Nutrition Counseling

NC: Diabetes Management (2007)

Read more about behavior change theory.

Cognitive-Behavioral Therapy

Diabetes management

Intervention
What is the evidence that cognitive behavior therapy of long-term duration (more than 12 months), targeted to prevention or delayed onset of diabetes, results in health or food behavior change in adults counseled in an outpatient or clinic setting?
- Conclusion
  Three large RCTs (two of positive quality and one of neutral quality) provide evidence that cognitive-behavioral therapy of greater than two years' duration is beneficial in preventing or delaying onset of diabetes mellitus.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Long-Duration CBT and Prevention or Delayed Onset of Diabetes
- Search Plan and Results: NC: Counseling Theories 2007
What is the evidence that cognitive-behavioral therapy of short-term duration (less than six months), targeted to diabetic management results in health or food behavior change in adults counseled in an outpatient or clinic setting?
- Conclusion
  Two positive-quality RCTs, involving adult subjects approximately 60 years of age with type 2 diabetes, provide evidence that short-term cognitive-behavioral therapy facilitates positive lifestyle changes. One traditional cognitive-behavioral program targeting African-Americans significantly decreased weight, BMI and lipid levels and improved glucose control beyond that of usual care. One individually-tailored cognitive-behavioral intervention significantly reduced self-reported fat intake and increased physical activity, as compared to a usual care group.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Short Duration CBT for Diabetes Risk Factors
- Search Plan and Results: NC: Counseling Theories 2007
What is the evidence that cognitive-behavioral therapy of intermediate duration (six to 12 months), targeted to diabetic management, results in health or food behavior change in adults counseled in an outpatient or clinic setting?
- Conclusion
  Three positive-quality RCTs and three neutral-quality trials (one RCT and two quasi-experimental-non-randomized trials) provide evidence that cognitive-behavioral therapy of a duration of six to 12 months, targeted to people with type 2 diabetes, resulted in significant improvements in HbA1C, fasting blood sugar, weight and numerous cardiovascular risk factors. Additional research is needed to determine if these positive outcomes can be sustained over time.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Intermediate Duration Cognitive-Behavioral Therapy for diabetes risk factors
- Search Plan and Results: NC: Counseling Theories 2007
What is the evidence that cognitive behavior therapy of long-term duration (over 12 months), targeted to diabetic management, results in health or food behavior change in adults counseled in an outpatient or clinic setting?
- Conclusion
  One positive-quality RCT and one neutral-quality non-randomized trial assessed the effect of behavioral therapy, added to usual care, on diabetic management over a two-year period. Clinically-significant outcomes reported at six months were generally not sustained at the two-year point, with the exception of a significant reduction in total serum cholesterol. A third positive-quality study demonstrated sustainment of positive behavioral and psycho-social change well-maintained at two years, but clinical outcomes beyond six months are not available. Additional research is needed on the effect of CBT of greater than 12 months' duration on patients with diabetes, using a research design which controls for pharmacotherapy.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: Long-Duration CBT for Diabetes Management
- Search Plan and Results: NC: Counseling Theories 2007