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Short-term effects of group-based nutritional education on nutritional adherence and glycaemic control in outpatients with type 2 diabetes: a randomised clinical trial

Published online by Cambridge University Press:  17 October 2025

Aline Busanello Open the ORCID record for Aline Busanello [Opens in a new window] ,
Olivia Garbin Koller ,
Vanessa Machado Menezes ,
Ândria Völz Andreia  and
Jussara Carnevale de Almeida
Aline Busanello
Affiliation:
Post-Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Olivia Garbin Koller
Affiliation:
Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Vanessa Machado Menezes
Affiliation:
Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Ândria Völz Andreia
Affiliation:
Post-Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Jussara Carnevale de Almeida*
Affiliation:
Post-Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Post-Graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Division of Nutrition and Dietetics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil Department of Nutrition, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
*
Corresponding author: Jussara Carnevale de Almeida; Email: jcalmeida@hcpa.edu.br
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Abstract

The objective of this study was to evaluate the impact of incorporating group-based nutritional education into usual care on adherence to nutritional counselling among outpatients with type 2 diabetes (T2DM). This parallel-group, randomised controlled superiority trial was conducted with outpatients diagnosed with T2DM and poor glycaemic control. The control group received individual usual care, while the intervention group received usual care plus group-based nutritional education, which included three sessions: ‘Let’s Go Shopping,’ ‘Healthy Plate’ and ‘Hunger and Satiety.’ Baseline and four-month follow-up assessments were conducted, and outcome measures included adherence to nutritional counselling, glycaemic control, weight and physical activity. A total of 213 participants were included: 61·9 % were women, aged 60 years (interquartile range (IQR) = 53–65), 67·6 % with low socio-economic status, 67·3 % had obesity and the glycated Hb (HbA1c) was 9·3 % (IQR = 8·3–10·2 %). The intervention did not result in superior glycaemic control; however, short-term reductions in HbA1c were observed across all participants (–0·3 % (IQR = –0·7–0·3 %)). The intervention group demonstrated an increase in physical activity levels between visits (262 metabolic equivalent tasks (IQR = 99–257); P = 0·038), but no significant difference between the groups. Participants in the intervention group adhered to 67 % of combinations, compared with 50 % in the control group (P = 0·012), and adherence to the diabetes plate method was significantly higher in this group (75·9 % v. 62·2 %; P = 0·05). In conclusion, no significant between-group differences in glycaemic control were found, although both groups improved HbA1c short-term. Group-based nutritional education increased dietary adherence, particularly to the diabetes plate method and physical activity. Long-term effects on metabolic outcomes warrant further study.

Keywords

Type 2 diabetes mellitusNutrition educationEating behaviourGlycated Hb ABody weight

Information

Type
Research Article
Information
British Journal of Nutrition , Volume 134 , Issue 11 , 14 December 2025 , pp. 892 - 903
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Nutrition Society

