Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings

IntroductionDiabetes self-care practices are less effective outside of controlled research settings, and almost half of patients do not achieve good glycemic control. Qualitative studies suggest some lifestyle strategies may be linked to good control, but those strategies have not been validated. Th...

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Published in:BMJ open diabetes research & care 2021-04, Vol.9 (1), p.e002103
Main Authors: Weller, Susan C, Vickers, Benjamin N
Format: Article
Language:English
Subjects:
Activities of daily living
Blood pressure
Calories
Clinical trials
Diabetes
diabetes mellitus
Diet
Eating behavior
Epidemiology/Health services research
Glucose monitoring
glycated hemoglobin A
Hyperglycemia
Insulin
Lifestyles
Nutrition research
Patients
self-management
type 2
Variables
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Vickers, Benjamin N
description IntroductionDiabetes self-care practices are less effective outside of controlled research settings, and almost half of patients do not achieve good glycemic control. Qualitative studies suggest some lifestyle strategies may be linked to good control, but those strategies have not been validated. This study provides population-based evidence that dietary strategies identified in qualitative studies are associated with glycemic control in US patients with diabetes.Research design and methodsIn a cross-sectional sample of the National Health and Nutrition Examination Survey (NHANES), qualitative self-management themes were matched to survey questions and used to predict good glycemic control (hemoglobin A1c
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Qualitative studies suggest some lifestyle strategies may be linked to good control, but those strategies have not been validated. This study provides population-based evidence that dietary strategies identified in qualitative studies are associated with glycemic control in US patients with diabetes.Research design and methodsIn a cross-sectional sample of the National Health and Nutrition Examination Survey (NHANES), qualitative self-management themes were matched to survey questions and used to predict good glycemic control (hemoglobin A1c &lt;7.0% (53 mmol/mol)). Patients were limited to those 50 years of age and older with a diagnosis of diabetes for at least 1 year (N=465).ResultsPatients averaged 65 years of age with a body mass index of 32.56 kg/m2 and 42% reported no physical activity. In logistic regression models controlling for sociodemographic and medical history variables, self-monitoring of blood glucose, weight loss, and physical activity were not significantly associated with glycemic control. Instead, dietary practices such as consuming low-calorie foods (OR=4.05, 95% CI 1.64 to 10.01), eating less fat (OR=2.15, 95% CI 1.03 to 4.47), and reducing sodium (OR=1.94, 95% CI 1.18 to 3.17) were significantly associated with good glycemic control, as was diabetes education or consultation with a dietitian (OR=3.48, 95% CI 1.28 to 9.45). Non-adherence to medications (OR=0.27, 95% CI 0.11 to 0.68) and general dietary descriptions, such as following a ‘diabetic diet’ (OR=0.32, 95% CI 0.17 to 0.57) and ‘changing eating habits for weight loss’ (OR=0.34, 95% CI 0.15 to 0.77), were associated with poorer glycemic control.ConclusionsThe NHANES validation of lifestyle management strategies suggests practices that may be sustainable. In a population that tends to be obese with low physical activity, successful self-care might emphasize specific dietary practices offering concrete touchpoints for patient communication and guidance. These strategies might help maintain glycemic control.</description><identifier>ISSN: 2052-4897</identifier><identifier>EISSN: 2052-4897</identifier><identifier>DOI: 10.1136/bmjdrc-2020-002103</identifier><identifier>PMID: 33888546</identifier><language>eng</language><publisher>England: American Diabetes Association</publisher><subject>Activities of daily living ; Blood pressure ; Calories ; Clinical trials ; Diabetes ; diabetes mellitus ; Diet ; Eating behavior ; Epidemiology/Health services research ; Glucose monitoring ; glycated hemoglobin A ; Hyperglycemia ; Insulin ; Lifestyles ; Nutrition research ; Patients ; self-management ; type 2 ; Variables</subject><ispartof>BMJ open diabetes research &amp; care, 2021-04, Vol.9 (1), p.e002103</ispartof><rights>Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b573t-fb1e899b36b4d81d84bdbb9ffbc1b10965c0361bc7e1147ee41727e5c1f95d5a3</citedby><cites>FETCH-LOGICAL-b573t-fb1e899b36b4d81d84bdbb9ffbc1b10965c0361bc7e1147ee41727e5c1f95d5a3</cites><orcidid>0000-0002-0695-736X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2516671369/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2516671369?