PMID- 31621640 OWN - NLM STAT- MEDLINE DCOM- 20200611 LR - 20211204 IS - 1438-8871 (Electronic) IS - 1439-4456 (Print) IS - 1438-8871 (Linking) VI - 21 IP - 10 DP - 2019 Oct 16 TI - Development and Efficacy of an Electronic, Culturally Adapted Lifestyle Counseling Tool for Improving Diabetes-Related Dietary Knowledge: Randomized Controlled Trial Among Ethnic Minority Adults With Type 2 Diabetes Mellitus. PG - e13674 LID - 10.2196/13674 [doi] LID - e13674 AB - BACKGROUND: Ethnic minority populations exhibit disproportionately high rates of type 2 diabetes mellitus (T2DM). Electronic health tools have the potential to facilitate the cultural adaptation and tailoring of T2DM education to improve the knowledge and management of diabetes mellitus (DM). OBJECTIVE: This study aimed (1) to develop an adaptable Interactive Lifestyle Assessment, Counseling, and Education (I-ACE) software to support dietitian-delivered lifestyle counseling among low-socioeconomic status (SES) ethnic minority patients with T2DM and (2) to evaluate its effect on DM-related dietary knowledge and management compared with standard lifestyle advice (SLA) in a randomized controlled trial (RCT). METHODS: The I-ACE software, developed in consultation with clinical dieticians, incorporates evidence-based dietary and physical activity (PA) recommendations and educational materials. The features and behavioral change techniques include quantitative lifestyle (dietary intake and PA) assessment and simulation, individually tailored education and recommendations, motivational interviewing, and goal setting. For the unblinded pilot RCT, 50 overweight or obese Arab adults (aged 40-62 years) with poorly controlled T2DM were recruited from primary care clinics and randomly assigned to receive 4 in-person, dietician-delivered counseling sessions over 6 months using either (1) the I-ACE tool (experimental arm) or (2) the SLA methods (comparison arm). All outcome assessments were face-to-face. DM-related dietary knowledge (primary outcome) was measured at baseline, 3, 6, and 12 months. Lifestyle and other parameters were measured before, during, and after the intervention. Multiple linear regression and repeated measures linear mixed models were used to compare the changes in study outcomes and explore time trends in between-group and within-group changes. RESULTS: A total of 25 participants were enrolled in each arm, of whom 24 and 21 completed the final assessment of the primary outcome in the I-ACE and SLA arms, respectively. DM-related lifestyle knowledge increased more rapidly in the I-ACE arm than in the SLA arm (P value for study armxtime interaction=.02). Within the I-ACE arm, the mean (SE) differences in added sugar and dietary fiber intakes from baseline to 12 months were -2.6% (SE 1.0%) of total energy (P=.03) and 2.7 (SE 0.0) g/1000 kcal (P=.003), respectively. The odds of engaging in any leisure PA at 12 months tended to be higher in the I-ACE arm versus SLA arm, but did not reach statistical significance (odds ratio 2.8; 95% CI 0.7-11.6; P=.16). Both arms exhibited significant reductions in HbA(1c) (P value for change over time <.001). CONCLUSIONS: The use of the I-ACE software in a 6-month, 4-session dietician-delivered lifestyle counseling intervention improved the efficiency of lifestyle education, compared with SLA, among low-SES, ethnic minority patients with T2DM. This pilot trial provides justification for conducting a large-scale trial to evaluate its effectiveness and applicability in routine clinical care among ethnically diverse populations. TRIAL REGISTRATION: ClinicalTrials.gov NCT01858506; https://clinicaltrials.gov/ct2/show/NCT01858506. CI - (c)Kathleen Abu-Saad, Havi Murad, Rivka Barid, Liraz Olmer, Arnona Ziv, Nuha Younis-Zeidan, Vered Kaufman-Shriqui, Michal Gillon-Keren, Shmuel Rigler, Yakir Berchenko, Ofra Kalter-Leibovici. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.10.2019. FAU - Abu-Saad, Kathleen AU - Abu-Saad K AUID- ORCID: 0000-0003-2957-852X AD - Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. FAU - Murad, Havi AU - Murad H AUID- ORCID: 0000-0003-2728-3736 AD - Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. FAU - Barid, Rivka AU - Barid R AUID- ORCID: 0000-0003-3062-6111 AD - Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. AD - Israel Central Bureau of Statistics, Jerusalem, Israel. FAU - Olmer, Liraz AU - Olmer L AUID- ORCID: 0000-0001-6274-0918 AD - Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. FAU - Ziv, Arnona AU - Ziv A AUID- ORCID: 0000-0003-1147-8686 AD - Information and Computerization Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. FAU - Younis-Zeidan, Nuha AU - Younis-Zeidan N AUID- ORCID: 0000-0001-5634-9592 AD - Diet and Nutrition Service Unit for the Arab population in Sharon-Shomron District, Clalit Health Services, Arara, Israel. FAU - Kaufman-Shriqui, Vered AU - Kaufman-Shriqui V AUID- ORCID: 0000-0003-3190-4187 AD - Department of Nutritional Sciences, Ariel University, Ariel, Israel. FAU - Gillon-Keren, Michal AU - Gillon-Keren M AUID- ORCID: 0000-0002-2467-3117 AD - Institute of Endocrinology and Diabetes, Schneider Children's Medical Center, Petah Tikva, Israel. FAU - Rigler, Shmuel AU - Rigler S AUID- ORCID: 0000-0001-6728-6662 AD - Sharon-Shomron District, Clalit Health Services, Hadera, Israel. FAU - Berchenko, Yakir AU - Berchenko Y AUID- ORCID: 0000-0002-9786-4061 AD - Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. AD - Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel. FAU - Kalter-Leibovici, Ofra AU - Kalter-Leibovici O AUID- ORCID: 0000-0002-7404-7333 AD - Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel. AD - Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. LA - eng SI - ClinicalTrials.gov/NCT01858506 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20191016 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - Adult MH - Counseling/*methods MH - Diabetes Mellitus, Type 2/*psychology MH - Ethnicity MH - Female MH - Humans MH - Life Style MH - Male MH - Middle Aged MH - Minority Groups MH - Pilot Projects PMC - PMC6913526 OTO - NOTNLM OT - culturally congruent care OT - diabetes mellitus, type 2 OT - diabetes-related dietary knowledge OT - ethnic minorities OT - lifestyle OT - software COIS- Conflicts of Interest: None declared. EDAT- 2019/10/18 06:00 MHDA- 2020/06/12 06:00 PMCR- 2019/10/16 CRDT- 2019/10/18 06:00 PHST- 2019/02/11 00:00 [received] PHST- 2019/08/19 00:00 [accepted] PHST- 2019/07/10 00:00 [revised] PHST- 2019/10/18 06:00 [entrez] PHST- 2019/10/18 06:00 [pubmed] PHST- 2020/06/12 06:00 [medline] PHST- 2019/10/16 00:00 [pmc-release] AID - v21i10e13674 [pii] AID - 10.2196/13674 [doi] PST - epublish SO - J Med Internet Res. 2019 Oct 16;21(10):e13674. doi: 10.2196/13674.