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What Participants Say About Dieting to Achieve Diabetes Remission

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What Participants Say About Dieting to Achieve Diabetes Remission MEDICINE DIGEST VERY-LOW-ENERGY DIETS WHAT PARTICIPANTS SAY ABOUT DIETING TO ACHIEVE DIABETES REMISSION 42 DIABETES U P D AT E SPRING 2018 42-46_MedicineDigest_SA4.indd 42 22/02/2018 13:58 The Counterbalance and DiRECT trials showed that very-low-energy and low- energy diets can lead to remission of Type 2 diabetes. But what is it like being on one of these trials? A new study explores the barriers and facilitators to success in a situation where calorie intake is severely restricted. The fi ndings could be used to optimise the outcomes of future diabetes remission studies eight loss achieved Counterbalance through a very-low- The Counterbalance study consisted energy diet (VLED) on an eight-week VLED, followed by a can normalise blood two-week stepped return to a calorie- glucose levels in people ontrolled diet. It involved 30 adults with Wwith Type 2 diabetes. Moreover, a review Type 2 diabetes of duration 0.5 to 23 of the evidence shows that VLEDs are years. The diet allowed 800kcal per day, associated with greater weight loss than of which 600kcal was in the form of low-energy diets, minimal interventions liquid formula soups and shakes. The or standard care at three and six rest of the calorie allowance was made months. Although VLEDs may seem up of vegetables, and participants were challenging, attrition rates are actually asked not to drink alcohol. In addition, similar to those for other weight loss all oral hypoglycaemic agents were regimens and have improved in recent stopped for the duration of the study. years. Attrition rates can be used as a The participants also attended the measure of how acceptable a weight Magnetic Resonance Centre at weeks loss plan is to the participant. 1, 4 and 8 for biomedical measurements There have been few studies, and interviews about their experience of however, on the acceptability of VLEDs the study. Weekly one-to-one support, in terms of improved quality of life. to maximise adherence, was provided There has been one study looking at by email, phone and face-to-face the experience of a VLED delivered in a contact. Changes in body mass, plasma group setting which showed that social ketones and food diaries were used to support, participation in a research monitor adherence. Participants were study and improvements in wellbeing also asked to record their fasting and contributed to weight reduction. Now, post-meal blood glucose levels three a new study, from researchers at times a week. Newcastle University, takes an in-depth look at participant experience of VLEDs. Exploring experiences Specifi cally, it examines perceived of the VLED barriers to, and facilitators of, adherence This new study is based on semi- and the various behaviour regulation structured interviews with strategies employed by a group of participants, carried out before people with Type 2 diabetes taking part and after the eight-week in a trial of a VLED for remission of the VLED. Only those condition. The new fi ndings are part of who achieved their the Counterbalance study, which is a weight loss goals single-centre trial conducted in the UK – generally 2.8 with the aim of achieving normalisation per cent body of blood glucose levels (also known as weight loss at diabetes remission), insulin secretion week 1 and and action and reductions of liver and 8 per cent at week 8 – pancreatic fat through application of a were permitted to continue in VLED. This is the fi rst qualitative study to the study. At the end of the VLED look at the acceptability and experience phase, the participants’ weight had of VLEDs in the context of diabetes fallen from 98.0 (±2.6)kg to 83.8 THINKSTOCK remission. It complements the evidence (±2.4)kg. Furthermore, 12 of the 30 on the effi cacy of the VLED in diabetes participants achieved remission of remission that has emerged from their Type 2 diabetes (fasting plasma PHOTOS: ▲ the main Counterbalance study. glucose <7mmol/l). DIABETES UPDATE SPRING 2018 43 42-46_MedicineDigest_SA4.indd 43 22/02/2018 13:58 MEDICINE DIGEST VERY-LOW-ENERGY DIETS What I found be healthy enough to take care of, and tended to increase the desire to ‘give in’ spend time with, family later in life. to temptation. But awareness and with the diet is that weighing up of the pros and cons the regimen suits "The main thing that I’m after strengthened resolve. Impulse, triggered me. I like to know is trying to cut myself free from by the sight or smell of food, as well diabetes. That’s a very strong as a conscious decision to ‘break’ the what I’m going motivation, because I am not diet led to deviations. It was when to have to eat getting any younger..." the participant was alone that such Woman, 35 years, diabetes