Nutrition and Exercise: A Scoping Review of Best Practices for Addressing Social Determinants of Health in the Management of Type 2 Diabetes.

Abstract

<h4>Aims</h4>Type 2 diabetes (T2DM) is a complex chronic condition that is highly prevalent in the United States (U.S.). Self-management practices are a critical component in diabetes care. A patient's engagement with medication, glucose monitoring, intake of nutrient-dense foods, and participation in physical activity (PA) is influenced by the social determinants of health (SDOH). In this scoping review article, we assessed the use of structural interventions that targeted SDOH to impact two self-management strategies, healthy food consumption and PA uptake, and subsequent diabetes-related health outcomes.<h4>Materials and methods</h4>Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Google Scholar, PubMed, and Web of Science databases were utilised to identify relevant articles using MeSH terms, keywords and Boolean logic searching. We included articles with a focus on structural interventions to increase intake of nutrient-dense foods or PA for the management of T2DM.<h4>Results</h4>We reviewed four articles-two focused on improving access to healthy foods, while two focused on multi-component, multi-domain, and multi-level interventions; we did not find structural PA interventions.<h4>Conclusions</h4>We found varying evidence for best practices regarding supportive elements embedded in interventions, but found there may be value in multi-component, multi-domain, and multi-level interventions to support T2DM self-management. Further research is needed to confirm value of multi-component, multi-domain, and multi-level interventions, particularly for underserved populations. In conclusion, there is not a one-size-fits-all approach to addressing determinants to healthy eating and PA, but interventions and outcomes may benefit when contributory factors beyond the individual level are addressed and communities affected are centred.