GUY RUTTEN, MD, PHD
5OBJECTIVE -To examine the effectiveness of a theory-driven self-management course in reducing cardiovascular risk in patients with screen-detected type 2 diabetes, taking ongoing medical treatment into account.
RESEARCH DESIGN AND METHODS -A total of 196 screen-detected patients, receiving either intensive pharmacological or usual-care treatment since diagnosis (3-33 months previously), were subsequently randomized to a control or intervention condition (selfmanagement course). A 2 ϫ 2 factorial design evaluated the behavioral intervention (selfmanagement course versus control) nested within the medical treatment (intensive versus usual care), using multilevel regression modeling to analyze changes in patients' BMI, A1C, blood pressure (BP), and lipid profiles over 12 months, from the start of the 3-month course to 9-month follow-up.RESULTS -The self-management course significantly reduced BMI (Ϫ0.77 kg/m 2 ) and systolic BP (Ϫ6.2 mmHg) up until the 9-month follow-up, regardless of medical treatment. However, intensive medical treatment was also independently associated with lower BP, A1C, total cholesterol, and LDL before the course and further improvements in systolic BP (Ϫ4.7 mmHg). Patients receiving both intensive medical treatment and the self-management course therefore had the best outcomes.CONCLUSIONS -This self-management course was effective in achieving sustained reductions in weight and BP, independent of medical treatment. A combination of behavioral and medical interventions is particularly effective in reducing cardiovascular risk in newly diagnosed patients.
Diabetes Care 30:2832-2837, 2007A bout 200 million people have been diagnosed with type 2 diabetes worldwide. The actual prevalence is believed to be considerably higher, with a large number of patients remaining undiagnosed, untreated, and unaware of their illness and its long-term health consequences. These patients may not feel ill, but the presence of obesity, chronic hyperglycemia, hypertension, and hypercholesterolemia can ultimately result in devastating micro-and macrovascular complications. In recognition, there has been a widespread call for screening programs to detect and treat patients at an earlier stage of their disease, thereby assuming that this will reduce their cardiovascular risk and improve their long-term health (1,2). There is good evidence that intensive treatments combining medication and lifestyle modifications are effective in both the prevention and management of type 2 diabetes (3-5). However, no studies have focused on the effectiveness of such treatments after a screeningbased diagnosis. Furthermore, the success of treatments ultimately depends on patients' ability to accept their diagnosis and actively manage their disease. Treatment adherence in patients with type 2 diabetes is notoriously low (6,7). Interventions to improve self-management have had some success in improving patient's lifestyles and also lead to significant reductions in cardiovascular risk factors; however, improvements ...