Web-based Interventions to Support Dietary Change in People with Type 2 Diabetes

Diet is essential for the management of type 2 diabetes. It helps people lower and maintain healthy blood glucose levels and optimise other aspects of their health such as weight, cholesterol and blood pressure.

However, as we all know, making changes to our diet isn’t an easy process. For people with type 2 diabetes, who also deal with the complexities of daily blood sugar management, dietary change is often one of the most challenging parts of their self-management.

While it would be ideal for every person with type 2 diabetes to consult with a dietitian on a regular basis, this is unfortunately unrealistic. In Australia, we have growing rates of type 2 diabetes and not enough health practitioners to meet the demand. There are also issues with accessibility and the cost involved in delivering programs or providing support face-to-face. 

Given these obstacles, how do we support people with type 2 diabetes to change their eating habits?

The answer can be found in technology as it can help us form scalable solutions to reach a greater number of people.

There has been research in various areas of technology such as mHealth, smartphone apps, telehealth, and web-based interventions. No review had previously assessed the effect of web-based interventions for changing dietary behaviour in people with type 2 diabetes.

Our systematic review investigated whether web-based interventions could be an effective way to support dietary change in people with type 2 diabetes, and also whether they influence clinical outcomes such as improving blood glucose control.

We found that such interventions have potential to improve eating habits and the overall quality of people’s diets in as little as 16 weeks. The results also showed the possibility that people may sustain their improved eating habits up to one year.

Blood glucose control did improve in some studies. The most common biomarker for measuring blood glucose control in people with type 2 diabetes is haemoglobin A1c (HbA1c), the reductions in HbA1c ranged from 0.3% to 0.8%. There were also improvements in fasting blood glucose, triglycerides, weight and waist circumference, but the results were inconsistent.

Interestingly, our review revealed there are still very big gaps in this field of research, mainly because there are very few studies in this area—only five met our inclusion criteria.

Most web-based interventions focus on overall self-management of diabetes and did not include any form of dietary assessment, which is surprising considering the importance of dietary modification for people with type 2 diabetes.

We need more web-based dietary interventions, or at least measurement of the dietary components that are included in web-based self-management interventions. It would also be beneficial to have similar validated dietary measurement tools being used across studies, so results could be compared.

Our review did uncover some valuable insights too. For instance, the inclusion of healthcare practitioner support in interventions is often suggested to improve results. In our review, it did not make any difference to outcomes. This may indicate that providing automated web-based interventions could be a first consideration. They have the potential to be more cost effective and scalable.

In comparison to people being given general healthy eating information and choosing their own goals, the potential for achieving success with dietary change seems to be enhanced when people are provided with clear dietary guidelines that are more instructional in nature. In addition, aiming for an intervention that is easy to understand is essential. Complexity has been noted many times as a barrier to success.

Methods to achieve simplicity and increase longer term participation and engagement may be using structured modules and including a user-centred approach—two methods that were highlighted by the review.

While there is still much work to be done in this field, overall, the results of our systematic review show promise for web-based interventions as a way to support dietary change in people with type 2 diabetes.

Jedha Dening is a PhD candidate in the Institute for Physical Activity and Nutrition (IPAN). Jedha’s PhD will evaluate the effectiveness of a web-based dietary intervention for adults with type 2 diabetes in Australia. She is also interested in user-centred qualitative research, adherence and engagement in digital behaviour change interventions, and other forms of digital health interventions to support people with type 2 diabetes.

Disclosure: Jedha is co-owner of Diabetes Meal Plans, a web-based low carbohydrate nutrition support service for people with type 2 diabetes and prediabetes.

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