Localising Structured Lifestyle Intervention for Dietary Management Success

Abstract

Medical Nutrition erapy (MNT) consisting of a healthful eating pattern and regular physical activity, is an important component in the management of diabetes alongside pharmacotherapy. It is well established that part of the role of MNT is to achieve weight reduction as a key therapeutic goal for the prevention and management of T2DM. 4 Weight reduction with intensive lifestyle modiications has been shown to reduce the incidence of diabetes by 58 percent. 5 For individuals with T2DM, the Look AHEAD study reported that a loss of 5-10 percent of body weight can improve tness, reduce HbA1c levels, improve cardiovascular disease risk factors, and decrease the use of diabetes, hypertension, and lipid-lowering medications. 6,7 Nevertheless, adherence to lifestyle changes as prescribed by the MNT is often a challenge. In Malaysia, 80 percent of patients with T2DM consume four or more meals a day and ate more than two carbohydrate portions per snack. 8 Only 16.4 percent of patients adhered to the dietary regimen provided by dietitians. 9 Several studies showed that weight reduction and glycaemic control in patients with overweight/obesity and T2DM was more feasible and had better adherence when structured lifestyle recommendations were provided. 10-12 EVIDENCE FOR STRUCTURED LIFESTYLE INTERVENTION In the Look AHEAD study 10 , overweight/obese patients with T2DM who were randomly assigned into the intensive lifestyle intervention (ILI) group lost signiicantly more weight and achieved greater HbA1c reduction compared to patients who received standard diabetes management and support. e ILI group received a structured low-calorie diet plan of 1200-1800 kcal/day, with meal replacements and one snack, ≥175 min/week of moderate-intensity physical activity and behaviour modiications for weight loss of ≥7 percent. Similarly, in the Why WAIT programme, 11 overweight/obese patients with T2DM who received a structured lifestyle intervention had 82.3 percent of patients achieving the target HbA1c of <7 percent, and 69.4 percent of patients were able to reduce their HbA1c to <6.5 percent within 12 weeks. e successful patients were prescribed with low-calorie diet plans, used meal replacements, ate calorie-controlled snacks, and as well as prescribed with an exercise regime, behaviour modiications, group education, and medication adjustment. We recently published the eeectiveness of the structured approach in a lifestyle intervention study in overweight/obese patients with T2DM in Malaysia. 13 We randomised 230 T2DM patients with overweight/obesity and HbA1c >7 percent to receive usual care or structured lifestyle intervention for six months, delivered with behavioural counselling technique. Patients receiving the structured lifestyle intervention demonstrated signiicant improvements in their PERSON CENTRED DIABETES CARE AND MEAL PLANNING FOR THE OLDER PERSON https://doi. ABSTRACT The growing prevalence of type 2 diabetes mellitus (T2DM) and the parallel increase in the prevalence of obesity warrants for effective intervention strategies. Overweight/obese patients with T2DM who attempt weight reduction often face considerable challenges. A recent study in Malaysia conducted among overweight/obese patients with T2DM showed that weight reduction and improved glycaemic control could be achieved with structured lifestyle intervention and the incorporation of behavioural counselling. The structured lifestyle recommendations in this study consisted of 1) a fixed low-calorie diet plan of 1200 kcal/day for female and 1500 kcal/day for male patients; 2) incorporation of one or two servings/day of diabetes-specific formula as a meal replacement; 3) a 14-day structured meal plan consisting of the ingredients list, cooking methods and nutrition facts; and the 4) healthy low-calorie snack options. Exercise prescription of ≥150 min/week of moderate-intensity was also encouraged. Behavioural counselling such as motivational interviewing not only facilitated adherence to the lifestyle recommendations but also further enhanced weight loss and glycaemic control in these patients. This article outlines the localisation of the structured lifestyle recommendations and its effectiveness in achieving weight loss and good glycaemic control in overweight/obese patients with T2DM.