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Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm (tDNA) in individuals with type 2 diabetes: a randomized controlled trial
  1. Winnie S S Chee1,
  2. Harvinder Kaur Gilcharan Singh1,
  3. Osama Hamdy2,
  4. Jeffrey I Mechanick3,
  5. Verna K M Lee4,
  6. Ankur Barua5,
  7. Siti Zubaidah Mohd Ali6,
  8. Zanariah Hussein7
  1. 1 Department of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
  2. 2 Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, USA
  3. 3 Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, USA
  4. 4 Department of Family Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
  5. 5 Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
  6. 6 Department of Non-Communicable Diseases, Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
  7. 7 Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, Malaysia
  1. Correspondence to Dr Winnie S S Chee; winnie_chee{at}


Objective Trans-cultural diabetes nutrition algorithm (tDNA) was created by international task force and culturally customized for Malaysian population. This study was designed to evaluate its effectiveness versus usual diabetes care in primary care settings.

Research design and methods We randomized 230 patients with overweight/obesity, type 2 diabetes, and glycated hemoglobin (A1c) 7%–11% to receive usual care (UC) or UC with tDNA for 6 months. The tDNA intervention consisted of structured low-calorie meal plan, diabetes-specific meal replacements, and increased physical activity. Participants were counseled either through motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice through conventional counseling. All patients were followed for another 6 months after intervention.

Results At 6 months, A1c decreased significantly in tDNA-MI (−1.1±0.1%, p<0.001) and tDNA-CC (−0.5±0.1%, p=0.001) but not in UC (−0.2±0.1%, p=NS). Body weight decreased significantly in tDNA-MI (−6.9±1.3 kg, p<0.001) and tDNA-CC (−5.3±1.2 kg, p<0.001) but not in UC (−0.8±0.5 kg, p=NS). tDNA-MI patients had significantly lower fasting plasma glucose (tDNA-MI: −1.1±0.3 mmol/L, p<0.001; tDNA-CC: −0.6±0.3 mmol/L, p=NS; UC: 0.1±0.3 mmol/L, p=NS) and systolic blood pressure (tDNA-MI: −9±2 mm Hg, p<0.001; tDNA-CC: −9±2 mm Hg, p=0.001; UC: −1±2 mm Hg, p=NS). At 1 year, tDNA-MI patients maintained significant reduction in A1c (tDNA-MI: −0.5±0.2%, p=0.006 vs tDNA-CC: 0.1±0.2%, p=NS and UC: 0.02±0.01%, p=NS) and significant weight loss (tDNA-MI: −5.8±1.3 kg, p<0.001 vs tDNA-CC: −3.3±1.2 kg, p=NS and UC: 0.5±0.6 kg, p=NS).

Conclusions Structured lifestyle intervention through culturally adapted nutrition algorithm and motivational interviewing significantly improved diabetes control and body weight in primary care setting.

  • lifestyle intervention
  • type 2 diabetes
  • metabolic control
  • weight loss

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  • Original reference: none

  • Parts of this study were presented as a late-breaking poster presentation at the 76th Scientific Sessions of the American Diabetes Association, New Orleans, LA, 10-14 June 2016.

  • Contributors All authors read and approved the final manuscript. WSSC was involved in conception and design of the study, data analysis and interpretation, and editing and writing of the manuscript. HKGS was involved in data collection, analysis, data interpretation, and editing of the manuscript. OH, JIM, AB, VKML, SZMA, and ZH provided input on the intellectual content of critical importance to the work described and editing of the manuscript.

  • Funding This study was funded by Abbott Nutrition, Malaysia. The funding body did not influence the collection, analysis and interpretation of data, writing of the report, and decision to publish the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval International Medical University Institutional Review Board and National Medical Research Registry, Ministry of Health Malaysia.

  • Provenance and peer review Not commissioned; externally peer reviewed.