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Diabetes Educ. 2008 Nov-Dec;34(6):1025-36. doi: 10.1177/0145721708325767.

Affecting behavior change in individuals with diabetes: findings from the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD).

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  • 1Saint Luke's Primary Care South, Overland Park, KS, USA.



This study evaluated whether health knowledge, attitudes, and behaviors of individuals with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus and those at high or low risk of T2DM were reflected in healthy behaviors and whether these attributes differed for T2DM respondents who did or did not see a health educator.


SHIELD, a U.S. population-based study, included respondents (> or =18 years of age) with T1DM (n = 366), T2DM (n = 3897), high risk (HR, n = 5449) defined as > or =3 of the following: abdominal obesity, high body mass index, dyslipidemia, hypertension, cardiovascular disease, and low risk (LR, n = 5725) defined as < or =2 factors.


T2DM respondents were more likely to receive health care professional recommendations to change their lifestyle habits (56%-62%) during their average 11 visits annually than the other groups (P < .0001). More T2DM and HR respondents tried losing weight, but fewer exercised regularly than T1DM and LR (P < .0001). T2DM respondents who saw a dietitian or health educator reported better current health and expectations for better future health, tried to make healthy food choices, and followed a prescribed eating plan than those who did not see these providers (P < .01). However, < or =30% of these T2DM respondents exercised regularly, or maintained desired weight.


SHIELD findings show that respondents know and understand that improving their diet or exercise will affect their health, but the majority of respondents have not translated it into a behavior. Interaction with health educators and patient-empowering support may improve the transition to behavior change.

[PubMed - indexed for MEDLINE]
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