Efficacy of a Brief Self-management Intervention in Type 2 Diabetes Mellitus: A Randomized Controlled Trial from India

Abstract

Background: Diabetes mellitus places a considerable burden on the individual and the family with respect to lifestyle changes. There is a paucity of systematic studies in India examining the efficacy of self-management programs for diabetes. The study examined the impact of a brief self-management intervention (SMI) on primary outcome of HbA1c and secondary outcomes of quality of life (QOL), self-care, perceived barriers to self-care (BSC), perceptions regarding illness and mood in patients with type 2 diabetes mellitus. Methods and materials: Eighty patients with type 2 diabetes mellitus were randomly allocated to either a 4-session SMI or treatment as usual (TAU) and were assessed on HbA1c levels, QOL, self-care, BSC, illness perceptions, anxiety, and depression at baseline, postintervention , and at three-month postintervention follow-up. Results: Repeated measures analysis of variance indicated significant improvement in the SMI group from baseline to follow-up on HbA1c (P = 0.001), impact of diabetes on QOL (P = 0.006), self-care with respect to diet and exercise (Ps = 0.001), perceived barriers in adherence to diet, exercise, (P = 0.001), medication (P < 0.01), glucose testing (P = 0.04), general BSC (P = 0.001), total barriers (P = 0.001), illness perceptions-timeline or chronicity of illness (P = 0.002), personal control over illness, (P = 0.001), belief in effectiveness of treatment (P = 0.002), understanding of one’s illness (P = 0.001), and emotional representations regarding illness (P =0.001), depression, (P = 0.001), and anxiety (P = 0.001). In the SMI group, large effect sizes were obtained at the postintervention assessment and the three-month follow-up on most outcome measures. Conclusions: Brief psychological intervention is efficacious in patients with type 2 diabetes.

Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol

“…28 31-37 Though, there is paucity of intervention studies to provide evidence on improvement in self-care practices from India. [38][39][40][41][42][43] These studies provide only limited post intervention effect on glycaemic control which range from 0.5 to 2 mg/dL for FBS, 0.5%-1% reduction in HbA1c level and inconsistent results for other health outcomes such as body weight, lipid profile, fruits and vegetables intake and sustainable behavioural change. Most of the interventions for diabetes self-care from the Indian subcontinent targeted towards selected component of the self-care behaviour namely diet, physical activity, foot care and medication adherence.…”

Effectiveness of Patient-centered Care for Diabetes Self-management to Improve Glycemic Control and Self-care Behaviors in Adults With Type 2 Diabetes: a Systematic Review

“…Authors of the studies were contacted to request additional information. Out of twenty one RCTs, nine were graded as low risk of bias (28-36); eight as high risk of bias (23,(37)(38)(39)(40)(41)(42)(43) and, four as unclear risk of bias (44)(45)(46)(47). Out of four QESs; two were of unclear risk of bias (22,48) and the other two were of high risk of bias (49,50).…”

“…Majority (68%) of the studies administered both educational and behavioral components of intervention. The follow-up duration ranged from three months(22, 38,39, 46,49,55,57, 58) to eighteen months (41). Five (20%) studies used the multidisciplinary care approach to deliver the intervention(29,32,44, 46,50).…”

Clinical outcomes and economic evaluation of patient-centered care system versus routine-service system for patients with type 2 diabetes in Thailand

“…In their consensus report, the American Diabetes Association, also advocated PCC to enhance patient engagement in self-care activities for T2D self-management [ 8 ]. Related studies conducted around the globe such as in Saudi Arabia, the Netherlands, China, India, Iran, Turkey and among African Americans, showed the effectiveness of PCC in improving glycemic control and self-care behaviors among adults with T2D [ [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. The findings from the systematic review and meta-analysis of 20 randomized controlled trials provided evidence supporting the effectiveness of patient-centered, self-management care interventions [ 16 ].…”