Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
BMC Prim Care. 2024 May 2;25(1):148. doi: 10.1186/s12875-024-02405-5.
Lifestyle changes, especially regarding diet quality and physical activity, are important in the management of type 2 diabetes (T2D). This mixed-methods study explores self-initiated lifestyle changes in patients with T2D who followed a periodic fasting-mimicking diet (FMD).
Quantitative data were obtained from the Fasting In diabetes Treatment trial (November 2018 to August 2021) in which 100 participants with T2D, using metformin only or no medication, were randomised to receive a monthly 5-day FMD for twelve months next to usual care, or usual care only. Diet quality and physical activity questionnaires were completed at baseline, six and twelve months. Changes over time were analysed using linear mixed models. Focus groups were organized with FMD participants to explore experiences regarding self-initiated lifestyle changes. The qualitative data was analysed using the Theoretical Domains Framework.
Questionnaires were available from 49 FMD participants and 43 controls. No differences in diet quality were found. Total physical activity in the FMD participants changed from 34.6 to 38.5 h per week (h/wk) from baseline to twelve months, while in controls it changed from 34.9 to 29.0 h/wk (between group difference, p = 0.03). In six focus groups with FMD participants (n = 20), individual participants perceived the FMD as an encouragement for (minor) lifestyle changes. There were no barriers to behaviour change related to the FMD. Important facilitators of healthy behaviour were an increase in awareness of the impact of lifestyle on health (knowledge), better physical fitness (physical) and health improvement (reinforcement). Facilitators unrelated to the FMD included family support (social influences) and opportunities in the neighbourhood (environmental context and resources), while barriers unrelated to the FMD were experiencing health problems (physical) and social events (social influences).
Using an FMD for five consecutive days per month did not affect diet quality in between FMD periods in quantitative analysis, but increased the number of hours per week spent on physical activity. Qualitative analysis revealed self-initiated improvements in both diet quality and physical activity in individual participants using an FMD. Healthcare professionals could use an FMD programme as a 'teachable moment' to stimulate additional lifestyle changes.
ClinicalTrials.gov; NCT03811587. Registered 22 January 2019.
生活方式的改变，尤其是饮食质量和身体活动，对于 2 型糖尿病（T2D）的管理很重要。这项混合方法研究探索了接受周期性断食模拟饮食（FMD）的 T2D 患者自行发起的生活方式改变。
定量数据来自 Fasting In diabetes Treatment 试验（2018 年 11 月至 2021 年 8 月），该试验将 100 名使用二甲双胍或无药物治疗的 T2D 患者随机分为接受每月 5 天的 FMD 治疗 12 个月，同时接受常规护理，或仅接受常规护理。在基线、6 个月和 12 个月时完成饮食质量和身体活动问卷。使用线性混合模型分析随时间的变化。与接受 FMD 的参与者组织焦点小组，以探讨关于自行发起的生活方式改变的经验。使用理论领域框架分析定性数据。
FMD 参与者和对照组各有 49 份和 43 份问卷可用。饮食质量没有差异。FMD 参与者的总体力活动从基线到 12 个月时从 34.6 小时/周增加到 38.5 小时/周（组间差异，p=0.03），而对照组从 34.9 小时/周增加到 29.0 小时/周。在 6 个有 FMD 参与者（n=20）的焦点小组中，个别参与者认为 FMD 鼓励（轻微）生活方式改变。行为改变没有与 FMD 相关的障碍。健康行为的重要促进因素是提高对生活方式对健康影响的认识（知识）、更好的身体健康（身体）和健康改善（强化）。与 FMD 无关的促进因素包括家庭支持（社会影响）和社区中的机会（环境背景和资源），而与 FMD 无关的障碍包括健康问题（身体）和社会事件（社会影响）。
在定量分析中，每月连续 5 天使用 FMD 并未影响 FMD 期间的饮食质量，但增加了每周的体力活动时间。定性分析显示，个体参与者使用 FMD 自行改善了饮食质量和体力活动。医疗保健专业人员可以将 FMD 计划用作“可教时刻”，以刺激额外的生活方式改变。
ClinicalTrials.gov；NCT03811587。于 2019 年 1 月 22 日注册。