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27549,27550,27924,27925,37012,37013,44590,53791,53793,55350,75126,77601,77632,77660,77686</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33888546$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weller, Susan C</creatorcontrib><creatorcontrib>Vickers, Benjamin N</creatorcontrib><title>Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings</title><title>BMJ open diabetes research &amp; care</title><addtitle>BMJ Open Diab Res Care</addtitle><addtitle>BMJ Open Diabetes Res Care</addtitle><description>IntroductionDiabetes self-care practices are less effective outside of controlled research settings, and almost half of patients do not achieve good glycemic control. Qualitative studies suggest some lifestyle strategies may be linked to good control, but those strategies have not been validated. This study provides population-based evidence that dietary strategies identified in qualitative studies are associated with glycemic control in US patients with diabetes.Research design and methodsIn a cross-sectional sample of the National Health and Nutrition Examination Survey (NHANES), qualitative self-management themes were matched to survey questions and used to predict good glycemic control (hemoglobin A1c &lt;7.0% (53 mmol/mol)). Patients were limited to those 50 years of age and older with a diagnosis of diabetes for at least 1 year (N=465).ResultsPatients averaged 65 years of age with a body mass index of 32.56 kg/m2 and 42% reported no physical activity. In logistic regression models controlling for sociodemographic and medical history variables, self-monitoring of blood glucose, weight loss, and physical activity were not significantly associated with glycemic control. Instead, dietary practices such as consuming low-calorie foods (OR=4.05, 95% CI 1.64 to 10.01), eating less fat (OR=2.15, 95% CI 1.03 to 4.47), and reducing sodium (OR=1.94, 95% CI 1.18 to 3.17) were significantly associated with good glycemic control, as was diabetes education or consultation with a dietitian (OR=3.48, 95% CI 1.28 to 9.45). Non-adherence to medications (OR=0.27, 95% CI 0.11 to 0.68) and general dietary descriptions, such as following a ‘diabetic diet’ (OR=0.32, 95% CI 0.17 to 0.57) and ‘changing eating habits for weight loss’ (OR=0.34, 95% CI 0.15 to 0.77), were associated with poorer glycemic control.ConclusionsThe NHANES validation of lifestyle management strategies suggests practices that may be sustainable. In a population that tends to be obese with low physical activity, successful self-care might emphasize specific dietary practices offering concrete touchpoints for patient communication and guidance. These strategies might help maintain glycemic control.</description><subject>Activities of daily living</subject><subject>Blood pressure</subject><subject>Calories</subject><subject>Clinical trials</subject><subject>Diabetes</subject><subject>diabetes mellitus</subject><subject>Diet</subject><subject>Eating behavior</subject><subject>Epidemiology/Health services research</subject><subject>Glucose monitoring</subject><subject>glycated hemoglobin A</subject><subject>Hyperglycemia</subject><subject>Insulin</subject><subject>Lifestyles</subject><subject>Nutrition research</subject><subject>Patients</subject><subject>self-management</subject><subject>type 2</subject><subject>Variables</subject><issn>2052-4897</issn><issn>2052-4897</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNqNkklv1TAUhSMEolXpH2CBLLFhk-Ihjm0WSKhieFIlNrC2PAY_JXFrO1Xfv8ch5dGyQKw8fef4-vo0zUsELxAi_Vs97W0yLYYYthBiBMmT5hRDituOC_b0wfykOc95DyGsMkQ4fd6cEMI5p11_2tztrJtL8IcwDyAvuagwKz06MAbvcjnUWS5JFTcEl4GPCUyVWKlVMMRowTAejJuCASbOJcXxHVDgVo3BqhLiDKIHN0tdlrq8dcCH2VZpftE882rM7vx-PGu-f_r47fJLe_X18-7yw1WrKSOl9Ro5LoQmve4sR5Z32motvNcGaQRFTw2sz9KGOYQ65lyHGGaOGuQFtVSRs2a3-dqo9vI6hUmlg4wqyF8bMQ1SpRLM6CQk2gpf7SxkXUep8l4QAzFhTHXc4ur1fvO6XvTkrKmdS2p8ZPr4ZA4_5BBvJYcMckqqwZt7gxRvltpfOYVs3Diq2cUlS0xR_RYm0HrX67_QfVzSXFu1Un3P6m-KSuGNMinmnJw_FoOgXHMit5zINSdyy0kVvXr4jKPkdyoq0G5AFf-f4cUf_ljmPwQ_Acxx2bw</recordid><startdate>20210422</startdate><enddate>20210422</enddate><creator>Weller, Susan C</creator><creator>Vickers, Benjamin N</creator><general>American