Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention. Integrating medical management with diabetes self-management training: a randomized control trial of the Diabetes Outpatient Intensive Treatment program. Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial Assessment of Barriers to Improve Diabetes Management in Older Adults A randomized comparison of online- and telephone-based care management with internet training alone in adult patients with poorly controlled type 2 diabetes. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention? Behavioural interventions for type 2 diabetes: an evidence-based analysis. Do Older Adults Aged 60–75 Years Benefit From Diabetes Behavioral Interventions? Social Support Groups in the Maintenance of Glycemic Control after Community-Based Intervention Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control Family Interactions Among African Americans Diagnosed With Type 2 Diabetes Management of Patients with Type 2 Diabetes by Pharmacists in Primary Care Clinics Effectiveness of a Culturally Tailored Diabetes Self-Management Program for Chinese Americans The Association between Driving Distance and Glycemic Control in Rural Areas Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes. Case management for patients with poorly controlled diabetes: a randomized trial. Effect of diabetes drug counseling by pharmacist, diabetic disease booklet and special medication containers on glycemic control of type 2 diabetes mellitus: a randomized controlled trial. The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Diabetes support groups improve health care of older diabetic patients. Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of approaches to nutrition in diabetes self-management education.
This study compared an activation intervention to passive education in a r and omized attention-control trial of 232 patients with type 2 diabetes . The activation intervention was based on Exp and ing Patient Involvement in Care ( EPIC ) trials , and was compared to time-matched passive education viewing of ADA video-tapes . Patient demographics and clinical characteristics of their diabetes were assessed with question naires , active involvement was assessed via ratings of taped interactions between patients and providers , and serum sample s were analyzed for HbA1c . Patients in the activation condition were rated as more actively involved in discussion s of diabetes self-management , and rated active involvement was predictive of improvement in glycemic control . No effect of the activation intervention was found on HbA1c . Thus , the activation intervention increased the active involvement of patients with type 2 diabetes in visits with practitioners , and active involvement led to improved glycemic control . However , the activation intervention did not improve glycemic control directly OBJECTIVE This study evaluated the Diabetes Outpatient Intensive Treatment ( DOIT ) program , a multiday group education and skills training experience combined with daily medical management , followed by case management over 6 months . Using a r and omized control design , the study explored how DOIT affected glycemic control and self-care behaviors over a short term . The impact of two additional factors on clinical outcomes were also examined ( frequency of case management contacts and whether or not insulin was started during the program ) . RESEARCH DESIGN AND METHODS Patients with type 1 and type 2 diabetes in poor glycemic control ( A1c > 8.5 % ) were r and omly assigned to DOIT or a second condition , entitled EDUPOST , which was st and ard diabetes care with the addition of quarterly educational mailings . A total of 167 patients ( 78 EDUPOST , 89 DOIT ) completed all baseline measures , including A1c and a question naire assessing diabetes-related self-care behaviors . At 6 months , 117 patients ( 52 EDUPOST , 65 DOIT ) returned to complete a follow-up A1c and the identical self-care question naire . RESULTS At follow-up , DOIT evidence d a significantly greater drop in A1c than EDUPOST . DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents ( ACFC ) of food compared with EDUPOST patients . An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients . Also , the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes . The addition of insulin did not appear to be a significant contributor to glycemic change . CONCLUSIONS DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors . However , it dem and s significant time , commitment , and careful coordination with many health care professionals . The role of the nurse case manager in providing ongoing follow-up contact seems important Background Persistently poor glycemic control in adult type 1 diabetes patients is a common , complex , and serious problem initiating significant damage to the cardiovascular , renal , neural , and visual systems . Currently , there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores . Objective The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type 1 diabetes in a two-group r and omized controlled trial . Methods Patients were recruited through an online type 1 diabetes support group and letters mailed to adults with type 1 diabetes throughout Australia . In a 6-month intervention , followed by a three-month follow-up , patients ( n=72 ) were r and omized to usual care ( control group ) or usual care and the use of a smartphone application ( Glucose Buddy ) with weekly text-message