Diabetes education in primary care: a randomized clinical trial

Grillo, Maria de Fátima Ferreira; Neumann, Cristina Rolim; Scain, Suzana Fiore; Rozeno, Raquel Farias; Beloli, Luis; Perinetto, Tiago; Gross, Jorge Luiz; Leitão, Cristiane Bauermann

doi:10.1590/0102-311x00097115

Cited by 22 publications

(40 citation statements)

References 18 publications

(16 reference statements)

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“…A total of 12,018 persons with T2DM were included, of whom 5,893 were in the intervention group (IG) and 6,125 in the control group (CG), with an average age of 59.88 years (59.76 and 60, respectively). The mean baseline HbA 1 c was 7.83%, this value being the primary outcome in all cases (Adachi et al, ; Adolfsson, Walker‐Engström, Smide, & Wikblad, ; Clancy, Huang, Okonofua, Yeager, & Magruder, ; Davies et al, ; Deakin, Cade, Williams, & Greenwood, ; DePue et al, ; D'Eramo Melkus et al, ; Gregg, Callaghan, Hayes, & Glenn‐Lawson, ; Grillo et al, ; Hörnsten, Lundman, Stenlund, & Sandström, ; Houweling et al, ; Jutterström, Hörnsten, Sandström, Stenlund, & Isaksson, ; Khunti et al, ; Mash et al, ; Salinero‐Fort et al, ; Sönnichsen et al, ; Sturt et al, ; Thom et al, ; Wattana, Srisuphan, Pothiban, & Upchurch, ; Welch et al, ) except the Look AHEAD Study (Redmon et al, ), in which it was the weight loss achieved. The follow‐up periods ranged from 3–36 months, the most common being 12–14 months (13 studies).…”

Section: Resultsmentioning

confidence: 99%

“…Twelve studies measured SBP (Adachi et al, ; Deakin et al, ; Grillo et al, ; Houweling et al, ; Jutterström et al, ; Khunti et al, ; Mash et al, ; Redmon et al, ; Salinero‐Fort et al, ; Sönnichsen et al, ; Thom et al, ; Welch et al, ), spanning a population of 4,454 persons in IG and 4,624 in CG. Overall, there were no differences between groups, with a MD of −1.34 mmHg (95% CI: −2.86 to 0.17) I‐squared = 70.6%.…”

Section: Resultsmentioning

confidence: 99%

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Impact of self‐care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta‐analysis

Caro‐Bautista

Kaknani‐Uttumchandani

García‐Mayor

et al. 2020

Journal of Clinical Nursing

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Aims and Objectives: To evaluate the effectiveness of self-care programmes in type 2 diabetes mellitus (T2DM) population in primary health care. Background: The impact of educational interventions on T2DM has been evaluated in various contexts, but there is uncertainty about their impact in that of primary care. Design: Systematic review and meta-analysis. Methods: A search was conducted in PubMed, CINAHL, WOS and Cochrane databases for randomised controlled trials carried out in the period January 2005-December 2017, including studies with at least one face-to-face educational interventions. The quality of the evidence for the primary outcome was evaluated using the GRADE System. A meta-analysis was used to determine the effect achieved although only the results classified as critical or important were taken into consideration. Checklist of Preferred Reporting Items for Systematic Reviews and Meta-analyses has been followed. PROSPERO registration Number: CRD42016038833. Results: In total, 21 papers (20 studies) were analysed, representing a population of 12,018 persons with T2DM. For the primary outcome, HbA 1 c, the overall reduction obtained was −0.29%, decreasing the effect in long-term follow-up. The quality of the evidence was low/very low due to very serious risk of bias, inconsistency and indirectness of results. Better results were obtained for individual randomised trials versus cluster designs and in those programmes in which nurses leaded the interventions. The findings for other cardiovascular risk factors were inconsistent.Conclusions: Educational interventions in primary care addressing T2DM could be effective for metabolic control, but the low quality of the evidence and the lack of measurement of critical results generates uncertainty and highlights the need for high-quality trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Impact of self‐care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta‐analysis