deviations were most likely to occur, duration 1.5 years Then there was the wish to get rid of underlining the importance of social the practicalities of managing diabetes, pressure and support. such as the need to take tablets and side effects associated with diabetes Facilitators The interviews included open-ended medication. of adherence questions about participants’ Participants thought about potential The study revealed that the three main experience of the VLED. These were barriers before they began on the VLED. factors facilitating adherence to a VLED conducted face-to-face and audio- Some worried that stressful situations were: rapid results, social support and recorded, with fi eld notes being taken might lead to lapses. Availability of social being involved in a research study. before and after the interview. The support during the study was seen as Weight loss led to being able to fi t into interviewer was a health psychology important – participants could approve smaller clothes and improvements in PhD student, with a Masters in health appearance and wellbeing, all of which psychology, supervised during the provided extra motivation to continue. study by an experienced academic Receiving compliments was a very clinical psychologist. The interviews important form of social support. were anonymised and transcribed Relatives and friends also helped verbatim. adherence through: The analysis of the interview • altering their own eating behaviour data aimed to: • eating at different times from • understand barriers and the participant facilitators to completing a • refraining from offering food VLED within a clinical study • warning the participant before • understand how intervention cooking, so they could avoid procedures can be optimised tempting sights and smells to maximise acceptability • reminding participants of the of the VLED ‘rules’. • enable more individuals with Type 2 diabetes to succeed with It was particularly helpful to get support dietary remission in the future. from a friend or relative who had successfully gone through a weight loss A thematic approach to the data programme. So was creating a support analysis was used, with coding of system with others who were losing predefi ned theory-based themes, and weight at the same time. Another inclusion of additional themes emerging or disapprove and study staff could element was the feeling of being from the data. offer information and encouragement, privileged by being in the study, for it as well as feedback in terms of weight involved only a small number of people. Motivation and initial and blood glucose measurement. Not wanting to let the researchers expectations down, appreciating the time and effort The main motives for taking part in The VLED experience involved on their part and wanting to Counterbalance were the prospect Although some participants had worried contribute to diabetes research were of diabetes remission and weight loss. that they would feel hungry on the diet, all powerful drivers of adherence. Many participants had previously tried adhering to it turned out to be easier to lose weight and maintain the loss, than anticipated. "I do recognise...that this is a with varying degrees of success. The medical study so I’m one of a prospect of large and rapid weight "I thought I would have been hungry handful of people that are lucky loss in Counterbalance was appealing. from the moment I opened my eyes to actually be on it..." People wanted to dress better and to the moment I closed my eyes " feel more confi dent in their bodies. but I wasn’t" Behaviour regulation Improvements in long-term health and The researchers learned about the regaining control over their health were The most important factors affecting behaviour regulation strategies also a big draw. The wish to increase adherence were physical and social employed to facilitate their adherence to THINKSTOCK the length and quality of life with environments, emotional states and the the diet. These centred around planning, increasing age was another motivating possession of self-regulatory skills. For avoiding and distraction. Some of these PHOTOS: factor. Many said how they wanted to instance, sadness, loneliness and stress strategies are listed in the following table. 44 DIABETES U P D AT E SPRING 2018 42-46_MedicineDigest_SA4.indd 44 22/02/2018 13:58 Theme Strategy Food removal Throwing away/giving away/eating up leftovers before starting the VLED Avoidance of… Television, to avoid food ads or snacking Social events with abundance of food Planning Having healthy nibbles (carrots, pieces of apple) to hand Carrying a bottle of water Hunger Drinking the VLED shakes hot or very cold to improve palatability management Going to bed earlier Getting active/distracting oneself from food with gardening or hobbies Reminding oneself of one’s success Social Telling others
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