Diabetes Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-0695-736X</orcidid></search><sort><creationdate>20210422</creationdate><title>Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings</title><author>Weller, Susan C ; Vickers, Benjamin N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b573t-fb1e899b36b4d81d84bdbb9ffbc1b10965c0361bc7e1147ee41727e5c1f95d5a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Activities of daily living</topic><topic>Blood pressure</topic><topic>Calories</topic><topic>Clinical trials</topic><topic>Diabetes</topic><topic>diabetes mellitus</topic><topic>Diet</topic><topic>Eating behavior</topic><topic>Epidemiology/Health services research</topic><topic>Glucose monitoring</topic><topic>glycated hemoglobin A</topic><topic>Hyperglycemia</topic><topic>Insulin</topic><topic>Lifestyles</topic><topic>Nutrition research</topic><topic>Patients</topic><topic>self-management</topic><topic>type 2</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weller, Susan C</creatorcontrib><creatorcontrib>Vickers, Benjamin N</creatorcontrib><collection>British Medical Journal Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMJ open diabetes research &amp; care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weller, Susan C</au><au>Vickers, Benjamin N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings</atitle><jtitle>BMJ open diabetes research &amp; care</jtitle><stitle>BMJ Open Diab Res Care</stitle><addtitle>BMJ Open Diabetes Res Care</addtitle><date>2021-04-22</date><risdate>2021</risdate><volume>9</volume><issue>1</issue><spage>e002103</spage><pages>e002103-</pages><issn>2052-4897</issn><eissn>2052-4897</eissn><abstract>IntroductionDiabetes self-care practices are less effective outside of controlled research settings, and almost half of patients do not achieve good glycemic control. Qualitative studies suggest some lifestyle strategies may be linked to good control, but those strategies have not been validated. This study provides population-based evidence that dietary strategies identified in qualitative studies are associated with glycemic control in US patients with diabetes.Research design and methodsIn a cross-sectional sample of the National Health and Nutrition Examination Survey (NHANES), qualitative self-management themes were matched to survey questions and used to predict good glycemic control (hemoglobin A1c &lt;7.0% (53 mmol/mol)). Patients were limited to those 50 years of age and older with a diagnosis of diabetes for at least 1 year (N=465).ResultsPatients averaged 65 years of age with a body mass index of 32.56 kg/m2 and 42% reported no physical activity. In logistic regression models controlling for sociodemographic and medical history variables, self-monitoring of blood glucose, weight loss, and physical activity were not significantly associated with glycemic control. Instead, dietary practices such as consuming low-calorie foods (OR=4.05, 95% CI 1.64 to 10.01), eating less fat (OR=2.15, 95% CI 1.03 to 4.47), and reducing sodium (OR=1.94, 95% CI 1.18 to 3.17) were significantly associated with good glycemic control, as was diabetes education or consultation with a dietitian (OR=3.48, 95% CI 1.28 to 9.45). Non-adherence to medications (OR=0.27, 95% CI 0.11 to 0.68) and general dietary descriptions, such as following a ‘diabetic diet’ (OR=0.32, 95% CI 0.17 to 0.57) and ‘changing eating habits for weight loss’ (OR=0.34, 95% CI 0.15 to 0.77), were associated with poorer glycemic control.ConclusionsThe NHANES validation of lifestyle management strategies suggests practices that may be sustainable. In a population that tends to be obese with low physical activity, successful self-care might emphasize specific dietary practices offering concrete touchpoints for patient communication and guidance. These strategies might help maintain glycemic control.</abstract><cop>England</cop><pub>American Diabetes Association</pub><pmid>33888546</pmid><doi>10.1136/bmjdrc-2020-002103</doi><orcidid>https://orcid.org/0000-0002-0695-736X</orcidid><oa>free_for_read</oa></addata></record>
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subjects Activities of daily living
Blood pressure
Calories
Clinical trials
Diabetes
diabetes mellitus
Diet
Eating behavior
Epidemiology/Health services research
Glucose monitoring
glycated hemoglobin A
Hyperglycemia
Insulin
Lifestyles
Nutrition research
Patients
self-management
type 2
Variables
title Identifying sustainable lifestyle strategies for maintaining good glycemic control: a validation of qualitative findings
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