Effectiveness of a Gradual Nutritional Intervention on Dietary Adherence and Glycemic Control in Adults with Type 2 Diabetes Mellitus
Effectiveness of a Gradual Nutritional Intervention on Dietary Adherence and Glycemic Control in Adults with Type 2 Diabetes Mellitus
DOI:
https://doi.org/10.19136/mhr.a11n1.6701Keywords:
Type 2 diabetes mellitus, Dietary adherence, nutritional intervention, glycated hemoglobinAbstract
Introduction: Poor adherence to dietary recommendations makes it difficult to manage type 2 diabetes; therefore, a stepwise nutritional intervention based on monthly goals was evaluated.
Objective: To evaluate the association between a gradual nutritional intervention based on monthly goals—implemented over six months at CESSA Gaviotas in Villahermosa, Tabasco—and changes in dietary adherence, HbA1c, BMI, and waist circumference in adults with T2DM.
Materials and Methods: A quantitative, quasi-experimental, single-group study was conducted, with pre- and post-intervention measurements of glycated hemoglobin (HbA1c), body mass index (BMI), and waist circumference. Dietary adherence was assessed using three instruments. Paired measurements were compared, and correlations between the observed changes were analyzed.
Results: No statistically significant changes were observed in BMI (p = 0.158) or waist circumference (p = 0.360). HbA1c decreased by 0.60 percentage points (p = 0.001), with a moderate effect size (d = -0.48). Changes in HbA1c were significantly correlated with the four indicators of adherence and eating behavior analyzed: foods to eliminate, foods to increase, MEDAS, and the behavioral scale (p < 0.001). Changes in BMI and waist circumference were not significantly associated with the adherence indicators (p > 0.05).
Discussion: The intervention was associated with statistically significant improvements in self-reported indicators of dietary adherence and a significant reduction in HbA1c. However, due to the single-group design and the absence of a control group, these changes should not be interpreted as evidence of causality. The lack of significant changes in BMI and waist circumference could indicate that, during the follow-up period, metabolic changes were more pronounced than anthropometric changes; this interpretation should be considered exploratory.
Conclusions: In this sample of adults with type 2 diabetes mellitus, a gradual nutritional intervention based on monthly goals was associated with statistically significant and large improvements in self-reported indicators of dietary adherence, as well as a moderate reduction in HbA1c. No significant changes were observed in BMI or waist circumference. Controlled studies with longer follow-up are needed to assess the independent effect of the intervention.
References
Abose, S., Dassie, G. A., Megerso, A., & Charkos, T. G. (2024). Adherence to recommended diet among patients with diabetes mellitus type 2 on follow-up at Adama Hospital Medical College, Ethiopia. Frontiers In Medicine, 11, 1484071. https://doi.org/10.3389/fmed.2024.1484071
American Diabetes Association Professional Practice Committee (2025). 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025. Diabetes care, 48(1 Suppl 1), S86–S127. https://doi.org/10.2337/dc25-S005
Ayele, A. A., Emiru, Y. K., Tiruneh, S. A., Ayele, B. A., Gebremariam, A. D., & Tegegn, H. G. (2018). Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital. Clinical Diabetes And Endocrinology, 4(1), 21. https://doi.org/10.1186/s40842-018-0070-7
Bandura, A. (1978). Autoeficacia: Hacia una teoría unificadora del cambio de comportamiento. Advances in Behaviour Research and Therapy, 1(4), 139–161. https://doi.org/10.1016/0146-6402(78)90002-4
Di Onofrio, V., Gallé, F., Di Dio, M. et al. Efectos de la intervención motivacional nutricional en pacientes con diabetes mellitus tipo 2: un estudio longitudinal en Nápoles, sur de Italia. BMC Public Health 18 , 1181 (2018). https://doi.org/10.1186/s12889-018-6101-6
Forouhi, N. G., Misra, A., Mohan, V., Taylor, R., & Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ, 361, k2234. https://doi.org/10.1136/bmj.k2234
Gardner, B., & Rebar, A. L. (2016). Habit Formation and Behavior Change. Oxford Research Encyclopedia Of Psychology. https://doi.org/10.1093/acrefore/9780190236557.013.129
Gu, X., Drouin-Chartier, J., Sacks, F. M., Hu, F. B., Rosner, B., & Willett, W. C. (2023). Red meat intake and risk of type 2 diabetes in a prospective cohort study of United States females and males. American Journal Of Clinical Nutrition, 118(6), 1153-1163. https://doi.org/10.1016/j.ajcnut.2023.08.021
Kempf, K., Dubois, C., Arnold, M., Amelung, V., Leppert, N., Altin, S., Vomhof, M., Icks, A., & Martin, S. (2023). Effectiveness of the Telemedical Lifestyle Intervention Program TeLIPro for Improvement of HbA1c in Type 2 Diabetes: A Randomized-Controlled Trial in a Real-Life Setting. Nutrients, 15(18), 3954. https://doi.org/10.3390/nu15183954
Liu, Y., Li, H., Zhao, Q., & Cui, W. (2025). Effects of 12 nutritional interventions on type 2 diabetes: a systematic review with network meta-analysis of randomized trials. Nutrition & Metabolism, 22(1), 94. https://doi.org/10.1186/s12986-025-00968-3