feedback from a Certified Diabetes Educator ( intervention group ) . All outcome measures were collected at baseline and every three months over the study period . Patients ’ glycosylated hemoglobin levels ( HbA1c ) were measured with a blood test and diabetes-related self-efficacy , self-care activities , and quality of life were measured with online question naires . Results The mean age of patients was 35.20 years ( SD 10.43 ) ( 28 male , 44 female ) , 39 % ( 28/72 ) were male , and patients had been diagnosed with type 1 diabetes for a mean of 18.94 years ( SD 9.66 ) . Of the initial 72 patients , 53 completed the study ( 25 intervention , 28 control group ) . The intervention group significantly improved glycemic control ( HbA1c ) from baseline ( mean 9.08 % , SD 1.18 ) to 9-month follow-up ( mean 7.80 % , SD 0.75 ) , compared to the control group ( baseline : mean 8.47 % , SD 0.86 , follow-up : mean 8.58 % , SD 1.16 ) . No significant change over time was found in either group in relation to self-efficacy , self-care activities , and quality of life . Conclusions In adjunct to usual care , the use of a diabetes-related smartphone application combined with weekly text-message support from a health care professional can significantly improve glycemic control in adults with type 1 diabetes . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12612000132842 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12612000132842 ( Archived by WebCite at http://www.webcitation.org/6Kl4jqn5u ) OBJECTIVE To evaluate whether assessment of barriers to self-care and strategies to cope with these barriers in older adults with diabetes is superior to usual care with attention control . The American Diabetes Association guidelines recommend the assessment of age-specific barriers . However , the effect of such strategy on outcomes is unknown . RESEARCH DESIGN AND METHODS We r and omized 100 subjects aged ≥69 years with poorly controlled diabetes ( A1C > 8 % ) in two groups . A geriatric diabetes team assessed barriers and developed strategies to help patients cope with barriers for an intervention group . The control group received equal amounts of attention time . The active intervention was performed for the first 6 months , followed by a “ no-contact ” period . Outcome measures included A1C , Tinetti test , 6-min walk test ( 6MWT ) , self-care frequency , and diabetes-related distress . RESULTS We assessed 100 patients ( age 75 ± 5 years , duration 21 ± 13 years , 68 % type 2 diabetes , 89 % on insulin ) over 12 months . After the active period , A1C decreased by −0.45 % in the intervention group vs. −0.31 % in the control group . At 12 months , A1C decreased further in the intervention group by −0.21 % vs. 0 % in control group ( linear mixed-model , P < 0.03 ) . The intervention group showed additional benefits in scores on measures of self-care ( Self-Care Inventory-R ) , gait and balance ( Tinetti ) , and endurance ( 6MWT ) compared with the control group . Diabetes-related distress improved in both groups . CONCLUSIONS Only attention between clinic visits lowers diabetes-related distress in older adults . However , communication with an educator cognizant of patients ’ barriers improves glycemic control and self-care frequency , maintains functionality , and lowers distress in this population AIMS Care management may improve the quality of diabetes care by enhancing contact between high-risk patients and their providers . This prospect i ve , longitudinal , r and omized trial sought to investigate whether telephone or online care management improves diabetes-related outcomes over time compared with usual care supplemented with Internet access and training . SUBJECTS AND METHODS One hundred fifty-one adult subjects with type 2 diabetes mellitus and an elevated hemoglobin A1c ( A1c ) level ( ≥8.5 % ) were r and omly assigned to  online care management ( n=51 ) , telephone-based care management ( n=51 ) , or Web training ( n=49 ) groups . Online and telephone participants interacted with a care manager through a diabetes education and care management Web site and by telephone , respectively . The Web training group was provided with online diabetes self-management re sources but no care management support . The primary outcome measure was A1c measured every 3 months for a year . RESULTS A1c declined significantly and substantially in all groups over 12 months . A1c declined linearly at a rate of 0.32 % ( P<0.0001 ) per quarter for the online group , 0.36 % ( P<0.0001 ) for the telephone group , and 0.41 % for the Web training group ( P<0.0001 ) . The rate of change over time did not differ significantly among groups . The groups converged at 12 months with average absolute A1c difference of -1.5 % . The number of interactions with care providers was not significantly associated with the change in A1c . Blood pressure , weight , lipid levels , and diabetes distress did not differ among groups over time . CONCLUSIONS Online , telephone-based care management , and Web training for diabetes patients with elevated A1c were each associated with a substantial improvement in A1c over a 1-year period . Internet access and training alone may be as effective as care management in patients with poorly controlled diabetes OBJECTIVE Examine influences of diabetes-specific social support ( D-SS ) and depressive symptoms on glycemic control over time , among adults r and omized to a diabetes self-management education and support ( DSME/S ) intervention or usual care .  