The study examined the impact of the Diabetes Prevention and Management programme on dietary tracking, changes in dietary behaviour, glycosylated Hb (HbA1c) and weight loss over 6 months among rural adults with type 2 diabetes and prediabetes. The programme was a health coach (HC)-led, community-based lifestyle intervention.

The study used an explanatory sequential quantitative and qualitative design to gain insight on participant’s dietary behaviour and macronutrient consumption as well as experience with food tracking. Five of the twenty-two educational sessions focussed on dietary education. Participants were taught strategies for healthy eating and dietary modification. Trained HC delivered the sessions and provided weekly feedback to food journals.

Obese adults with type 2 diabetes or prediabetes (n 94) participated in the programme and 56 (66 %) completed dietary tracking (optional) for 6 months. Twenty-two participated in three focus groups.

Fifty-nine percent consistently completed food journals. At 6 months, average diet self-efficacy and dietary intake improved, and average weight loss was 4·58 (sd 9·14) lbs. Factors associated with weight loss included attendance, consistent dietary tracking, higher HbA1c, diabetes status and energy intake (adjusted R2 = 43·5 %; F = 0·003). Focus group participants reported that the programme improved eating habits. The consistency of dietary tracking was cumbersome yet beneficial for making better choices and was key to being honest.

Participants who consistently tracked their diet improved dietary self-efficacy and intake over 6 months. This model has the potential to be reproduced in other rural regions of the United States.