Community Program Improves Quality of Life and Self‐Management in Older Adults with Diabetes Mellitus and Comorbidity

Abstract

ObjectivesTo compare the effect of a 6‐month community‐based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self‐efficacy, self‐management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities.DesignMultisite, single‐blind, parallel, pragmatic, randomized controlled trial.SettingFour communities in Ontario, Canada.ParticipantsCommunity‐dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159).InterventionClient‐driven, customized self‐management program with up to 3 in‐home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation.MeasurementsQuality‐of‐life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12‐item Short‐Form Health Survey (SF‐12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES‐D‐10), Summary of Diabetes Self‐Care Activities (SDSCA), Self‐Efficacy for Managing Chronic Disease, and healthcare costs.ResultsMorbidity burden was high (average of eight comorbidities). Intention‐to‐treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference = 2.68, 95% confidence interval (CI) = 0.28–5.09, P = .03), SDSCA (mean difference = 3.79, 95% CI = 1.02–6.56, P = .01), and CES‐D‐10 (mean difference = −1.45, 95% CI = −0.13 to −2.76, P = .03). No group differences were seen in PCS score, anxiety, self‐efficacy, or total healthcare costs.ConclusionParticipation in a 6‐month community‐based intervention improved quality of life and self‐management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs.

Effects of Community-Based Psychological Interventions on Depressive Symptoms and Blood Glucose Control for Older Individuals with Type 2 Diabetes: A Systematic Review and Meta- Analysis

“…Fourth, various types of comparison conditions were used in the studies and this may have affected study findings. Among the three studies that compared psychological interventions to usual care or standard treatment (Bond et al, 2010;Taviera et al, 2011;Markle-Reid et al, 2018), the intervention group had a significant reduction in depressive symptoms in two studies (Bond et al, 2010;Markle-Reid et al, 2018). No intervention effect on depressive symptoms was observed in the studies using placebo or alternative therapy as a comparison group (Weiss et al, 2015;Nowlan et al, 2016).…”

“…Of the five RCTs, four (80%) adequately described their randomization sequence (Bond et al, 2010 -Reid et al, 2018), blinding of study per-sonnel was not described; all were rated as either high or unclear. For the attrition bias assessment, only two studies (40%) were free from frequent missing data (Nowlan et al, 2015;Weiss et al, 2015).…”

“…For the attrition bias assessment, only two studies (40%) were free from frequent missing data (Nowlan et al, 2015;Weiss et al, 2015). In the three remaining studies (Bond et al, 2010;Taveira et al, 2011;Markle-Reid et al, 2015, 2018, no information was provided concerning the attrition rate or reasons for missing data. Lastly, for the selective reporting assessment, one study (20%) provided a study protocol (Weiss et al, 2015).…”

“…RCTs(Bond et al, 2010;Taveira et al, 2011;Nowlan et al, 2015;Weiss et al, 2015;Markle- Reid et al, 2018) were included in a qualitative literature synthesis and a description of changes in depressive symptoms and blood glucose controls.…”

“…The publication years ranged between 2007 and 2018, and three(Nowlan et al, 2015;Weiss et al, 2015;Markle-Reid et al, 2018) of the five studies were published within the last five years. The studies were conducted in three countries: The United States (n=3), Canada (n=1), and Australia(n=2).…”