Caro‐Bautista

Kaknani‐Uttumchandani

García‐Mayor

et al. 2020

Journal of Clinical Nursing

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“…In contrast, the study that achieved the least reduction in BMIs was a group educational program (Grillo et al, ) of 5 weeks’ duration with reinforcement every 4 months over a year. In this study, patients received an increased dose of insulin in their treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, in some works (e.g., Grillo et al, 2016) there was an increase in the patients' insulin regimens during the study. Most articles specified the dose of preintervention medication, but not the postintervention dose, so we do not know if the parameters analyzed were improved by an increase in the medication dose or by the educational intervention.…”

Section: Discussionmentioning

confidence: 98%

“…Total Cholesterol, LDL-C, HDL-C, and Triglycerides. Post-intervention total cholesterol (Table S4) changes showed both decreases of 14 mg/dL (p = .001; Parra-Sánchez et al, 2015) and increases of 2 mg/dL (p < .001; Grillo et al, 2016). The greatest decrease was obtained through a supervised aerobic exercise program (Parra-Sánchez et al, 2015).…”

Section: Secondary Variablesmentioning

confidence: 99%

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Efficacy of Diabetes Education in Adults With Diabetes Mellitus Type 2 in Primary Care: A Systematic Review

Cruz-Cobo

Cano

2020

J of Nursing Scholarship

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Purpose To analyze the effect of different diabetes education methods on metabolic control, body mass index (BMI), and blood pressure. Design A systematic review was carried out. Data Sources PubMed, Medline, Embase, Cochrane, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), CUIDEN, Ibecs, and Scopus databases were consulted. The search was done in May 2018. Studies included controlled clinical trials on diabetes education in primary care that were published in English and Spanish during the years 2011 to 2018. Results The post‐intervention results were as follows: glycosylated hemoglobin concentration (HbA1c) ranged between ‐1.6% (individual education [IE]) and + 0.05% (mixed education [ME]). The values of BMI varied from ‐0.7% (group education [GE]) to ‐0.3% (GE). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) fluctuated. SBP varied from ‐8.5 mmHg (GE) to +2.9 mmHg (GE); DBP varied from ‐3.1 mmHg (GE) to ‐0.9 mmHg (GE). Total cholesterol ranged from ‐15.9/dL (GE) to +2 mg/dL (GE). LDL cholesterol ranged from ‐18.3 mg/dL (GE) to ‐7 mg/dL (ME). HDL cholesterol ranged from +0.8 mg/dL (IE) to +8.12 mg/dL (GE). Triglycerides varied from ‐21.1 mg/dL (GE) to +11.0 (GE). Conclusions The most profound decrease in HbA1c was achieved using individual education. However, to decrease BMI, SBP, DBP, total cholesterol, LDL cholesterol, and triglycerides, group education was the most effective intervention. Clinical Relevance To obtain good metabolic control, it is necessary to address both clinical and psychological aspects, including modifying nutritional and dietary habits, monitoring medication, increasing knowledge of diabetes, and combining theoretical content with physical exercise programs. Reinforcement strategies are very important to achieve the objectives of educational programs.

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Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

Chew

Vos

Metzendorf

et al. 2017

Cochrane Database of Systematic Reviews

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Low-quality evidence showed that none of the psychological interventions would improve DRD more than usual care. Low-quality evidence is available for improved self-efficacy and HbA1c after psychological interventions. This means that we are uncertain about the effects of psychological interventions on these outcomes. However, psychological interventions probably have no substantial adverse events compared to usual care. More high-quality research with emotion-focused programmes, in non-US and non-European settings and in low- and middle-income countries, is needed.

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Diabetes education in primary care: a randomized clinical trial

Abstract: Abstract

Cited by 22 publications

References 18 publications

Impact of self‐care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta‐analysis

Impact of self‐care programmes in type 2 diabetes mellitus population in primary health care: Systematic review and meta‐analysis

Efficacy of Diabetes Education in Adults With Diabetes Mellitus Type 2 in Primary Care: A Systematic Review

Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

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