No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: A cluster randomised trial

Abstract

ObjectiveTo study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care.Design and settingCluster randomised trial in general practices.InterventionNurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting.SubjectsPrimary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m2.Main outcome measuresHbA1c, diet, and physical activity (medical records and patient questionnaires).ResultsMultilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI 20.8–0.35) and diet (fat (difference between groups = 0.19; CI 20.82–1.21); vegetables (difference between groups = 0.10; CI-0.21–0.41); fruit (difference between groups = 20.02; CI 20.26–0.22)), and physical activity (difference between groups = 21.15; CI 212.26–9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life.ConclusionA comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.

Effect of motivational interviewing on self-management in patients with type 2 diabetes mellitus: A meta-analysis

“…This result was caused by a lack of preciseness in the research design: one trial [12] did not describe the randomisation method, and one trial [12] did not report the number of patients lost to follow-up. The three highquality trials [7,9,11] adopted blinding, allocation concealment, and intention-to-treat analysis.…”

“…One trial [12] assessed the effect of 14 months of MI on the HbA1c level. After 14 months of MI, no significant difference in the reduction of the HbA1c level was observed between the intervention and control groups (WMD, À0.10; 95% CI, À0.25 to 0.05; p ¼ 0.19) (Fig.…”

Nurse-Led Behavioral Management of Diabetes and Hypertension in Community Practices: A Randomized Trial

“…Moreover, we are not alone in experiencing this difficulty in community practices; since the end of our trial, three trials have been published of similar interventions in community practices in three countries in Europe, all of which showed no impact on clinical outcomes. [25][26][27] The purpose of our trial was to rigorously evaluate an intervention similar to nurse behavioral management interventions that have almost certainly been implemented in a number of community practices. These interventions likely show apparent efficacy in uncontrolled settings, thus encouraging practices to continue to devote resources to nurse management.…”

What is agenda setting in the clinical encounter? Consensus from literature review and expert consultation

“…It has been described as a process of establishing shared focus [10] that sets the relational tone for the consultation [11,12] facilitating patient engagement [13,14] and involvement in decision making [15], while maintaining efficiency [16,17]. Agenda setting has been used in many different clinical contexts including primary care [10,13,[18][19][20], adolescent weight loss [21], oncology [15], type 1 Diabetes [17,22,23], type 2 Diabetes [24,25], asthma [26], pediatric mental health [27,28] and psychiatry [29].…”