk of diabetes and physical activity were assessed. The transcribed interview data were analysed using inductive qualitative content analysis. Results Two themes emerged from the data: a threatening risk perception and a rejected risk perception. The threatening risk perception occurred when the risk was unexpected by the participant, but became internalized through the screening procedure. The threatening perception also involved a commitment to increase physical activity to prevent diabetes. However, short‐term anxiety and subsequently emerging hopelessness were also part of this perception. The rejected risk perception involved indifference and scepticism regarding the risk. Here, physical activity behaviour and cognitions appeared to remain unchanged. Rejection also involved difficulties in accepting one's high‐risk identity. The rejecting group lacked motivation for increased physical activity, while the other group showed determination regarding increased physical activity, often leading to success. Conclusion Perceptions of the risk of diabetes emerged as threatening or as rejected. Participants' perceptions reflected varying and intertwining emotional, cognitive, and behavioural mechanisms for coping with the risk, all of which should be recognized in promoting physical activity among high‐risk individuals. What is already known on this subject? Diabetes screening has few adverse psychological effects on screened individuals. Diabetes can be prevented by increased physical activity and modest weight loss among high‐risk individuals. The evidence on the effects of screening on protective behaviour is limited and inconsistent.What does this study add? High‐risk individuals' threatening perception of risk appears encouraging increased physical activity. Individuals having problems in adjusting to high‐risk identification may not be motivated to engage in physical activity for prevention. Failure to achieve the outcomes expected from lifestyle changes may lead people with threatening risk perception to a sense of hopelessness.

Poskiparta, M. (2012). Perceived sufficiency of physical activity levels among adults at high risk of type 2 diabetes. The FIN-D2D study. International Journal of Behavioral Medicine, 21 (1), 99-108. doi:10.1007/s12529-012-9285-7 2012 Final Draft International Journal of Behavioral MedicinePerceived sufficiency of physical activity levels among adults at high risk of type 2 diabetes. The FIN-D2D study Purpose. This study assessed the determinants of perceived physical activity levels (PALs) among adults at high risk of diabetes, and the associations with self-reported physical activity. Methods. In total, 10,149 adults participated in the FIN-D2D lifestyle intervention at baseline. Opportunistic screening was used in identifying high risk individuals. Physical activity and perceived PAL sufficiency were assessed and compared. Key risk factors for diabetes and psychosocial and demographic characteristics were analyzed as determinants using logistic regression. Results. PAL sufficiency was rated realistically by 73% of men and 75% of women. Perception of sufficient PAL was more likely among individuals with a smaller waist circumference, a higher level of perceived fitness, and no exercise intention. In men, a higher age, and in women, a lower education, and a lower occupational status, also Powered by Editorial Manager® and Preprint Manager® from Aries Systems Corporationincreased the likelihood of perceiving PAL as sufficient. Out of all the participants, 65% of men and 66% of women were inactive. Among the inactive participants, 20% (men) and 16% (women) overestimated their PAL sufficiency. In both genders such overestimation was predicted by dyslipidemia, a lower waist circumference, a higher level of perceived fitness, and no exercise intention; also (among men) by a higher age and a family history of diabetes, and (among women) by a lower occupational status, and a lower BMI. Conclusions. In diabetes prevention, it is important to recognize the groups that perceive their PAL as sufficient, since they may not see increased PAL as a tool for decreasing their risk of diabetes.Response to Reviewers: Dear Editor and Reviewer #1, Thank you for your comments regarding our manuscript. We are pleased to hear the manuscript is ready to be accepted with minor changes. We have made the corrections as suggested, please see below;1) The last referee comment (item 9) about content and presentation of Associate Editor -could the authors please add the total N of participants in each category of each independent variable, for both men and women, to Table 2 (i.e., two new columns preceding the % columns, indicating the number of participants in each category).Authors' comment: We have now added new columns with the total N of participants (men and women) in each category.To be more reader-friendly, we have now also defined family history of diabetes, hypertension, dyslipidemia, waist-circumference in the footnotes of each table. Powered by Editorial Manager® and Preprint Manager® from Aries Systems CorporationCovering p...