Can Web-Based Interventions Change Dietary Behavior In T2D?

What is the efficiency of web-based interventions for dietary changes and glycemic control in adults with type 2 diabetes? 

Type 2 diabetes in adults is one of the most critical health conditions that affect millions of people worldwide. With the growing number of patients diagnosed with type 2 diabetes, there is an urgent need for diabetes interventions.  Besides medication, guidelines highly recommend lifestyle modifications, including diet control, weight loss, and physical activity. Past studies report that the rate of obtaining diabetes education was low worldwide; the United States 23-66%, the United Kingdom at 11%, and Australia at 40%. Web-based programs reported that patients with type 2 diabetes showed a decrease in HbA1c by 0.47%-1.49%, and mobile health reduction of HbA1c at an average of 0.8%. Mobile apps intervention reported a decline in HbA1c 0.4%-1.9%.  Telehealth reported an average decrease in HbA1c of 0.17%. The authors of this study stated that no reviews have previously evaluated the effects of web-based interventions on dietary behavior changes in people with type 2 diabetes.   

The purpose of this review was to determine the efficiency of web-based interventions for dietary changes and glycemic control in adults with type 2 diabetes.  This study was a systematic review that used the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. This review’s primary outcome was to recognize and synthesize the available evidence-based literature from randomized controlled trials to determine the effectiveness of web-based interventions on dietary behavior change and glycemic control in type 2 diabetes patients. Using a systematic literature search, the authors searched the following databases:  Medline, Embase, The Cochrane Library, and CINAHL.  They reviewed papers from January 2013 to May 2019.  They used the Cochrane risk-of-bias tool to assess the risk of bias of the randomized trials.  The authors calculated the results for a quality assessment rating of low, fair, or reasonable quality. The data was statistically significant if the p-value was <0.05. 

The author’s search strategy concluded 714 papers, but only five studies met the study’s inclusion criteria.  In the RCT pilot study, there were ≤ 26 participants, and the other RCT studies had ≤ 463 with an average age of 50.5 – 59.  The dietary recommendations were prescribed in three RCTs, while the other two studies used computer-assisted, self-management, plus social support.  Four of the studies reported a significant dietary behavior as healthier food choices, improvements in diet habits, decline in carbohydrates consumption and the addition of sugars, sodium, saturated fat, and overall fat intake, with an increase in knowledge of dietary options.  Mean reductions for HbA1c reported as -0.3% to -0.8%, weight loss as -2.3kg to -12.7 kg, fasting blood glucose decreased -1 mmol/L, and waist circumference -1 cm, and triglycerides with a reduction of -60.1 mg/dL all reported in only three of the five studies.  The five studies’ dietary recommendations are different in using the standard nutritional guidelines, national health program guidelines, and the very low carbohydrate ketogenic diet (VLCKD).  The ANODE study reported 21% of participants had a > 5% weight loss, and 90% obtained a 5% weight loss in the VLCKD intervention.  The participants who used the VLCKD had significant reductions in triglycerides.  

To conclude, the systematic review stated that even though these studies provided evidence that web-based interventions may be an effective way to improve dietary behavior in adults with type 2 diabetes, with the positive outcomes in glycemic control and the clinical outcomes, these studies had inconsistent results.  The limited number of studies that met the inclusion criteria leave the authors having a more challenging time drawing a concrete conclusion.  Limitations were that only five studies were reviewed and were heterogeneous with dietary recommendations.  There were differences between the studys’ outcomes; using different dietary measurements cannot be generalized.  Future studies need to include detail designed studies that provide the dietary prescription and adherence of the patients with type 2 diabetes to determine better the effects of dietary behavior and improvement in clinical outcomes, and to have a larger diverse population with a longer duration of the study.   

Practice Pearls: 

• Diet control, weight loss, and physical exercise are lifestyle modifications that assist type 2 diabetes patients with glycemic control. 
• Web-based interventions promise patients with type 2 diabetes the benefits of diabetes education and detailed dietary behaviors. 
• Interventions with type 2 diabetes are necessary to combat the many risk factors and comorbidities. 

Dening J, Islam SMS, George E, Maddison R. Web-Based Interventions for Dietary Behavior in Adults With Type 2 Diabetes:

Tarshay Boyd, PharmD. Candidate, LECOM School of Pharmacy