Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: a systematic review and meta-analysis

Background: Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA(1c) and body weight. Methods: We performed a systematic review of papers published between 1975-2015 describing randomised controlled trials (RCTs) that focused exclusively on both diet and physical activity. The constituent BCTs, intervention features and methodological rigour of these interventions were evaluated. Changes in HbA(1c) and body weight were meta-analysed and examined in relation to use of BCTs. Results: Thirteen RCTs were identified. Meta-analyses revealed reductions in HbA(1c) at 3, 6, 12 and 24 months of -1. 11 % (12 mmol/mol), -0.67 % (7 mmol/mol), -0.28 % (3 mmol/mol) and 0.26 % (2 mmol/mol) with an overall reduction of - 0.53 % (6 mmol/mol [95 % CI - 0.74 to -0.32, P < 0.00001]) in intervention groups compared to control groups. Meta- analyses also showed a reduction in body weight of -2.7 kg, -3.64 kg, -3.77 kg and -3.18 kg at 3, 6, 12 and 24 months, overall reduction was -3.73kg (95 % CI -6.09 to -1.37 kg, P =0.002). Four of 46 BCTs identified were associated with > 0.3 % reduction in HbA(1c): \u27instruction on how to perform a behaviour\u27, `behavioural practice/rehearsal\u27, \u27demonstration of the behaviour\u27 and \u27action planning\u27, as were intervention features \u27supervised physical activity\u27, \u27group sessions\u27, \u27contact with an exercise physiologist\u27, \u27contact with an exercise physiologist and a dietitian\u27, \u27baseline HbA(1c) > 8 %\u27 and interventions of greater frequency and intensity. Conclusions: Diet and physical activity interventions achieved clinically significant reductions in HbA(1c) at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes