Teaching patients to monitor their risk factors retards the progression of vascular complications in high‐risk patients with Type 2 diabetes mellitus—a randomized prospective study

Rachmani, Rita; Levi, Zohar; Slavachevski, Inna; Avin, M.; Ravid, Mordchai

doi:10.1046/j.1464-5491.2002.00701.x

Cited by 92 publications

(81 citation statements)

References 38 publications

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“…To prevent progression in microalbuminuric or proteinuric patients, it is important to adopt an integrated approach, comprising tight antihypertensive control, including pharmacologic blockade of the RAS by ACE inhibitors or angiotensin receptor blockers, intensified glycemic control, cessation of smoking, body weight reduction when appropriate (91), and dietary sodium restriction. As shown in Table 6, the loss of GFR was significantly less in type 2 diabetic patients receiving such integrated structured treatment in a diabetes clinic compared wth patients managed by private physicians (95)(96)(97). A recent 4-yr randomized controlled trial confirmed that changes in lifestyle can be implemented in type 2 diabetic patients with appropriate education and close follow-up (98).…”

Section: Prevention Of Progressionmentioning

confidence: 98%

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

Wolf¹,

Ritz²

2003

Journal of the American Society of Nephrology

101

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Section: Prevention Of Progressionmentioning

confidence: 98%

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

Wolf¹,

Ritz²

2003

Journal of the American Society of Nephrology

101

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“…The assays were unchanged during the study period. The analytical methods were previously described (10). Renal outcome was assessed by estimated GFR (e-GFR) (11).…”

Section: Methodsmentioning

confidence: 99%

“…The extrapolation of the achievements of these programs to primary care is difficult because of both financial and organizational shortcomings. We showed previously that sharing the therapeutic responsibility with the patients themselves had a major impact on retarding the progress of microvascular complications (10). Reported herein is the second, 4-yr, phase of the study highlighting the influence of the intervention on cardiovascular outcomes.…”

mentioning

confidence: 98%

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Treatment of High-Risk Patients with Diabetes

Rachmani

Slavacheski

Berla

et al. 2005

Journal of the American Society of Nephrology

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The aim of this study was to examine whether motivating patients to gain expertise and closely follow their risk parameters will attenuate the course of microvascular and cardiovascular sequelae of diabetes. A randomized, prospective study was conducted of 165 patients who had type 2 diabetes, hypertension, and hyperlipidemia and were referred for consultation to a diabetes clinic in an academic hospital. Patients were randomly allocated to standard consultation (SC) or to a patient participation (PP) program. Both groups were followed by their primary care physicians. The mean follow-up was 7.7 yr. The SC group attended eight annual consultations. The PP patients initiated on average one additional consultation per year. There E ducational and behavioral interventions hitherto published in patients with diabetes had only modest effects on alleviation of disease progression (1). The poor outcomes may be partially due to deficiencies in diabetes knowledge, compliance, and motivation (2,3). Intensive therapeutic programs are effective in reducing diabetic complications and cardiovascular morbidity and mortality (4 -9). These programs, however, all have been randomized, prospective trials conducted by experts in academic medical centers. The extrapolation of the achievements of these programs to primary care is difficult because of both financial and organizational shortcomings. We showed previously that sharing the therapeutic responsibility with the patients themselves had a major impact on retarding the progress of microvascular complications (10). Reported herein is the second, 4-yr, phase of the study highlighting the influence of the intervention on cardiovascular outcomes. Materials and MethodsA total of 167 patients who had type 2 diabetes, hypertension, and dyslipidemia and referred for consultation to the diabetes clinic of Meir Hospital during the years 1995 to 1996 were randomized to a standard consultation (SC) or to a patient-participation program (PP). The inclusion criteria were age 40 to 70 yr; type 2 diabetes of Ͻ10 yr duration; BMI Յ35 kg/m 2 ; BP values Ն140/90 mmHg; LDL Ն120 mg/dl; serum creatinine Յ2 mg/dl (176 mol/L); albumin/creatinine ratio Ͻ200 mg/g; and no history of myocardial infarction, angina pectoris, vascular surgery, stroke, or any systemic or malignant disease. A total of 154 patients signed informed consent forms, 13 patients were excluded, and 141 were randomized by the help of computergenerated random numbers to either SC (n ϭ 70) or PP (n ϭ 71) programs. The flow of the patients throughout the study is outlined in Figure 1.Patients of both groups were initially interviewed and examined twice over 2 wk and annually thereafter. Consultation letters were written to the family physicians. No prescriptions were ever issued by members of the consultation team. The patients of the SC group attended standard consultation visits, whereas the patients of the PP program were given two 2-h teaching sessions about ways to achieve tight control of the modifiable risk factors including also ...

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“…Both Trento and colleagues in Italy (25) and Rachmani and colleagues in Israel, provide exemplary models of this in the published literature (26). However, to achieve improved outcomes, healthcare professionals need to create an understanding of the reality of diabetes for their patient by:…”

Section: Goal-setting and Treatment Outcomesmentioning

confidence: 99%

Psychological barriers

Skinner

2004

European Journal of Endocrinology

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Type 2 diabetes treatment outcomes ultimately depend on patients and their ability to make longterm behavioural changes that support good self-care and metabolic control. Patients' perceptions about diabetes and diabetes-related complications can have a strong influence on their emotional well-being, as well as day-to-day self-care and the quality of metabolic control. The gravity of diabetes is often underestimated, and many patients do not understand the link between poor glycaemic control and long-term complications of the disease. Similarly, people with diabetes commonly undervalue the role of lifestyle changes and pharmacological therapy in preventing future complications. Negative emotions and preconceptions about treatment can also discourage adherence to treatment plans. 'Psychological insulin resistance' caused by fear and concerns about insulin and daily insulin injections can discourage many patients from starting insulin therapy, even if oral agents have failed. Depression, stress and anxiety represent further obstacles to optimum self-care and the attainment of glucose goals. Healthcare professionals should endeavour to understand and accommodate these issues when setting personal treatment goals and developing plans to achieve them. Importantly, the advice and support they provide should be tailored to the unique needs of each patient. There is scope to improve outpatient consultations to ensure agreement between patients and professionals concerning issues discussed and decisions made, and this may help to improve recall and motivation to manage diabetes. Engaging patients in the goal-setting process can help to overcome potential barriers to good self-care and may increase the probability that treatment goals are achieved.European Journal of Endocrinology 151 T13-T17

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Teaching patients to monitor their risk factors retards the progression of vascular complications in high‐risk patients with Type 2 diabetes mellitus—a randomized prospective study

Cited by 92 publications

References 38 publications

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

Diabetic Nephropathy in Type 2 Diabetes Prevention and Patient Management

Treatment of High-Risk Patients with Diabetes

Psychological barriers

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