Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis

Abstract

BackgroundChanging diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c and body weight.MethodsWe performed a systematic review of papers published between 1975–2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA1c and body weight were meta-analysed and examined in relation to use of BCTs.ResultsThirteen RCTs were identified. Meta-analyses revealed reductions in HbA1c at 3, 6, 12 and 24 months of -1.11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and -0.26 % (2 mmol/mol) with an overall reduction of -0.53 % (6 mmol/mol [95 % CI -0.74 to -0.32, P < 0.00001]) in intervention groups compared to control groups. Meta-analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73 kg (95 % CI -6.09 to -1.37 kg, P = 0.002).Four of 46 BCTs identified were associated with >0.3 % reduction in HbA1c: ‘instruction on how to perform a behaviour’, ‘behavioural practice/rehearsal’, ‘demonstration of the behaviour’ and ‘action planning’, as were intervention features ‘supervised physical activity’, ‘group sessions’, ‘contact with an exercise physiologist’, ‘contact with an exercise physiologist and a dietitian’, ‘baseline HbA1c >8 %’ and interventions of greater frequency and intensity.ConclusionsDiet and physical activity interventions achieved clinically significant reductions in HbA1c at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0436-0) contains supplementary material, which is available to authorized users.

Diet Behavior Change Techniques in Type 2 Diabetes: A Systematic Review and Meta-analysis

“…Our findings might suggest that higher frequency and greater number of contacts are associated with greater reductions in HbA 1c which is consistent with our previous systematic review of combined diet and physical activity interventions (8), although, this may arise from more intervention content being delivered. However, we cannot be sure because fidelity was so poorly reported in almost all categories and in all studies apart from one subcategory of 'monitoring and improving enactment of treatment skills' where 68.5% of studies reported use of fidelity.…”

Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews

“…Of the remaining 6,173 articles, the titles and abstracts were screened for eligibility and 141 full texts were obtained for a full assessment. Nine reviews met all criteria (Alageel, Gulliford, McDermott, & Wright, ; Avery et al ., ; Cheng et al ., ; Cradock et al ., ; Dombrowski, Sniehotta, Avenell, & Coyne, ; Goodwin, Ostuzzi, Khan, Hotopf, & Moss‐Morris, ; Huttunen‐Lenz, Song, & Poland, ; Lara, Evans, et al ., ; Samdal, Eide, Barth, Williams, & Meland, ). In total, 132 texts were excluded (see Figure and Appendix S4 for excluded papers).…”

Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis

“…Systematic reviews in other health contexts suggest that use of BCTs does influence intervention outcomes, although not always positively . Varying combinations of BCTs (action planning, instructions, demonstration, behavioural practice, self‐monitoring, feedback, risk communication, social support, and graded tasks) were associated with positive outcomes in reviews of physical activity and dietary interventions across heterogeneous populations . However, in some reviews, goal setting, self‐monitoring, graded tasks, and social comparison were associated with poorer outcomes .…”