Malaysian adults with type 2 diabetes and overweight or obesity saw sustained improvements in body weight and glycemic control after a 6-month, culturally adapted intervention that included medical nutrition therapy combined with motivational interviewing, according to published findings.
“Weight loss of at least 5% to 10% in patients with overweight/obesity and type 2 diabetes confers significant benefit in terms of decreasing insulin resistance and improving glycemic control, dyslipidemia and blood pressure,” Winnie Siew Swee Chee, PhD, MSc, professor of nutrition and dietetics at the International Medical University School of Health Sciences in Kuala Lumpur, Malaysia, and colleagues wrote. “Effective implementation of medical nutrition therapy with diabetes-specific therapeutic diets also improves glycemic control and risk for type 2 diabetes complications. Therefore, based on expanding and compelling evidence linking healthy lifestyle interventions with clinical benefit in type 2 diabetes, an international group of diabetes and nutrition experts developed the transcultural diabetes nutrition algorithm as a practical tool to optimize care centered on cultural, ethnic and geographic adaptations.”
Chee and colleagues analyzed data from 230 adults aged 30 to 65 years with non-insulin-treated type 2 diabetes, BMI of at least 23 kg/m² and HbA1c between 7% and 11% from a primary care clinic in Negeri Sembilan, Malaysia. Researchers randomly assigned patients to usual care (n = 115) or a Malaysian transcultural diabetes nutrition algorithm (n = 115) for 6 months. The transcultural intervention included medical nutrition therapy consisting of a low-calorie meal plan (1,200-1,500 kcal per day), one or two diabetes-specific meal replacements (Glucerna, Abbott Nutrition), and recommended physical activity of 150 minutes per week. Usual care followed the Malaysian Clinical Practice Guideline for type 2 diabetes and included advice to follow a low-calorie diet plan and lifestyle education. Patients in the intervention arm were then further assigned to motivational interviewing (n = 58) or conventional counseling (n = 57) to promote adherence to lifestyle recommendations. All patients were followed at 3 and 6 months after the intervention ended; during this phase, patients were required to keep diaries of food intake and physical activity. Primary outcome was change in HbA1c; secondary outcome measures included changes in body weight, BMI, waist circumference, percentage body fat, fasting plasma glucose, BP and high-sensitivity C-reactive protein.
In both intervention groups, HbA1c improved at 6 months, with patients in the motivational interviewing arm exhibiting a greater decrease vs. those in conventional counseling (–1.1% vs. –0.5%; P < .001 for both). Both intervention arms also saw a greater decrease in body weight and BMI vs. usual care, again with the motivational interviewing group seeing the greatest weight loss vs. the conventional counseling arm (mean, –6.9 kg vs. –5.3 kg; P < .001 for both).
Decrease in waist circumference was also greatest in the motivational interviewing arm (mean, –4 cm) vs. the counseling arm (mean, –2.7 cm) or usual care (mean, –0.5 cm). Patients in the motivational interviewing arm also saw a greater drop in FPG vs. the counseling arm or usual care (mean, –1.1 mmol/L vs. –0.6 mmol/L vs. 0.1 mmol/L, respectively).
At follow-up 6 months after the intervention ended, weight, BMI and HbA1c increased in all groups, according to researchers; however, patients in the motivational interviewing arm maintained a greater mean weight loss from baseline vs. those in the counseling group or usual care (mean, –5.8 kg vs. –3.3 kg vs. 0.5 kg; P < .001 respectively). The motivational interviewing group also maintained a reduction in HbA1c.
“One of the most significant findings of this study is the beneficial effects of using a counseling approach that incorporates motivational interviewing as part of a structured lifestyle intervention,” the researchers wrote. Patients in the intervention arm that included motivational interviewing “showed significantly better outcomes in terms of weight, BMI, body composition, [HbA1c], FPG, systolic blood pressure, reduced energy intake and increased exercise minutes during the 6 months’ intervention period. Moreover, patients receiving motivational interviewing maintained significantly lower body weight and [HbA1c] levels even 1 year after the intervention terminated.”
The researchers noted that providers who apply the motivational interviewing “spirit” (such as collaboration) and motivational interviewing-consistent strategies (such as reflective statements) had patients with obesity who demonstrated greater weight loss than with those providers who did not employ those tactics.
“Providing a structured intervention was able to help individuals simplify the decision-making process and identify how to make changes, and in addition the use of meal replacements provided a strategy that enhanced dietary adherence,” the researchers wrote. – by Regina Schaffer
Disclosures: Abbott Nutrition Malaysia funded this study.