Avedzi Hayford M, Storey Kate, Johnson Jeffrey A, Johnson Steven T
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Centre for Nursing and Health Studies, Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada.
JMIR Res Protoc. 2019 Mar 6;8(3):e11707. doi: 10.2196/11707.
Rigorous evidence is needed regarding the best approach for increasing the uptake of Diabetes Canada's evidence-based recommendations to include low-glycemic index (GI) foods in daily meal planning as an effective dietary self-care strategy for glycemic control among people with type 2 diabetes (T2D).
This study aims to present the study design and baseline data from the Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI) trial, which was designed to evaluate the effectiveness of an enhanced GI-targeted nutrition education on GI-related knowledge and mean daily GI among adults with T2D in Edmonton, Alberta.
We used a pragmatic randomized controlled trial design and allocated 67 adults (aged ≥18 years) with T2D living in Edmonton, Alberta, Canada, to a control group that received standard printed copies of Canada's Food Guide and Diabetes Canada's GI resources or to an intervention group that received the same materials, plus a customized Web-based platform with 6 self-directed learning modules and print material. Each module included videos, links to reliable websites, chat rooms, and quizzes. Evidence-based GI concept information included GI values of foods and low-GI shopping, recipes, and cooking tips by a registered dietitian. In addition, support through email, text messaging (short message service), phone calls, or postal mail was provided to reinforce participants' learning. The primary outcome, average dietary GI, was assessed using 3-day food records. Additional measures including GI knowledge and self-efficacy, glycated hemoglobin (HbA), lipids, systolic blood pressure, body mass index (BMI; weight, height), waist circumference, and computer proficiency were assessed at baseline and at 3-month postintervention.
Between November 2017 and February 2018, we contacted adults (aged ≥18 years) with T2D living in Edmonton, Alberta, screened and recruited eligible participants into the study. All data collection ended in June 2018. Overall, 64% (43/67) participants were males; mean age was 69.5 (SD 9.3) years, with a mean diabetes duration of 19.0 (SD 13.7) years. Mean BMI was 30.1 (SD 5.7) kg/m, and mean HbA value was 7.1% (SD 1.2%). Data analysis was completed in December 2018.
The GI concept is often difficult to teach. The HEALD-GI study aims to provide evidence in support of an alternative approach to translating the GI concept to adults with T2D. Findings from this study may help registered dietitians to better disseminate low-GI dietary recommendations using efficient and cost-effective, patient-centered approaches. Furthermore, evidence generated will contribute to addressing some of the controversies regarding the clinical usefulness of the GI concept.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11707.
需要确凿的证据来证明哪种最佳方法能够提高加拿大糖尿病协会基于证据的建议的采纳率，即将低升糖指数（GI）食物纳入日常饮食计划，作为2型糖尿病（T2D）患者血糖控制的有效饮食自我护理策略。
本研究旨在介绍糖尿病健康饮食与积极生活方式——升糖指数（HEALD-GI）试验的研究设计和基线数据，该试验旨在评估强化的针对升糖指数的营养教育对加拿大艾伯塔省埃德蒙顿市成年T2D患者的升糖指数相关知识及每日平均升糖指数的有效性。
我们采用了实用随机对照试验设计，将67名居住在加拿大艾伯塔省埃德蒙顿市、年龄≥18岁的T2D成人患者分配到对照组，该组接受加拿大食物指南和加拿大糖尿病协会升糖指数资源的标准印刷版；或分配到干预组，该组接受相同材料，外加一个定制的基于网络的平台，该平台有6个自主学习模块及印刷材料。每个模块包括视频、可靠网站链接、聊天室和测验。基于证据的升糖指数概念信息包括食物的升糖指数值以及注册营养师提供的低升糖指数购物、食谱和烹饪小贴士。此外，还通过电子邮件、短信（短消息服务）、电话或邮政信件提供支持，以加强参与者的学习。主要结局指标，即平均饮食升糖指数，采用3天食物记录进行评估。在基线和干预后3个月评估包括升糖指数知识和自我效能、糖化血红蛋白（HbA）、血脂、收缩压、体重指数（BMI；体重、身高）、腰围和计算机操作能力等其他指标。
在2017年11月至2018年2月期间，我们联系了居住在加拿大艾伯塔省埃德蒙顿市、年龄≥18岁的T2D成人患者，筛选并招募符合条件的参与者进入研究。所有数据收集于2018年6月结束。总体而言，64%（43/67）的参与者为男性；平均年龄为69.5（标准差9.3）岁，平均糖尿病病程为19.0（标准差13.）年。平均BMI为30.1（标准差5.7）kg/m²，平均HbA值为7.1%（标准差1.2%）。数据分析于2018年12月完成。
升糖指数概念往往难以传授。HEALD-GI研究旨在提供证据，支持将升糖指数概念转化给成年T2D患者的另一种方法。本研究的结果可能有助于注册营养师使用高效、经济且以患者为中心的方法更好地传播低升糖指数饮食建议。此外，所产生的证据将有助于解决一些关于升糖指数概念临床实用性的争议。
国际注册报告识别码（IRRID）：DERR1-10.2196/11707。
