Management of Obese Patients With Diabetes Mellitus: Comparison of Advice Education With Group Management

Abstract

The purpose of our study was to compare the effect on diabetes control of group management with the advice-educational technique traditionally used in managing obese outpatients with poorly controlled non-insulin-dependent diabetes mellitus (NIDDM). Forty-one patients were randomly assigned to these two treatment programs, and 32 patients completed the 6-mo study. Initially, patients were seen for 1-h sessions at 1- and 2-wk intervals and later at 1-mo intervals. Patients were asked to do home blood glucose monitoring, decrease caloric intake, increase exercise, and if they were taking insulin, to adjust the dose to attain approximate euglycemia and to stabilize food and exercise patterns. The combined groups reduced mean +/- SD glycohemoglobin from 10.9 +/- 3.1 to 9.4 +/- 2.4% (P less than .05). Internal Health Locus of Control Scale was negatively and significantly correlated with initial and subsequent glycohemoglobin values (the more internal, the lower the glycohemoglobin). At the end of the study the patients in the group management program had significantly lower blood glucose levels than those given advice and education, but no significant differences in glycohemoglobin values or percentage overweight were observed. One patient had a normal initial glycohemoglobin, and only 4 patients had values in the normal range of 4-6.8% at the end of the study. Better management programs need to be developed for treating obese outpatients with NIDDM.

Self-Management Education for Adults With Type 2 Diabetes

“…The care delivered to the control group also varied greatly, and improvements in GHb may be found in that group because of the Hawthorne effect, control group contamination, and unintended cointerventions. In several studies there were greater improvements in the control than the intervention group, leading to a net increase in ⌬I Ϫ ⌬C (32,48,68). Several meta-analyses have been previously published on this subject.…”

“…If a study had several different intervention groups, we averaged GHb and variances within each study, weighted by the sample size (8,27,30,38,(41)(42)(43)(44)(45)(46). In several studies, GHb point estimates and CIs were not presented in numeric form, and they were estimated from graphs (28,30,47,48). If the SE was missing for the control or intervention groups at baseline or followup, then it was assumed to be the same as the value reported for the other group (27,29,30,42,43,49).…”

Effectiveness of Self-Management Training in Type 2 Diabetes

“…Most studies measuring changes in diabetes knowledge demonstrate improvement with education (Table 2) (26 -46), including those with follow-up of 6 -12 months after the last intervention contact (28 -30,36,40,43). Seven studies demonstrated improved knowledge for both the intervention and control groups (47)(48)(49)(50)(51)(52)(53), suggesting possible contamination due to the infeasibility of blinding participants. A number of studies demonstrated that regular reinforcement or repetition of the intervention seemed to improve knowledge levels at variable lengths of follow-up: Bloomgarden et al (34) (26,30,32,33,35,39,44,47,52,54 -56).…”

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

“…49,56,[72][73][74]80,81,87,88 It was unclear what approach was used in two studies. 57,63 Over half of the interventions lasted 0-5 months (n = 28), 47,53,[58][59][60][61][62][63][64][67][68][69][71][72][73][74][75][76][77][78][79][80]85,86 12 interventions ranged between 6 and 11 months, 46,52,[54][55][56][57]66,70,84,90,91 six interventions were 12 months or longer 49,65,81,82,84,87,88 and in five cases the total programme duration was unclear. 48,…”

“…Physical activity (n = 16), 49 47,53,58,59,62,66,70,71,79,[89][90][91] and the remainder used a mixed individual and group approach (n = 6). 49,56,[72][73][74]80,81,87,88 It was unclear what approach was used in two studies.…”