Diabetes Intervention Study: Multi-Intervention Trial in Newly Diagnosed NIDDM

Hanefeld, Markolf; Fischer, Sabine; Schmechel, H; Rothe, G.; Schulze, Jan; Dude, H; Schwanebeck, Uta; Julius, Ulrich

doi:10.2337/diacare.14.4.308

Cited by 159 publications

(141 citation statements)

References 9 publications

(5 reference statements)

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“…1 and Table 2). [30][31][32][33][34][35] We summarize the key study characteristics for these studies [30][31][32][33][34][35] in Appendix Table 5. No study evaluated mortality as a primary outcome.…”

Section: Long-term Clinical Outcomesmentioning

confidence: 99%

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

et al. 2014

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BACKGROUND: Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control. METHODS: Electronic databases were searched from inception through November 2011. Of 16,290 citations, two independent reviewers identified 138 randomized trials comparing PAIs to usual care/control groups in adults with DM2 that reported intermediate or longterm outcomes or harms. For meta-analyses of continuous outcomes, we used a random-effects model to derive pooled weighted mean differences (WMD). For allcause mortality, we calculated the pooled odds ratio (OR) using Peto's method. We assessed statistical heterogeneity using the I 2 statistic and conducted meta-regression using a random-effects model when I 2 >50 %. A priori meta-regression primary variables included: intervention strategies, intervention leader, baseline outcome value, quality, and study duration. RESULTS: PAIs modestly reduced intermediate outcomes [A1c: WMD 0.37 %, CI 0.28-0.45 %, I 2 83 %; SBP: WMD 2.2 mmHg, CI 1.0-3.5 mmHg, I 2 72 %; body weight: WMD 2.3 lbs, CI 1.3-3.2 lbs, I 2 64 %; and LDLc: WMD 4.2 mg/dL, CI 1.5-6.9 mg/dL, I 2 64 %]. The evidence was moderate for A1c, low/very low for other intermediate outcomes, low for long-term mortality and very low for complications. Interventions had no effect on hypoglycemia (evidence: low) or short-term mortality (evidence: moderate). Higher baseline A1c, pharmacistled interventions, and longer follow-up were associated with larger A1c improvements. No intervention strategy outperformed any other in adjusted meta-regression. CONCLUSIONS: PAIs modestly improve A1c in adults with DM2 without increasing short-term mortality. These results support integration of these interventions into primary care for adults with uncontrolled glycemia, and provide evidence to insurers who do not yet cover these programs. INTRODUCTIONType 2 diabetes is common and contributes to excess morbidity, mortality, and health care costs, accounting for approximately one in five U.S. health care dollars. 1,2 Behavioral interventions are one important way to improve patient outcomes, 3 yet less is known about a subset of novel behavioral interventions focused on engaging patients in care 4-6 (often termed "patient activation" 7,8 ). Hibbard et al. 7,9 have described patient activation interventions as those that promote motivation, knowledge, and disease self-management skills. 7,9 Despite the growing evidence suggesting improved patient outcomes by engaging patients, 4-6,10 these interventions are often not integrated into practice due to uncertainty about benefit, lack of resources needed for integration, lack of health insurance coverage across insurers, and lack of clarity on the best strategies to incorporate. 11,12 Understanding the imp...

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Section: Long-term Clinical Outcomesmentioning

confidence: 99%

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

et al. 2014

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“…A limited amount of research has evaluated the longer-term effects of physical activity interventions in people with Type 2 diabetes. A large prospective study reported that only 25% of people with Type 2 diabetes were still engaged with their supervised exercise programme 2 years later [16]. Two studies [14,15] reported no significant change in physical activity 12 months after giving people with Type 2 diabetes written and oral instructions for exercise.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, they are expensive to develop and maintain, and they achieve poor long-term adherence. A large prospective study reported that only 25% of their Type 2 diabetic subjects were still engaged with their supervised exercise programmes after 2 years [16]. Required are alternative interventions that are effective in stimulating long-term changes in physical activity behaviour and that can be realistically implemented into current diabetes care.…”

Section: Introductionmentioning

confidence: 99%

Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with Type 2 diabetes

et al. 2004

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Aims/hypothesis. The aim of this study was to investigate the effectiveness of physical activity counselling in promoting physical activity in people with Type 2 diabetes and to evaluate resultant physiological and biochemical effects. Methods. A total of 70 inactive people with Type 2 diabetes were given standard exercise information and randomised to receive physical activity counselling (n=35, experimental) or not (n=35, control). Physical activity consultations were delivered at baseline and after 6 months, with follow-up phone calls after 1, 3, 6 and 9 months. Changes from baseline after 6 and 12 months were assessed for physical activity (7-day recall and accelerometer), for physiological characteristics (body mass index and blood pressure) and for biochemical variables (HbA 1 c, lipid profile, fibrinogen, tissue plasminogen activator and microalbuminuria). Results. Significant differences between groups were recorded for physical activity after 6 and 12 months (p<0.01). The experimental group had increased levels of physical activity from baseline to 6 months (p<0.01), with no decrease from 6 to 12 months (p>0.05). In the control group, accelerometer counts per week decreased from baseline to 12 months (p=0.03). Between-group differences (p<0.05) were recorded for the change in HbA 1 c (experimental: 0.26% decrease; control: 0.15% increase), for systolic blood pressure (experimental: 7.7 mm Hg decrease; control: 5.6 mm Hg increase) and for fibrinogen (experimental: 0.28 mmol/l decrease; control: 1.43 mmol/l increase) from baseline to 6 months, and for total cholesterol (experimental: 0.33 mmol/l decrease; control: 0.04 mmol/l increase) from baseline to 12 months (p<0.05). No significant differences were recorded in other measured variables. Conclusions/interpretations. Physical activity counselling was effective in promoting physical activity in people with Type 2 diabetes. The counselling improved glycaemic control as well as the status of cardiovascular risk factors in these patients.

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“…The odds ratio for myocardial infarction compared to the general population for males at the age of 50-59 was 2.7, and for females 6.2 after 5 years' followup [3]. Cardiovascular diseases (32 %) were the major cause of death although clinical manifestations of this disease group represented an exclusion criterion and the average age at entry was only 46.7 (CI 46.3-47.0) years.…”

mentioning

confidence: 99%

“…The Diabetes Intervention Study (DIS) is a prospective multicentre trial of newly detected middleaged NIDDM patients classified as diet-controlled at entry into the study [3]. As previously reported [4] 15.2 % of the patients suffered from myocardial infarction and 19.8 % had died after 11 years' follow-up.…”

mentioning

confidence: 99%

Predictors of coronary heart disease and death in NIDDM: The Diabetes Intervention Study experience

Hanefeld

Schmechel²,

Schwanebeck

et al. 1997

Diabetologia

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Diabetes Intervention Study: Multi-Intervention Trial in Newly Diagnosed NIDDM

Cited by 159 publications

References 9 publications

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

Effects of a 12-month physical activity counselling intervention on glycaemic control and on the status of cardiovascular risk factors in people with Type 2 diabetes

Predictors of coronary heart disease and death in NIDDM: The Diabetes Intervention Study experience

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