Evidence-Based Behavioral Interventions for Diabetes Prevention in the United States: A Scoping Review Using 24-Hour Recalls and Objective Activity Measures

The prevalence of type 2 diabetes (T2D) continues to rise, with behavioral interventions recognized as effective preventive strategies among adults in the USA. The American Diabetes Association (ADA) recommends improving diet, and activity behaviors (physical activity and sedentary behavior) as key targets for T2D prevention. Thus, this scoping review aimed to identify and describe key features of behavioral interventions that successfully improved diet and/or activity behaviors (aligned with ADA), including their delivery modes, target populations, and behavior change techniques (BCTs) used. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched till February 7, 2026, for randomized controlled trials (RCTs) evaluating efficacious behavioral interventions targeting diet and/or activity. Efficacious interventions were defined as those that demonstrated statistically significant effects on at least diet or activity outcome, assessed with validated measures, such as 24-hr dietary recalls and objective activity assessments, among adults. Data were extracted on study samples, target populations, delivery modes, and BCTs, which were classified using Michie's taxonomy. Twenty-three trials encompassing 2,583 adults were included. Most efficacious US-based interventions were tested among women, non-Hispanic White adults with at least some college education, aged 31-50, in an individual-based format (71%). According to delivery mode, intervention types were grouped into face-to-face (8%), e-interventions (29%), environmental (8%) and combined modes (54%). Common BCTs included goal setting (96%), instruction on how to perform a behavior (83%), social support (79%), feedback on behavior (67%). Although digital and combined delivery approaches were common among efficacious interventions and several frequently used BCTs were identified, the limited representation of diverse populations highlights the need for future research to evaluate the applicability and effectiveness of these strategies across broader demographic groups. REGISTRY AND REGISTRY NUMBER: Open Science Framework (https://doi.org/10.17605/OSF.IO/UDNV7).