Long Tianxue, Zhang Yating, Zhang Yiyun, Wu Yi, Huang Jing, Jiang Hua, Luo Dan, Cai Xue, Tang Rongsong, Zhang Dan, Peng Lang, Guo Xiaojing, Li Mingzi
School of Nursing, Peking University, Beijing 100891, China.
School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210023, China.
Nutrients. 2025 May 3;17(9):1574. doi: 10.3390/nu17091574.
BACKGROUND/OBJECTIVES: Traditional diet management for type 2 diabetes (T2DM) is often complex and effortful to sustain. Nudging offers low-effort and automatic approaches to dietary behaviour change yet remains underexplored in T2DM. This study evaluated the independent and combined 6-month effects of nudging education (NE) and nudging tableware (NT) on HbA1c, along with other secondary health outcomes, among adults with T2DM and overweight/obesity, compared to their non-nudge counterparts (control education, CE; control tableware, CT).
A 2 × 2 factorial cluster RCT was conducted in 12 primary healthcare settings in China (pre-registered as ChiCtr2100044471). Participants were randomly assigned to the nudging education group (NE + CT), the nudging tableware group (CE + NT), the combined group (NE + NT) or the full-control group (CE + CT) for 1 month. The primary outcome was HbA1c. Secondary outcomes included dietary behaviours, metabolic indicators, and psychological health. Generalized linear mixed models were used for analysis.
A total of 284 participants (mean age, 52.28 years; 54.3% male) were randomly assigned and included in the analysis. After 6 months, NE and NT independently led to HbA1c reductions (-0.76%, < 0.001; -0.33%, = 0.042, vs. controls), with an additive but non-interactive effect when combined, resulting in a 1.04% reduction ( < 0.001) in the combined group. They also improved total calorie, macronutrient, and vegetable intake, FBG, plasma lipids, and BMI. NE additionally reduced diabetes distress and enhanced self-efficacy.
Both NE and NT improved dietary and metabolic outcomes without increasing the psychological burden. The combined group showed the greatest benefits. Findings highlighted the importance of considering automatic processes in diabetes management.
背景/目的：2型糖尿病（T2DM）的传统饮食管理通常复杂且难以持续。助推提供了低努力且自动的饮食行为改变方法，但在T2DM中仍未得到充分探索。本研究评估了助推教育（NE）和助推餐具（NT）对T2DM合并超重/肥胖成年人糖化血红蛋白（HbA1c）的独立及联合6个月效果，以及其他次要健康结局，并与非助推对照组（对照教育，CE；对照餐具，CT）进行比较。
在中国的12个基层医疗保健机构进行了一项2×2析因整群随机对照试验（预先注册为ChiCtr2100044471）。参与者被随机分配到助推教育组（NE+CT）、助推餐具组（CE+NT）、联合组（NE+NT）或完全对照组（CE+CT），为期1个月。主要结局是HbA1c。次要结局包括饮食行为、代谢指标和心理健康。采用广义线性混合模型进行分析。
共有284名参与者（平均年龄52.28岁；54.3%为男性）被随机分配并纳入分析。6个月后，NE和NT分别使HbA1c降低（-0.76%，P<0.001；-0.33%，P=0.042，与对照组相比），联合使用时具有相加但无交互作用的效果，联合组HbA1c降低了1.04%（P<0.001）。它们还改善了总热量、宏量营养素和蔬菜摄入量、空腹血糖（FBG）、血脂和体重指数（BMI）。NE还额外减轻了糖尿病困扰并增强了自我效能感。
NE和NT均改善了饮食和代谢结局，且未增加心理负担。联合组显示出最大益处。研究结果突出了在糖尿病管理中考虑自动过程的重要性。
