title: Nutritional education through internet-delivered menu plans among adults with type 2 diabetes mellitus: pilot study.
abstract: BACKGROUND
  A potential barrier to weight loss and vascular risk reduction is difficulty in operationalizing dietary education into a concrete plan. Although a variety of Internet-based software tools are now available to address this issue, there has been little formal evaluation of these tools.
  
  
  OBJECTIVE
  The aim of this single-arm pilot study is to determine the effect of a 24-week Internet-based menu-planning program, by examining pre- to postintervention changes in the body weight, blood pressure, and glycemia, specifically among overweight adults with type 2 diabetes mellitus (DM2), a clinical population at high risk for vascular diseases.
  
  
  METHODS
  A total of 33 adults with DM2 were recruited by collaborating registered dietitians to a 24-week Internet-based menu-planning program. Individualized dietary prescriptions were operationalized into weekly Internet-delivered menu plans through an adapted version of a commercially available service. Adherence was defined as logging into the program at least once per week for a minimum of 18 of the 24 weeks. Multiple imputations were used for missing data. Using baseline and postintervention assessments, we calculated the weight changes (mean, 95% CI) and investigated the corresponding effects (linear regression models) on blood pressure (systolic, diastolic) and hemoglobin A1C (ie, glycemia).
  
  
  RESULTS
  The mean age was 58 (SD 7) years and the mean baseline body mass index was 34.4 (SD 4.6) kg/m(2). The results of this study showed that ≥5% weight reduction was achieved by 6/33 participants (18%) and by 5/18 adherent participants (28%). A mean weight change of -2.0% (95% CI -2.6 to -1.4) was observed, with changes occurring in the adherent (-3.6%, 95% CI -4.5 to -2.8) but not in the nonadherent (0%, 95% CI -0.6 to 0.7). It was found that each 1% reduction in body weight was associated with a -2.4 mmHg change in systolic (95% CI -3.5 to -1.2) and a -0.8 mmHg change in diastolic blood pressure (95% CI -1.4 to -0.2). Percent weight change was not found to be related to changes in A1C.
  
  
  CONCLUSIONS
  In adults with DM2, an Internet-based menu-planning program has the potential to lead to clinically important weight reductions in more than one quarter of those who adhere, with corresponding improvements in blood pressure.
authors.affiliation: School of Dietetics and Human Nutrition, McGill University, Montreal, QC, Canada.
authors.forename: Abeer
authors.initials: A
authors.lastname: Bader
authors.forename: Réjeanne
authors.initials: R
authors.lastname: Gougeon
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.forename: Deborah
authors.initials: D
authors.lastname: Da Costa
authors.forename: Kaberi
authors.initials: K
authors.lastname: Dasgupta
keywords: Internet; Web; blood pressure; diet; hemoglobin A1C; menu; obesity; type 2 diabetes mellitus; weight loss