Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country

Abstract

BackgroundType 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) has proven to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Health Service – Osakidetza (Spain).Method/DesignThis is a randomised clinical trial in which patients diagnosed with DM2, 18–79 years of age, from four health regions within the Basque Health Service will be randomised into two groups: an intervention group, who will follow the SDSMP, and a control group, who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region. The intervention consists of 2,5 hour-group sessions once a week for six weeks. The sessions cover target setting and problem solving techniques, promotion of physical exercise, basic knowledge of nutrition, proper use of medication, effective communication with relatives and health professionals, and basic knowledge about DM2 and its complications. This content is complemented by educational material: books, leaflets and CDs. The primary outcome measure will be the change in glycated haemoglobin (HbA1c), and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables, cardiovascular risk, quality of life, self-efficacy, number of consultations and drug prescriptions. The results will be analysed 6, 12 and 24 months after the intervention.DiscussionIf the intervention were to be effective, the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases.Trial registrationClinicalTrials.gov identifier NCT01642394

Fatores Associados Ao Conhecimento E À Atitude Em Relação Ao Diabetes Mellitus

“…Destaca-se que o conhecimento sobre a doença é essencial para o manejo apropriado da condição crônica, mas somente isso não se traduz em mudança de comportamento (7)(8) . Isso porque o conhecimento é influenciado por características individuais, pelo significado que o indivíduo atribui à condição crônica e por suas atitudes diante dela (9) .…”

“…Pode também favorecer o protagonismo do indivíduo para enfrentar sua condição crônica, de forma a estimulá-lo com relação às medidas de autocuidado, melhora dos resultados clínicos, uso adequado dos serviços de saúde e, por conseguinte, utilização eficiente dos recursos públicos (6)(7)(8)(9) . Diante do exposto, o estudo teve por objetivo identificar fatores associados ao conhecimento e à atitude diante da doença em pessoas com DM2.…”

La Actividad Física en El Currículo Universitario Español De Los Grados De Medicina Y Ciencias De La Actividad Física Y Del Deporte Como Recurso en La Prevención Y Tratamiento De Las Enfermedades Crónicas

“…Las prescripciones individualizadas sobre cada persona con una ECNT deben incluir el tipo, la carga y la periodicidad del ejercicio físico a realizar, para utilizar el ejercicio físico como instrumento preventivo y de tratamiento en lugar de emplear consejos generalizados para la amplia gama de pacientes que poseen los centros de Atención Primaria (36). En España, se han desarrollado programas preventivos educacionales para adecuar y aumentar la práctica de ejercicio físico en pacientes con diabetes tipo II que han tenido resultados satisfactorios (37). También se debe fomentar el empleo de una evaluación de diagnóstico que indique el nivel de actividad y de sedentarismo que ofrece un paciente como un marcador de salud (38).…”

A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country

“…The effect on blood pressure has not been included in any of the evaluations of the DSMP we identified in our review of the literature [28, 34, 35]. Given the high prevalence of hypertension in people with diabetes and the importance of decreasing blood pressure for reducing cardiovascular morbidity and mortality, this potentially promising finding should be confirmed in future prospective studies, while the influence of a blood pressure reduction in the cardiovascular risk should also be further explored [20]. …”

“…Furthermore, the obtained data served to estimate the subsequent clinical trial sample size [19], while offering initial estimations of the expected effects for the main and secondary outcomes [19]. Finally, the experiences and lessons learned during this phase helped the investigators to better prepare, organize, and control all aspects of the subsequent clinical trial [20]. …”