Transtheoretical model-based dietary interventions in primary care: a review of the evidence in diabetes

The objective of this study was to review the evidence concerning stage-based dietary inter-ventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and man-ual search. Selection criteria were randomized controlled studies with stage-based dietary in-tervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclu-sion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardio-vascular diseases and being overweight, not di-abetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, dia-stolic blood pressure, health status and well-being. The existing data are insufficient for drawing conclusions on the benefits of the trans-theoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing sep-arately on education interventions for patients and providers