Theoretical perspectives to increase clinical effectiveness of lifestyle modification strategies in diabetes.

Diabetes affects more than 18 million people in the United States. The prevalence of type 2 diabetes has increased at an alarming rate in the past 20 years. Minorities are disproportionately affected, with the greatest increase in adult prevalence noted in African-American women. The increasing prevalence of type 2 diabetes in both children and adults is strongly associated with the increasing prevalence of obesity. Diabetes and its complications can be controlled with appropriate health care and patient self-management techniques. There is strong empirical evidence supporting the efficacy of dietary and physical activity interventions in the prevention and treatment of type 2 diabetes. The results of empirical studies have not translated well into clinical practice. Four key theoretical concepts are presented in an effort to increase the effectiveness of lifestyle intervention counseling by primary care providers. The four concepts include: perceptual congruence, mutual goal setting, readiness to change, and tailored interventions.