Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore

Abstract

Purpose: The purpose of the study was to investigate the effectiveness of a community-based intervention on improving knowledge about diabetes, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus (T2DM) in Singapore, a country in Asia with a high prevalence of diabetes. Methods: A 3-arm cluster randomized controlled trial involving community-dwelling older adults ages 55 to 99 with T2DM was conducted. Intervention group 1 and 2 participants received a 12-session intervention program designed to teach knowledge and practical skills in diabetes self-care with psychological techniques for behavioral change like problem solving, goal setting, and motivational interviewing. In addition, intervention group 2 participants received a glucometer and a supply of accessories each. The control group received routine care from their health care providers. Results: Compared to the control group, intervention group 2 reported an increase in medication adherence and self-monitoring of blood glucose (SMBG) at 3-month follow-up and increased knowledge about diabetes and self-care behavior in general diet control at 6-month follow-up. Conclusions: The community-based intervention should be extended to more older adults with T2DM in the community. Glucometers and accessories could be provided at subsidized rates or be made free contingent on older adults’ income status to overcome the barrier of performing SMBG.

The effects of diabetes self-management programs on clinical and patient reported outcomes in older adults: a systematic review and meta-analysis

“…Our included studies had a total sample of 5976 older adults (intervention group: n=3510; usual care group: n=2466). Each intervention arm comprised a self-management approach that fit into the five categories of Chodosh’s framework: 1 study - medical care ( 25 ); 3 studies - psychological emphasis ( 26 – 28 ); 4 studies – tailoring ( 29 – 32 ); 4 studies - group setting ( 33 – 36 ); and 5 studies emphasized feedback ( 37 – 41 ). The characteristics of the included studies may be found in Supplementary Table 3 .…”

“…The pooled effect of diabetes self-management program interventions for older adults resulted in statistically significant improvements in the standardized mean differences in patient-reported outcomes measures for behaviour change, diabetes knowledge and self-efficacy (-0.91 SMD; 95% CI -042, 1.41; p <0.00) ( 27 , 29 , 30 , 33 , 35 – 38 , 40 ) ( Figure 6 ). The most effective self-management program intervention strategy associated with the greatest improvements in patient-reported outcomes was feedback (1.64; 95% CI 1.08, 2.21; p <0.01).…”