Efficacy of a self‐management education program for people with type 2 diabetes: Results of a 12 month trial

Abstract

Aim: Patient education that enhances one's self-management ability is of utmost importance for improving patient outcomes in chronic diseases. We developed a 12 month self-management education program for type 2 diabetes, based on a previous 6 month program, and examined its efficacy. Methods: A randomized controlled trial was carried out on outpatients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate. They were randomly divided into an intervention group that followed the program and a control group that followed usual clinical practise. The intervention group received <30 min of monthly interviews based on the program's textbook and biweekly telephone calls from a nurse educator throughout the 12 months. Results: Of the 50 participants in the intervention group and the 25 participants in the control group, 42 and 23, respectively, completed the program (a completion rate of 84.0%). The body weight, HbA1c, self-efficacy, dietary and exercise stages, quality of life, diastolic blood pressure, and total cholesterol level were significant by two-way repeated-measures anova. As for changes over time within the groups, only the intervention group showed significant differences by Friedman's test. The complication prevention behaviors showed a high implementation rate in the intervention group. The overall evaluation of this program by the participants was very high and, therefore, they highly recognized the need for this type of program. Conclusions: Self-management education works successfully in relation to patients' behavior modification skills, degree of goal attainment, and self-efficacy, consequently improving their health outcomes.

Patient engagement as a risk factor in personalized health care: a systematic review of the literature on chronic disease

“…Five studies focused on diabetes [32,37-40], and there was one study each on individuals with various chronic diseases (for example, hypertension, diabetes, coronary artery disease, and so on) [34], multiple sclerosis (MS) [31], arthritis [33], asthma [35], and bronchiectasis [36]. Six studies [34-39] (60%) compared the intervention to usual care or no active control, while the remaining four studies (40%) compared the intervention to an attention control [33] (n = 1), enhanced usual care [32] (n = 1), or a wait-list control [31,40] (n = 2). Half of the interventions were in-person group-based workshops [31,33,34,36,38] (n = 5); the remaining interventions were in person one-on-one sessions [35,39] (n = 2), internet-based modalities [32,37] (n = 2), and personal telephonic coaching [40] (n = 1).…”

“…Six studies [34-39] (60%) compared the intervention to usual care or no active control, while the remaining four studies (40%) compared the intervention to an attention control [33] (n = 1), enhanced usual care [32] (n = 1), or a wait-list control [31,40] (n = 2). Half of the interventions were in-person group-based workshops [31,33,34,36,38] (n = 5); the remaining interventions were in person one-on-one sessions [35,39] (n = 2), internet-based modalities [32,37] (n = 2), and personal telephonic coaching [40] (n = 1). Intervention lengths ranged from weekly 2-hour sessions for 6 weeks to 24 months.…”

“…Intervention lengths ranged from weekly 2-hour sessions for 6 weeks to 24 months. Four of the 10 studies [33,35,36,39] (40.0%) were high quality based on Jadad scoring (score ≥3) (Table  2). …”

“…Five studies [31-33,35,36] (50%) used disease-specific or chronic disease measures of self-efficacy, and one study [39] (10%) used a general measure of self-efficacy. Most studies had multiple behavioral measures (for example, medication adherence, physical activity, nutrition/eating, goal attainment, symptom management), while only Barlow et al ’s [31] study of MS had a single measure of the behavioral component of engagement.…”

“…Additionally, each study examined one primary biological outcome (HbA1C) as well as other biological (for example, lipids, blood pressure) and health-related (for example, self-rated health, diabetes distress) outcomes. Three [32,37,39] of the five studies reported a significant reduction in HbA1C for all intervention subjects compared with controls. A second [40] found a significant reduction in HbA1C for intervention subjects who enrolled with elevated baseline levels (>7.0).…”