This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.

This paper describes the development and first results of a brief self-management course for patients recently diagnosed with Type 2 diabetes. The intervention incorporates elements from proactive coping and self-regulation theory in a five-step plan to help newly diagnosed patients formulate and carry out intentions with regard to their self-management. The theoretical framework and course program are described, patient evaluations are summarized and proximal outcomes of the course will be analyzed, investigating whether the course is able to increase patients' proactive skills, goal attainment and confidence in dealing with self-management issues. Participants included 180 patients, diagnosed 3-33 months previously during a population screening. Participants were randomized into an intervention (n = 78) or control group (n = 102). Course evaluations were very positive, regardless of patients' demographic or medical background and participants were particularly positive about the five-step plan and potential for peer interaction. Compared with the control group, course participants improved significantly in terms of proactive coping, goal achievement and self-efficacy. An intervention based on proactive coping appears to meet the needs of patients newly diagnosed with Type 2 diabetes, teaching them new proactive skills, improving their goal achievement and increasing their self-efficacy in dealing with their self-management tasks.

Participants, nonparticipants, and dropouts did not differ in their attitudes toward diabetes, but the intervention did attract patients with lower self-care. Variations in participation by treatment and disease duration suggest that patients prefer self-management interventions at different times depending on their medical treatment. Finally, education appears to be the most important factor determining participation. Alternative strategies are needed to attract and retain patients with low education.

OBJECTIVE -The objective of this study was to investigate how time since diagnosis and treatment intensity influence psychological outcomes in patients with screen-detected type 2 diabetes.RESEARCH DESIGN AND METHODS -A 2 ϫ 2 factorial cross-sectional design was used to examine psychological outcomes in 196 patients with screen-detected diabetes diagnosed 3-33 months previously who were receiving usual care or intensive multifactorial pharmacological treatment. Outcomes included anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, and self-care. Multivariate analysis was used to examine variations in outcomes based on time since diagnosis (Ͻ1 vs. 2-3 years) and treatment intensity.RESULTS -Most patients reported little distress, low perceived seriousness and vulnerability, high self-efficacy, and low self-care, but outcomes varied considerably across conditions. Time effects were found for perceived vulnerability, which increases significantly with time since diagnosis. Time ϫ treatment interactions were found for anxiety, diabetes-related distress, and self-efficacy; notably, intensively treated patients showed more distress and less self-efficacy in the 1st year, and usual-care patients reported more distress and less self-efficacy 2-3 years after diagnosis.CONCLUSIONS -Screen-detected patients generally do not experience much difficulty with their condition in the first few years, but early and intensive treatment can influence patients' psychological outcomes, leading to relatively more anxiety and less self-efficacy in the 1st year after diagnosis but not necessarily improving self-care. This suggests that intensive treatments confront patients with their diabetes earlier on whereas milder treatments may delay confrontation. This finding should be taken into account in the development and timing of psychological interventions for patients with newly diagnosed diabetes.

GUY RUTTEN, MD, PHD 5OBJECTIVE -To examine the effectiveness of a theory-driven self-management course in reducing cardiovascular risk in patients with screen-detected type 2 diabetes, taking ongoing medical treatment into account. RESEARCH DESIGN AND METHODS -A total of 196 screen-detected patients, receiving either intensive pharmacological or usual-care treatment since diagnosis (3-33 months previously), were subsequently randomized to a control or intervention condition (selfmanagement course). A 2 ϫ 2 factorial design evaluated the behavioral intervention (selfmanagement course versus control) nested within the medical treatment (intensive versus usual care), using multilevel regression modeling to analyze changes in patients' BMI, A1C, blood pressure (BP), and lipid profiles over 12 months, from the start of the 3-month course to 9-month follow-up.RESULTS -The self-management course significantly reduced BMI (Ϫ0.77 kg/m 2 ) and systolic BP (Ϫ6.2 mmHg) up until the 9-month follow-up, regardless of medical treatment. However, intensive medical treatment was also independently associated with lower BP, A1C, total cholesterol, and LDL before the course and further improvements in systolic BP (Ϫ4.7 mmHg). Patients receiving both intensive medical treatment and the self-management course therefore had the best outcomes.CONCLUSIONS -This self-management course was effective in achieving sustained reductions in weight and BP, independent of medical treatment. A combination of behavioral and medical interventions is particularly effective in reducing cardiovascular risk in newly diagnosed patients. Diabetes Care 30:2832-2837, 2007A bout 200 million people have been diagnosed with type 2 diabetes worldwide. The actual prevalence is believed to be considerably higher, with a large number of patients remaining undiagnosed, untreated, and unaware of their illness and its long-term health consequences. These patients may not feel ill, but the presence of obesity, chronic hyperglycemia, hypertension, and hypercholesterolemia can ultimately result in devastating micro-and macrovascular complications. In recognition, there has been a widespread call for screening programs to detect and treat patients at an earlier stage of their disease, thereby assuming that this will reduce their cardiovascular risk and improve their long-term health (1,2). There is good evidence that intensive treatments combining medication and lifestyle modifications are effective in both the prevention and management of type 2 diabetes (3-5). However, no studies have focused on the effectiveness of such treatments after a screeningbased diagnosis. Furthermore, the success of treatments ultimately depends on patients' ability to accept their diagnosis and actively manage their disease. Treatment adherence in patients with type 2 diabetes is notoriously low (6,7). Interventions to improve self-management have had some success in improving patient's lifestyles and also lead to significant reductions in cardiovascular risk factors; however, improvements ...