Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial

Abstract

Objective: To evaluate the effect of a participant-customised nutrition education programme on glycated Hb (HbA 1c ), blood lipids, blood pressure, BMI and dietary behaviours in patients with type 2 diabetes mellitus. Design: A randomised controlled trial. The control group (n 41) received education materials. The intervention group (n 41) received the same education materials and participated in eight weekly (2-2·5 h) group nutrition education sessions and follow-up sessions. Outcomes were assessed at 6 and 12 months. An intention-to-treat analysis was conducted. ANCOVA compared the groups (adjustments for baseline values, age, sex and clinic). Setting: Two community health centres, Moretele sub-district (North West Province), South Africa. Subjects: Adults (aged 40-70 years) with type 2 diabetes, HbA 1c ≥8 %. Results: Differences in HbA 1c (primary outcome) were −0·64 % (P = 0·15) at 6 months and −0·63 % (P = 0·16) at 12 months in favour of the intervention group. Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P = 0·005) at 6 months and 9·9 v. 11·9 servings/d (P = 0·017) at 12 months. Median energy intake was significantly lower in the intervention group at 12 months (5988 v. 6946 kJ/d, P = 0·017). No significant group differences in BMI, lipid profile, blood pressure and intakes of macronutrients, vegetables and fruits were observed. Conclusions: Nutrition education was not efficacious on HbA 1c ; however, it improved specific dietary behaviours. Group education and hands-on activities appeared to contribute to the improvement. Optimal goal setting and self-efficacy training/assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in resource-limited settings.

Subjects’ experiences of a nutrition education programme: a qualitative study of adults with type 2 diabetes mellitus living in a rural resource-limited setting in South Africa

“…The findings indicated high participant programme satisfaction, as well as perceived or real benefits from participating in the study. Although significant clinical and some dietary outcomes were not achieved in the main study, 12 it was indicated through the qualitative arm of the study that participants believed that they had benefited in diverse ways. Thus, the findings highlight the limitations of using quantitative measures only to assess the effect of an intervention.…”

“…The ability to visualise what was taught (from the visual tools, materials and food displays) could have contributed to the significant finding on reduced starchy food intake (servings) in the intervention group. 12 Strengths and limitations of the study Process evaluation, nested in a randomised controlled trial, was employed in this study. Therefore, insight was gained into participants' experience of the intervention.…”

“…12 All intervention participants (n = 41 at 8 weeks, and n = 38 at 12 months) were invited to participate. A convenience sample of participants who were available on the days of data collection was used.…”

“…12 Briefly, the nutrition education programme (intervention) was implemented over 12 months in 2010/2011. The implementation was staggered and based on the time of participant recruitment.…”

Replicating group‐based education interventions for the management of type 2 diabetes: a review of intervention reporting

“…The intervention descriptions included in the 53 publications were assessed for completeness and replicability using the TIDieR checklist . The studies by Gagliardino et al .…”