Am Fam Physician. 2008 Jul 15;78(2):262-264.
Background: Although adherence to lifestyle interventions and medication regimens to treat type 2 diabetes is notoriously low, successful treatment of diabetes depends on the patient's acceptance of the diagnosis and ability to actively manage it. Previous studies have shown that self-management interventions have small, short-term benefits, but no study has focused on sustained benefits in patients with screening-detected type 2 diabetes. Thoolen and colleagues studied patients from a larger ongoing study of intensive treatment to assess the sustained effectiveness of a three-month, theory-driven, self-management program in reducing cardiovascular risks.
The Study: Participants in the ADDITION (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Type 2 Diabetes in Primary Care) trial were eligible to participate in the current study if they did not have serious medical or mental comorbidities. Patients were randomly allocated to the diabetes self-management program or the control group, which received only a brochure on self-management. The 12-week intervention program was comprised of two one-hour individual sessions and four two-hour biweekly group meetings. Using strategies based on proactive coping and self-regulation, patients were counseled on formulating and carrying out personally relevant goals relating to diet, exercise, and medication use.
Out of the 227 eligible patients, 30 did not have access to the classes and were excluded, although the 11 patients who dropped out during the study were included in the intention-to-treat analysis. Within the groups, patients were stratified by whether they were receiving standard care or intensive medical management based on the ADDITION protocol. Participants were more educated than nonparticipants and were less likely to report self-management behavior. Patients in the two study groups, however, were sociodemographically similar.
Several variables were reviewed for each patient, including body mass index (BMI), A1C level, systolic and diastolic blood pressure measurements, and complete lipid profiles. Multilevel regression modeling analyzed these variables to determine which factors affected the study results.
Results: In the intervention group, BMIs decreased over the 12-month study, whereas patients in the control group gained about the same amount of weight that the intervention group lost, leading to a BMI difference of 0.77 kg per mm2 (2.6 kg [5 lb, 12 oz]). Female sex was the only control variable that affected BMI (significantly higher in women); the intensity of medical therapy did not affect BMI. Systolic blood pressure levels were significantly reduced and sustained in those in the self-management program who also received intensive medical therapy (i.e., angiotensin-converting enzyme inhibitors and aspirin in those with blood pressure levels greater than 120/80 mm Hg), whereas those receiving either intervention alone had only short-term reductions in systolic blood pressure. Conversely, patients who did not receive additional care had a net increase in systolic blood pressure over 12 months. The self-management program had no effect on A1C levels or lipid profiles.
Conclusion: The authors conclude that self-management strategies are effective in mitigating some cardiovascular risks in patients with diabetes, even in patients whose health status has already improved with intensive medical management. A theory-driven approach to self-care may be more effective than other educational strategies in leading patients to sufficiently manage their diabetes.
Thoolen B, et al. Effectiveness of a self-management intervention in patients with screen-detected type 2 diabetes. Diabetes Care. November 2007;30(11):2832–2837.
Copyright © 2008 by the American Academy of Family Physicians.
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