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Title

Nutritional behaviors in Pre-Diabetic patients and differences in stages of change” decisional balance” self-efficacy and process of change based on Trans-theoretical Model in Yazd-Iran

English Abstract

OBJECTIVE (Background): Impaired fasting glucose (IFG) and Impaired glucose tolerance (IGT) are considered to constitute “pre-diabetes.”[1] and are now recognized as pre-diabetes states. [2] which is characterized by elevated blood glucose levels with either fasting plasma glucose between 100 and 125.[3] Pre-diabetes prevalence varied by age, sex, and race/ethnicity, and there was considerable discordance between measures of pre-diabetes.[4] Subjects with IFG/IGT have an increased risk of developing diabetes and a higher prevalence of cardiovascular disease than normoglycemic individuals .[5] men and women with pre--diabetes were significantly older; had significantly higher BMI.[6]Research suggests that PD is associated with an increased risk of developing diabetes.[3]. Obesity-associated diabetes in adolescents is increasing throughout the world.[7] The Stages of Change Model has been used in interventions as a way of assessing and measuring participants' readiness for change.[8] Therefore, pre-diabetes is a condition in which primary prevention efforts through lifestyle modification are particularly important.[9]This study identifies pre-diabetes related characteristics of individuals at different stages of readiness to change to healthy eating. The objective of the current study is to determine nutritional behaviors of Pre-Diabetic persons based on Trans-theoretical model and relationships between nutrition behaviors and BMI among a population of Pre-diabetes adults in Yazd - Iran. Achieving glycemic control in patients with pre-diabetes through lifestyle and pharmacologic interventions can effectively prevent or delay the development of diabetes and its associated complications. The first step, however, is to identify patients at risk. RESEARCH DESIGN AND METHODS: Stage based differences in demographic, eating related, health care utilization, were examined in a sample of 220 pre-diabetic individuals aged thirty and above from health centers Yazd City. Validity of questionnaires was assessed by face & content method. Test retest and internal consistency methods were used for reliability of stages of change questionnaire and for nutritional knowledge scale respectively. The internal consistency of knowledge scale was high (Cronbach alpha= .73). Data was analyzed using SPSS17 using central indexes tests. We used fasting plasma glucose test to assess the IFG and pre-diabetes and used the Trans-theoretical Model (TTM) to estimate the nutritional behaviors. The TTM has recently provided insight into dietary changes regarding reducing fat, increasing fiber and losing weight. Participants completed validated questionnaires to assess the constructs of the TTM. This assessed where the patient was in the stage of change cycle, motivation to nutritional behaviors, how easy they thought this would be and attendance rate. Inclusions criteria were ability to read and understand Persian. A 5-point Likert scale was used; 1 being not at all confident and 5 being very confident. RESULTS: For pre- diabetic participants, sex, percent calories from fat, carbohydrate and protein differed across stages. Those in Pre-action stages were more likely than action and Social support was highest for those in the contemplation stage and lowest for those in the action stage. The majority of participants were in the Pre-action stages. CONCLUSIONS: These data validate the Trans-theoretical Model, where those in the action stages displayed healthier eating. Pre-contemplators and contemplators were a heterogeneous group and may need individually tailored interventions. Nutritional Behavior is important in preventing diabetes. It is, therefore, important at all levels of diabetes prevention. Keywords: Stages of Change Model, Trans-theoretical Model, Nutrition, Pre-diabetes

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