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References

World Health Organization (2019) Classification of Diabetes Mellitus. World Health Organization. https://iris.who.int/handle/10665/325182 (accessed June 2024).Google Scholar
International Diabetes Federation (2021) IDF Diabetes Atlas, 10th ed. https://diabetesatlas.org/ (accessed June 2024).Google Scholar
American Diabetes Association (2024) Standards of medical care in diabetes. Diabetes Care 47, 1.Google Scholar
Evert, AB, Dennison, M, Gardner, CD, et al. (2019) Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 5, 731–754.CrossRefGoogle Scholar
Cradock, KA, ÓLaighin, G, Finucane, FM, et al. (2017) Diet behavior change techniques in type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 12, 1800–1810.CrossRefGoogle Scholar
Mannucci, E, Giaccari, A, Gallo, M, et al. (2022) Self-management in patients with type 2 diabetes: group-based v. individual education. A systematic review with meta-analysis of randomized trials. Nutr Metab Cardiovasc Dis 2, 330–336.CrossRefGoogle Scholar
Odgers-Jewell, K, Ball, LE, Kelly, JT, et al. (2017) Effectiveness of group-based self-management education for individuals with type 2 diabetes: a systematic review with meta-analyses and meta-regression. Diabet Med 8, 1027–1039.CrossRefGoogle Scholar
Chrvala, CA, Sherr, D & Lipman, RD (2016) Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns 6, 926–943.CrossRefGoogle Scholar
Almutairi, N, Hosseinzadeh, H & Gopaldasani, V (2020) The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs. Prim Care Diabetes 1, 12–20.CrossRefGoogle Scholar
Ministério da Saúde (2016) Instrutivo: metodologia de trabalho em grupos para ações de alimentação e nutrição na atenção básica (Instructive: Group Work Methodology for Food and Nutrition Actions in Primary Care). https://www.gov.br/saude/pt-br/composicao/saps/promocao-da-saude/guias-alimentares/publicacoes/instrutivo_metodologia_trabalho_nutricao_ab.pdf/view (accessed June 2024).Google Scholar
Kim, J & Hur, MH (2021) The effects of dietary education interventions on individuals with type 2 diabetes: a systematic review and meta-analysis. Int J Environ Res Public Health 18, 168439.Google ScholarPubMed
Bekele, H, Asefa, A, Getachew, B, et al. (2020) Barriers and strategies to lifestyle and dietary pattern interventions for prevention and management of type-2 diabetes in Africa, systematic review. J Diabetes Res 2020, 7948712.CrossRefGoogle ScholarPubMed
Mogre, V, Johnson, NA, Tzelepis, F, et al. (2019) A systematic review of adherence to diabetes self-care behaviours: evidence from low- and middle-income countries. J Adv Nurs 75, 3374–3389.CrossRefGoogle ScholarPubMed
Baral, J, Karki, KB, Thapa, P, et al. (2022) Adherence to dietary recommendation and its associated factors among people with type 2 diabetes: a cross-sectional study in Nepal. J Diabetes Res 2022, 6136059.CrossRefGoogle ScholarPubMed
Busanello, A, Menezes, VM, Koller, OG, et al. (2025) Effect of group-based nutritional education combined with individual standard care for outpatients with type 2 diabetes: study protocol for a randomized clinical trial {1}. Trials 26, 78.CrossRefGoogle ScholarPubMed
Ministério da Saúde (2014) Guia alimentar para a população brasileira (Food Guide for the Brazilian Population), 2nd ed. https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf (accessed June 2024).Google Scholar
American Diabetes Association (2020) What is the Diabetes Plate Method? https://diabetes.org/food-nutrition/eating-healthy (accessed June 2024).Google Scholar
Colberg, SR, Sigal, RJ, Yardley, JE, et al. (2016) Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 11, 2065–2079.CrossRefGoogle Scholar
Sociedade Brasileira de Diabetes (2023) Diretrizes da Sociedade Brasileira de diabetes (Brazilian Diabetes Society (2023) Guidelines of the Brazilian Diabetes Society). https://diretriz.diabetes.org.br (accessed June 2024).Google Scholar
Sawka, MN, Cheuvront, SN & Carter, R (2005) Human water needs. Nutr Rev 63, S30–S39.CrossRefGoogle ScholarPubMed
Cacau, LT, Marcadenti, A, Bersch-Ferreira, AC, et al. (2022) The AHA recommendations for a healthy diet and ultra-processed foods: building a new diet quality index. Front Nutr 11, 804121.CrossRefGoogle Scholar
Critério de Classificação Econômica Brasil (2021) Associação Brasileira de Empresas de Pesquisa (Brazil Economic Classification Criteria (2021) Brazilian Association of Research Companies). http://www.abep.org/criterio-brasil (accessed June 2024).Google Scholar
Dunstan, DW, Dogra, S, Carter, SE, et al. (2021) Sit less and move more for cardiovascular health: emerging insights and opportunities. Nat Rev Cardiol 18, 637–648.CrossRefGoogle Scholar
