Efectividad de una intervención nutricional gradual sobre la adherencia alimentaria y el control glucémico en adultos con diabetes mellitus tipo 2

Introduction: Poor adherence to dietary recommendations makes it difficult to manage type 2 diabetes; therefore, a stepwise nutritional intervention based on monthly goals was evaluated. Objective: To evaluate the association between a gradual nutritional intervention based on monthly goals—implemented over six months at CESSA Gaviotas in Villahermosa, Tabasco—and changes in dietary adherence, HbA1c, BMI, and waist circumference in adults with T2DM. Materials and Methods: A quantitative, quasi-experimental, single-group study was conducted, with pre- and post-intervention measurements of glycated hemoglobin (HbA1c), body mass index (BMI), and waist circumference. Dietary adherence was assessed using three instruments. Paired measurements were compared, and correlations between the observed changes were analyzed. Results: No statistically significant changes were observed in BMI (p = 0.158) or waist circumference (p = 0.360). HbA1c decreased by 0.60 percentage points (p = 0.001), with a moderate effect size (d = -0.48). Changes in HbA1c were significantly correlated with the four indicators of adherence and eating behavior analyzed: foods to eliminate, foods to increase, MEDAS, and the behavioral scale (p < 0.001). Changes in BMI and waist circumference were not significantly associated with the adherence indicators (p > 0.05). Discussion: The intervention was associated with statistically significant improvements in self-reported indicators of dietary adherence and a significant reduction in HbA1c. However, due to the single-group design and the absence of a control group, these changes should not be interpreted as evidence of causality. The lack of significant changes in BMI and waist circumference could indicate that, during the follow-up period, metabolic changes were more pronounced than anthropometric changes; this interpretation should be considered exploratory. Conclusions: In this sample of adults with type 2 diabetes mellitus, a gradual nutritional intervention based on monthly goals was associated with statistically significant and large improvements in self-reported indicators of dietary adherence, as well as a moderate reduction in HbA1c. No significant changes were observed in BMI or waist circumference. Controlled studies with longer follow-up are needed to assess the independent effect of the intervention.