Development and testing of a population-based electronic diabetes nutritional education tool

Abstract

Nutritional education for pre- and type 2 diabetes empowers individuals to make positive dietary and lifestyle choices. As the world migrates to digital devices, opportunities arise for education resources that have a wide reach in society to ease the pressure on over-stretched healthcare services.

The objective was to develop and test the effectiveness of an electronic nutritional education resource for pre- and type 2 diabetes suitable for the multi-ethnic New Zealand population.

This PhD project consists of five parts: A literature review (part one), examining the effectiveness of conventional and electronically delivered diabetes education. A needs assessment (part two), of ethnic-specific groups using focus groups (Māori, Pacific Island, European, East Asian and Indian) involving 29 people with pre- and type 2 diabetes. Focus group discussions were transcribed and analysed using inductive and deductive techniques. An online survey (part three), assessing nutritional knowledge, sources of information and preferred ways of receiving information responded to by 64 people with pre- and type 2 diabetes, 312 people interested in diabetes and 72 health professionals. Two satiety crossover trials (part four), in which a). the satiating qualities of rice, pasta and potato-based meals were tested (n=14); and b). how replacing starchy carbohydrate (rice or pasta) with non-starchy vegetables affected satiety (n=77). Both studies used validated visual analogue scales and area-under-the (satiety)-curves (AUC). Testing of an educational resource (part five), developed using information gathered in previous parts and with input from a focus group of ten diabetes dietitians. The resource was pre-validated in 93 individuals and its effectiveness was tested in 156 people (17 with pre- and type 2 diabetes, 118 people interested in diabetes, and 21 health professionals) using pre- and post-video quizzes. Ethics approvals were obtained for parts two to five.

Lack of diabetes nutritional knowledge, confusion, and a desire to learn was apparent in all ethnic focus groups. The need for nutritional education was confirmed by diabetes dietitians. The survey result showed health professionals had better nutritional knowledge than other respondents, and a diagnosis of diabetes was not predictive of improved nutritional knowledge in terms of which foods affect blood glucose. In the satiety studies, potato meals had a higher satiating effect than rice and pasta meals (AUChunger for potato, rice and pasta meal; 2635, 3745 and 4445 mm∙min respectively, P<0.05 between potato and the other meals). Replacing 50 grams of rice or pasta with an equal weight of non-starchy vegetables did not affect satiety. After viewing the educational resource, the accuracy of identifying foods that increase blood glucose improved by 17.4% (P=0.013) in people with pre- and type 2 diabetes, 12.8% (P=0.003) in health professionals, and 16.3% (P<0.001) in people interested in the condition, including an improvement among ethnic minority participants of 14.1% (P=0.003); with participants signalling intentions to make positive dietary and lifestyle choices.

The electronic nutritional education resource is an effective means for delivering education. It has potential to bridge the gap between the limited supply of healthcare resources and the increasing demand for diabetes nutritional education.