Monteiro, CA, Levy, RB, Claro, RM, et al. (2010) A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica 11, 2039–2049.CrossRefGoogle Scholar
Alvarenga, M, Figueiredo, M & Timerman, F (2019) Nutrição Comportamental (Behavioral Nutrition), 2nd ed. Barueri: Manole.Google Scholar
Antonaccio, C & Figueiredo, M (2018) Mindiful Eating: Comer com Atenção Plena (Mindful Eating: Eating with Mindfulness). São Paulo: Abril.Google Scholar
Steinfeldt, L, Anand, J & Murayi, T (2013) Food reporting patterns in the USDA automated multiple-pass method. Procedia Food Sci 2, 145–156.CrossRefGoogle Scholar
Alexopoulos, AS, Yancy, WS, Edelman, D, et al. (2021) Clinical associations of an updated medication effect score for measuring diabetes treatment intensity. Chronic Illn 4, 451–462.CrossRefGoogle Scholar
Das, T, Takkar, B, Sivaprasad, S, et al. (2021) Recently updated global diabetic retinopathy screening guidelines: commonalities, differences, and future possibilities. Eye (Lond) 10, 2685–2698.CrossRefGoogle Scholar
Viana, LV, Gross, JL, Camargo, JL, et al. (2012) Prediction of cardiovascular events, diabetic nephropathy, and mortality by albumin concentration in a spot urine sample in patients with type 2 diabetes. J Diabetes Complications 5, 407–412.CrossRefGoogle Scholar
Carey, RM & Whelton, PK (2017) Hypertension guideline writing committee. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med 5, 351–358.Google Scholar
Associação Brasileira de Empresas de Pesquisa (2021) Critério de Classificação Econômica Brasil (Brazilian Association of Research Companies (2021) Brazil Economic Classification Criteria). http://www.abep.org/criterio-brasil (accessed June 2024).Google Scholar
International Physical Activity Questionnaire (2005) Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ) Short and Long Forms. http://biobank.ndph.ox.ac.uk (accessed June 2024).Google Scholar
Gibson, R (1990) Principles of Nutritional Assessment, 1st ed. New York: Oxford University Press. p. 195.Google Scholar
Cardinal, TR, Vigo, A, Duncan, BB, et al. (2018) Optimal cut-off points for waist circumference in the definition of metabolic syndrome in Brazilian adults: baseline analyses of the Longitudinal Study of Adult Health (ELSA-Brasil). Diabetol Metab Syndr 15, 49.CrossRefGoogle Scholar
Trindler, P (1969) Determination of blood glucose using an oxidase-peroxidase system with a non carcinogenic chromogen. J Clin Pathol 2, 158–161.CrossRefGoogle Scholar
Davis, JE, McDonald, JM & Jarett, L (1978) A high-performance liquid chromatography method for hemoglobin A1c. Diabetes 2, 102–107.CrossRefGoogle Scholar
Heinegård, D & Tiderström, G (1973) Determination of serum creatinine by a direct colorimetric method. Clin Chim Acta 3, 305–310.CrossRefGoogle Scholar
Levey, AS, Stevens, LA, Schmid, CH, et al. (2009) CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 9, 604–612.CrossRefGoogle Scholar
Teppo, AM (1982) Immunoturbidimetry of albumin and immunoglobulin G in urine. Clin Chem 6, 1359–1361.CrossRefGoogle Scholar
Naik, AD, Palmer, N, Petersen, NJ, et al. (2011) Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Arch Intern Med 5, 453–459.Google Scholar
Matsudo, S, Araújo, T, Matsudo, V, et al. (2012) Questionário Internacional de Atividade Física (IPAQ): estudo de validade e reprodutibilidade no Brasil (International Physical Activity Questionnaire (IPAQ): validity and reproducibility study in Brazil). Rev Bras Ativ Fís Saúde 2, 5–18.Google Scholar
American Heart Association (2024) What is Cardiovascular Disease. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease (accessed March 2025).Google Scholar
Safren, SA, Gonzalez, JS, Wexler, DJ, et al. (2014) A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes. Diabetes Care 3, 625–633.CrossRefGoogle Scholar
Eshete, A, Lambebo, A, Mohammed, S, et al. (2023) Effect of nutritional promotion intervention on dietary adherence among type II diabetes patients in North Shoa Zone Amhara Region: quasi-experimental study. J Health Popul Nutr 1, 49.CrossRefGoogle Scholar
Steinsbekk, A, Rygg, L, Lisulo, M, et al. (2012) Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res 12, 213.CrossRefGoogle ScholarPubMed
Bowen, ME, Cavanaugh, KL, Wolff, K, et al. (2016) The diabetes nutrition education study randomized controlled trial: a comparative effectiveness study of approaches to nutrition in diabetes self-management education. Patient Educ Couns 8, 1368–1376.CrossRefGoogle Scholar
Hohberg, V, Lichtenstein, E, Kreppke, JN, et al. (2025) Effects of lifestyle interventions to promote physical activity on physical activity and glycated hemoglobin in patients with type 2 diabetes: a systematic review and meta-analysis. Sports Med 55, 1165–1181.CrossRefGoogle ScholarPubMed
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