Motivational interviewing delivered by diabetes educators: Does it improve blood glucose control among poorly controlled type 2 diabetes patients?

Abstract

Aims To determine whether glycemic control is improved when Motivational Interviewing (MI), a patient-centered behavior change strategy, is used with Diabetes Self Management Education (DSME) as compared to DSME alone. Methods Poorly controlled type 2 diabetes (T2DM) patients (n=234) were randomized into 4 groups: MI+DSME or DSME alone, with or without use of a computerized summary of patient self management barriers. We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change. Results Study patients attended the majority of intervention visits (mean 3.4/4), but drop-out rate was high at follow-up research visits (35%). Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower (less improved) than those not receiving MI (t=2.10; p=0.037). Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress; no between-group differences were found. Conclusions DSME improved blood glucose control, underlining its benefit for T2DM management. However, MI+DSME was less effective than DSME alone. Overall, weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators.

Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

“…The U.S. health care system will be unable to afford the costs of care unless incidence rates and diabetesrelated complications are reduced. DSME/S improves hemoglobin A 1c (HbA 1c ) by as much as 1% in people with type 2 diabetes (3,7,(16)(17)(18)(19)(20). Besides this important reduction, DSME has a positive effect on other clinical, psychosocial, and behavioral aspects of diabetes.…”

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

“…The U.S. health care system will be unable to afford the costs of care unless incidence rates and diabetes-related complications are reduced. DSME/S improves hemoglobin A 1c (HbA 1c ) by as much as 1% in people with type 2 diabetes (3,7,(16)(17)(18)(19)(20). Besides this important reduction, DSME has a positive effect on other clinical, psychosocial, and behavioral aspects of diabetes.…”

Development and Effects of a Motivational Interviewing Self-management Program for Elderly Patients with Diabetes Mellitus

“…Bandura [9]의 자기효능이론을 기반으로 자가간호 교육프로그램 [10], 문제상 황대처 교육프로그램 [11], 자기조절 교육프로그램 [12] [18]. 성인 당뇨병 환자를 대상으로 한 연구에서도 자기효능감 [18], 체중조절 [19], 치 료만족도와 운동시간 [20], 혈당조절 [18][19][20][21] Perception of importance of self-management (using importance ruler 0~10) Perception of one's self-management level (developing discrepancy) Pro and cons of self-management (rolling with resistance) Barriers and coping strategies for self-management (expressing empathy, giving information, reflection of hange talk) Goal setting & planning one's self-management (giving information) Assessment of one's self efficacy level for performance of self-management plan (using confidence ruler 0~10) Supporting self-efficacy for performance of self-management plan (self-efficacy enhancement strategy: verbal persuasion, enactive attainment) Next session will begin with sharing experience of self-management at home (self-efficacy enhancement strategy: vicarious experience, verbal persuasion) …”