Martín-Peláez, S., Fito, M., & Castaner, O. (2020). Mediterranean Diet Effects on Type 2 Diabetes Prevention, Disease Progression, and Related Mechanisms. A Review. Nutrients, 12(8), 2236. https://doi.org/10.3390/nu12082236
Marume, A., Chidoko, E., & Chirenda, J. (2025). Dietary interventions and glycaemic control in type 2 diabetes: A systematic review and meta-analysis. Journal Of Public Health In Africa, 16(1), 1325. https://doi.org/10.4102/jphia.v16i1.1325
Palomo, M. C., Denman, C. A., Cornejo-Vucovich, E. C., Landeros-Flores, P. E., & Rodríguez-Ibarra, S. (2022). Barreras y facilitadores para una alimentación saludable entre participantes de Meta Salud Diabetes en Sonora, México. Estudios Sociales Revista de Alimentación Contemporánea y Desarrollo Regional. https://doi.org/10.24836/es.v32i59.1220
Parrales-Chávez, G. S., Rodríguez-Jaramillo, A. M., & Quevedo-Reyna, G. A. (2022). Factores Asociados al Control Glucémico en Personas con Diabetes Mellitus: Función de la Hemoglobina Glicosilada y Estilo de Vida. Dialnet. https://dialnet.unirioja.es/servlet/articulo?codigo=8399914
Petroni, M. L., Brodosi, L., Marchignoli, F., Sasdelli, A. S., Caraceni, P., Marchesini, G., & Ravaioli, F. (2021). Nutrition in Patients with Type 2 Diabetes: Present Knowledge and Remaining Challenges. Nutrients, 13(8), 2748. https://doi.org/10.3390/nu13082748
PRONAM (s. f.) (2025). Viviendo con diabetes, viviendo bien: Manual para personas que viven con diabetes. Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México. https://pronamsalud.csg.gob.mx/
Roddy, M. K., Pfammatter, A. F., & Mayberry, L. S. (2023). Optimizing adaptive stepped-care interventions to change adults’ health behaviors: A systematic review. Journal Of Clinical And Translational Science, 7(1), e190. https://doi.org/10.1017/cts.2023.618
Saveanu, C. I., Ilie, P., Anistoroaei, D., Bobu, L. I., Saveanu, A. E., Boronia, O., & Golovcencu, L. (2025). Dietary Behaviors, Sugar Intake, and Public Awareness of Nutritional Labeling Among Young Adults: Implications for Oral and Systemic Health. Nutrients, 18(1), 91. https://doi.org/10.3390/nu18010091
Schröder, H., Fitó, M., Estruch, R., Martínez-González, M. A., Corella, D., Salas-Salvadó, J., Lamuela-Raventós, R., Ros, E., Salaverría, I., Fiol, M., Lapetra, J., Vinyoles, E., Gómez-Gracia, E., Lahoz, C., Serra-Majem, L., Pintó, X., Ruiz-Gutierrez, V., & Covas, M. (2011). A Short Screener Is Valid for Assessing Mediterranean Diet Adherence among Older Spanish Men and Women. Journal Of Nutrition, 141(6), 1140-1145. https://doi.org/10.3945/jn.110.135566
Stunkard, AJ, & Messick, S. (1985). El cuestionario de alimentación de tres factores para medir la restricción alimentaria, la desinhibición y el hambre. Journal of Psychosomatic Research , 29 (1), 71–83. https://doi.org/10.1016/0022-3999(85)90010-8
Sunuwar, D. R., Nayaju, S., Dhungana, R. R., Karki, K., Pradhan, P. M. S., Poudel, P., Nepal, C., Thapa, M., Shakya, N. S., Sayami, M., Shrestha, P. K., Yadav, R., & Singh, D. R. (2023). Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with type 2 diabetes in Nepal: a single centre, open-label, randomised controlled trial. The Lancet Regional Health - Southeast Asia, 18, 100285. https://doi.org/10.1016/j.lansea.2023.100285
Sylvetsky, A. C., Edelstein, S. L., Walford, G., Boyko, E. J., Horton, E. S., Ibebuogu, U. N., Knowler, W. C., Montez, M. G., Temprosa, M., Hoskin, M., Rother, K. I., Delahanty, L. M., & Diabetes Prevention Program Research Group (2017). A High-Carbohydrate, High-Fiber, Low-Fat Diet Results in Weight Loss among Adults at High Risk of Type 2 Diabetes. The Journal of nutrition, 147(11), 2060–2066. https://doi.org/10.3945/jn.117.252395
Terán, Y. A. M., Manzano, A. S., Ortiz, S. B., Ulloa, V. A., Sandoval, V., Fajardo, A. C. E., & Carpio-Arias, T. V. (2021). Construcción de un Cuestionario de Frecuencia de Consumo de Alimentos para Adultos Ecuatorianos, estudio transversal. Revista Española de Nutrición Humana y Dietética, 25(4), 394-402. https://doi.org/10.14306/renhyd.25.4.1340
Villafaña-Guillén, N., Rojas-Lemus, M., González-Villalva, A., López-Valdez, N., Cervantes-Valencia, M. E., Bizarro-Nevares, P., Ustarroz-Cano, M., & Fortoul, T. I. (2025). Consumo de bebidas azucaradas y sus efectos en la salud. Revista de la Facultad de Medicina (México), 68(3), 9-19. https://doi.org/10.22201/fm.24484865e.2025.68.3.02
Wan, X., Liu, X., Ao, Y., Zhang, L., Zhang, L., Zhuang, P., Jiao, J., & Zhang, Y. (2024). Associations between cooking method of food and type 2 diabetes risk: A prospective analysis focusing on cooking method transitioning. Environmental Pollution, 360, 124662. https://doi.org/10.1016/j.envpol.2024.124662
Zhang, Y., Han, H., & Chu, L. (2022). Effectiveness of restricted diet with a plate in patients with type 2 diabetes: A randomized controlled trial. Primary Care Diabetes, 16(3), 368-374. https://doi.org/10.1016/j.pcd.2022.03.007
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
