Currently submitted to: Journal of Medical Internet Research
Date Submitted: Sep 29, 2019
Open Peer Review Period: Sep 29, 2019 - Nov 24, 2019
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Web-based interventions for dietary behavior in adults with type 2 diabetes: a systematic review of randomized controlled trials
Type 2 diabetes mellitus (T2DM) is among the most prevalent non-communicable health conditions worldwide, affecting over 500 million people globally. Diet is a key aspect of T2DM management with dietary modification shown to elicit clinically meaningful outcomes such as improved glycemic control, and reductions in weight and cardiovascular disease risk factors. Web-based interventions provide a potentially convenient and accessible method for delivering dietary education but its effects on dietary behavior in people with T2DM are unknown.
The objective of this review was to determine the effectiveness of web-based interventions on dietary behavior change and glycemic control in people with T2DM.
In accordance with PRISMA guidelines, systematic literature searches were performed using Medline, Embase, The Cochrane Library, and CINAHL to retrieve papers from January 2013 to May 2019. Randomized controlled trials of web-based interventions in adults with T2DM with reported dietary assessment were included. Population and intervention characteristics, dietary guidelines and assessments, and significant clinical outcomes were extracted. Differences between groups and within groups were assessed for dietary behavior and clinical outcomes.
There were 714 records screened and five studies comprising 1056 adults were included. Studies measured dietary changes by assessing overall diet quality, changes in specific dietary components, or dietary knowledge scores. Significant improvements in dietary behavior were reported in four out of the five studies, representing healthier food choices, improvements in eating habits, reductions in carbohydrates, added sugar, sodium, saturated fat and overall fat intake, and/or increases in dietary knowledge. Three studies found significant mean reductions for hemoglobin A1c ranging from –0.3% to –0.8%, and/or weight ranging from –2.3 kg to –12.7 kg, fasting blood glucose (–1 mmol/L), waist circumference (–1 cm), and triglycerides (–60.1 mg/dL). These studies provided varied dietary recommendations from standard dietary guidelines, national health program guidelines, and a very low carbohydrate ketogenic diet.
Web-based interventions are effective for supporting dietary behavior change in adults with T2DM in most cases, though changes in glycemic control and other clinical outcomes are inconsistent. There was considerable heterogeneity in the diets recommended and the dietary assessment measures used across all studies, therefore, more research is needed to determine whether these effects are sufficiently greater than those achieved through usual care.
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