Dissertations & Theses (Open Access)

Date of Award

Winter 12-15-2023

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

Nalini Ranjit

Second Advisor

Baojiang Chen

Third Advisor

Deanna M Hoelscher

Abstract

Short- and long-term changes in diet or physical activity in relation to type 2 diabetes mellitus (T2DM) and factors associated with behavior change with adequate inclusion of relevant confounding and effect-modifying variables have been minimally explored. The objective of this research was to examine changes in diet and physical activity following a diagnosis of T2DM and identify sociodemographic, medical, psychosocial, and lifestyle factors associated with changes in dietary or physical activity behaviors. This dissertation utilized two prospective cohorts of U.S. female nurses participating in the Nurses’ Health Study (1976-2016) and Nurses’ Health Study II (1989-2017). Linear mixed effects modeling was conducted to assess short-term changes in diet and activity behaviors by comparing pre- and post-regression-adjusted average diet and activity scores determined by date of diagnosis of T2DM. Group-based trajectory analysis was conducted to examine trajectories of long-term changes in diet and physical activity among women diagnosed with T2DM, and specifically, if there are distinct subgroups experiencing different trajectories of change in behaviors over time. The results from this work support previous findings that, overall, women improve their diet and physical activity levels after diagnosis of T2DM in the short term, but adherence is not sustained over the longer term. The current research contributes to a larger understanding of how women adapt diet and physical activity behaviors after T2DM diagnosis and what factors are associated with short-term and long-term changes in behavior.

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