METHODS Data were from 108 African-American and Latino participants in a 6-month intervention trial . Multivariable linear regression models assessed associations between baseline D-SS from family and friends and depressive symptoms with changes in HbA1c . We then examined whether baseline D-SS or depression moderated intervention-associated effects on HbA1c . RESULTS Higher baseline D-SS was associated with larger improvements in HbA1c ( adjusted ΔHbA1c -0.39 % for each + 1-point D-SS , p=0.02 ) , independent of intervention-associated HbA1c decreases . Baseline depressive symptoms had no significant association with subsequent HbA1c change . Neither D-SS nor depression moderated intervention-associated effects on HbA1c . CONCLUSIONS AND PRACTICE IMPLICATION S Diabetes self-management education and support programs have potential to improve glycemic control for participants starting with varying levels of social support and depressive symptoms . Participants starting with more support for diabetes management from family and friends improved HbA1c significantly more over 6 months than those with less support , independent of additional significant DSME/S intervention-associated HbA1c improvements . Social support from family and friends may improve glycemic control in ways additive to UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT OBJECTIVE In this secondary analysis , we examined whether older adults with diabetes ( aged 60–75 years ) could benefit from self-management interventions compared with younger adults . Seventy-one community-dwelling older adults and 151 younger adults were r and omized to attend a structured behavioral group , an attention control group , or one-to-one education . RESEARCH DESIGN AND METHODS We measured A1C , self-care ( 3-day pedometer readings , blood glucose checks , and frequency of self-care ) , and psychosocial factors ( quality of life , diabetes distress , frustration with self-care , depression , self-efficacy , and coping styles ) at baseline and 3 , 6 , and 12 months postintervention . RESULTS Both older ( age 67 ± 5 years , A1C 8.7 ± 0.8 % , duration 20 ± 12 years , 30 % type 1 diabetes , 83 % white , 41 % female ) and younger ( age 47 ± 9 years , A1C 9.2 ± 1.2 % , 18 ± 12 years with diabetes , 59 % type 1 diabetes , 82 % white , 55 % female ) adults had improved A1C equally over time . Importantly , older and younger adults in the group conditions improved more and maintained improvements at 12 months ( older structured behavioral group change in A1C −0.72 ± 1.4 % , older control group −0.65 ± 0.9 % , younger behavioral group −0.55 ± 1.2 % , younger control group −0.43 ± 1.7 % ) . Furthermore , frequency of self-care , glucose checks , depressive symptoms , quality of life , distress , frustration with self-care , self-efficacy , and emotional coping improved in older and younger participants at follow-up . CONCLUSIONS The findings suggest that , compared with younger adults , older adults receive equal glycemic benefit from participating in self-management interventions . Moreover , older adults showed the greatest glycemic improvement in the two group conditions . Clinicians can safely recommend group diabetes interventions to community-dwelling older adults with poor glycemic control Native Hawaiians and other Pacific Isl and ers ( NH/PI ; e.g. , Samoan and Chuukese ) have higher type 2 diabetes prevalence compared to other groups in Hawai‘i . Partners in Care ( PIC ) , a culturally tailored , community-based , diabetes self-management education intervention ( DSME ) , is effective at improving participants ' glycemic control and self-care behaviors . Maintenance of improvements is challenging . Diabetes-related social support groups ( SSG ) are a promising maintenance component for DSME . This study examined the effects of a diabetes-specific SSG component relative to a control group , after the receipt of the 3-month PIC intervention , which was delivered to 47 adult NH/PI with type 2 diabetes . Participants were then r and omized to either a 3-month , 6-session SSG or a control group .  Hemoglobin A1c ( HbA1c ) , blood pressure , triglycerides , cholesterol , and diabetes self-management knowledge and behaviors were assessed at baseline , 3 months , and 6 months . Results indicated significant improvements in HbA1c , diabetes-related self-management knowledge , and behaviors from baseline to 3-month assessment . However , no differences between the SSG and control group from 3-month to 6-month assessment suggest that all participants were able to maintain initial improvements . The SSG group had a significant decrease in systolic blood pressure from 3-month to 6-month assessment while the control group did not . Study limitations and future directions are discussed Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes ( T2DM ) . Methods Using a 2-group , experimental repeated measures design , 157 dyads ( participant with T2DM and family member ) were r and omly assigned to an intervention ( education , social support , home visits , and telephone calls ) or a wait list control group . Data were collected at baseline , postintervention ( 3 months ) , and 6 months postintervention . A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects . Results Significant changes over time were reported in diet self-management , exercise self-management , total self-management , diabetes self-efficacy for general health and total diabetes self-efficacy , physician distress , regimen distress , interpersonal distress , and total distress . There were likewise sustained effects for diet self-management , total self-management , diabetes self-efficacy for general health , total self-efficacy , physician distress , regimen distress , and interpersonal distress . Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive , longer , tailored interventions to achieve glycemic control Objective : To assess quality of life ( QoL ) and glycemic control in adolescents with type 1 diabetes and to investigate the impact of an educational program . Methods : A quasiexperimental study with nonr and omized experimental and control groups was conducted in which a total of 503 adolescents with type 1 diabetes completed a question naire using the Diabetes Quality of Life Instrument for Youth . Adolescents were then assigned to experimental and control groups . The experimental group was subjected to four 120-minute sessions of an educational program over a period of 4 months . Extracted medical chart data included the duration of diabetes , insulin dosage , and most recent hemoglobin A1c levels . Analysis of covariance was used to detect the impact of intervention . Results : The overall mean QoL score ( % ) was 76.51 ± 9.79 , with good QoL in 38 % of all adolescents . Poorer QoL was significantly associated with older age ( P < 0.001 ) , more hospital admissions in the last 6 months ( P = 0.006 ) , higher levels of depression ( P < 0.001 ) , poor self-esteem ( P < 0.001 ) , and poor self-efficacy ( P < 0.001 ) . There was significant deterioration in all domains of QoL in the experimental group after intervention . However , this deterioration was significantly less severe than in the control group . Between-group effects on total knowledge , adherence to exercise , glucose monitoring , treatment , self-efficacy , family contribution to management , glycemic control , and satisfaction with life were significantly in favor of the experimental group . Conclusion : Education intervention for adolescents with type 1 diabetes could be a safeguard against possible deterioration in QoL and glycemic control over time OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical trial , the Mobile Diabetes Intervention Study , r and omly assigned 26 primary care practice s to one of three stepped treatment groups or a control group ( usual care ) . A total of 163 patients were enrolled and included in analysis . The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period . Secondary outcomes were changes in patient-reported diabetes symptoms , diabetes distress , depression , and other clinical ( blood pressure ) and laboratory ( lipid ) values . Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support . Patients received automated , real-time educational and behavioral messaging in response to individually analyzed blood glucose values , diabetes medications , and lifestyle behaviors communicated by mobile phone . Providers received quarterly reports summarizing patient ’s glycemic control , diabetes medication management , lifestyle behaviors , and evidence -based treatment options . RESULTS The mean declines in glycated hemoglobin were 1.9 % in the maximal treatment group and 0.7 % in the usual care group , a difference of 1.2 % ( P = 0.001 ) over 12 months . Appreciable differences were not observed between groups for patient-reported diabetes distress , depression , diabetes symptoms , or blood pressure and lipid levels ( all P > 0.05 ) . CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data , lifestyle behaviors , and patient self-management data individually analyzed and presented with evidence -based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year Purpose The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes  and their willingness to be involved in a culturally tailored program . Methods This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual st and ard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes . Twenty-one participants were r and omly assigned to an individual education group or a culturally tailored intervention group . Family members/ peers ( n = 6 ) attended invited group sessions to obtain information about diabetes and family/peer support . The facilitator of the invited group sessions used a guide to help with group discussion s. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide , thus identifying recurring themes within the participants ' responses . Results The data revealed that family and friends made a difference in the diabetes management of individuals with dia- betes . Although family and friends may have been helpful at times , they also created moments of problems and an environment that made it more difficult to care for diabetes . The data also revealed that diabetes is hard to manage and control . Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging . Conclusions These findings confirm that family and peers greatly influence diabetes management among rural African Americans . The study 's results will help health care providers underst and the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes , particularly within rural African American communities where re sources are limited OBJECTIVE : To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus . DESIGN : Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose . The pharmacists provided diabetes education , medication counseling , monitoring , and insulin initiation and /or adjustments . All initial patient interactions with the pharmacists were face-to-face . Thereafter , patient – pharmacist interactions were either face-to-face or telephone contacts . SETTING : Two primary care clinics in a university-affiliated Veterans Affairs Medical Center . PARTICIPANTS : Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control . OUTCOME MEASURES : Primary outcome variables were changes from baseline in glycosylated hemoglobin , fasting blood glucose , and r and om blood glucose measurements . Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia , and the number of emergency room visits or hospitalizations related to diabetes . Twenty-three veterans aged 65 ± 9.4 years completed the study . Fifteen ( 65 % ) patients were initiated on insulin by the pharmacists ; 8 ( 35 % ) were already using insulin . Patients were followed for a mean ± SD of 27 ± 10 weeks . Glycosylated hemoglobin , fasting blood glucose concentrations , and r and om blood glucose concentrations significantly decreased from baseline by 2.2 % ( p = 0.00004 ) , 65 mg/dL ( p < 0.01 ) , and 82 mg/dL ( p = 0.00001 ) , respectively . Symptomatic hypoglycemic episodes occurred in 35 % of patients . None of these episodes required physician intervention . CONCLUSIONS : This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin Purpose The purpose of the study was to test the feasibility and efficacy of a diabetes self-management and education program for Chinese Americans in a support group format . The rationale for the study was to create culturally appropriate diabetes education and management programs in response to the growing diabetes prevalence among Chinese Americans . The investigators hypothesized that participants will have improved diabetes knowledge and practice s , hemoglobin A1C , and social support . The study objectives were at least : 50 % will have significant improvements in diabetes knowledge and practice activities , 30 % of participants will have significant improvements in A1C , and 50 % will report a gain in emotional support . Methods The program consisted of 12 90-minute diabetes education and support group sessions offered in a medical office setting . The sample included 23 Chinese Americans with either type 1 or type 2 diabetes . Using a single-group , pre-post test design , A1C and diabetes knowledge were assessed at baseline and 6 months . Data were collected through clinical assessment s and written question naires . Results The results indicated high attendance and statistically significant increases in glycemic control and diabetes knowledge . Statistically insignificant differences were shown in diabetes management practice s. Secondary outcomes assessed participants ’ perceived diabetes management and emotional and social support . Conclusions Diabetes Self-Management : A Cultural Approach ( DSMCA ) support group model demonstrates that a culturally tailored support group utilizing a community-based participatory research approach is an effective format to improve diabetes self-management skills among Chinese Americans . The program can be adapted for other ethnic population s. The efficacy of the intervention can be further tested in larger r and omized trials Background : In order to optimize care and improve outcomes in people with diabetes , adequate access to health care facilities and re sources for self-management is required . Methods : Data on 3369 individuals with type 2 diabetes who received education at 7 diabetes centers were collected prospect ively between June 2005 and January 2007 . The driving distances of subjects who were in good control [ hemoglobin A1c ( A1C ) > 7.0 % ] were compared with the driving distances of those who were not ( A1C > 7.0 % ) . The association between A1C and improvement in A1C with travel burden was tested . Results : The mean distance subjects traveled to visit their center was 13.3 miles . The results indicated that residing more than 10 miles from the diabetes management center [ odds ratio ( OR ) = 1.91 , p < .0001 ] , being younger ( OR = 0.99 , p = .00015 ) , and having a longer duration of diabetes ( OR = 1.03 , p = .0007 ) were significant contributors to a A1C > 7 % adjusted for individual- and community-level factors . In addition , those who lived within 10 miles of their center were 2.5 times more likely to have improved their A1C values between their first and last Office visits . Conclusion : Health care providers should be aware of travel burden as a potential barrier to glycemic control . In the future , it may be useful to minimize driving distance for individuals with diabetes , perhaps by improved public transportation , more diabetes center locations in rural areas , telemedicine , or home visits This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans , a fast growing minority population experiencing a diabetes epidemic . Patients with diabetes need assistance interpreting and managing symptoms , which are often annoying and potentially life-threatening . A repeated measures r and omized controlled trial was conducted with 72 Mexican Americans aged 25 - 75 years with type 2 diabetes . Experimental condition participants received eight weekly , in-home , one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness , glucose self-testing and appropriate treatments , followed by eight biweekly support telephone sessions . Wait-listed control condition participants served as comparisons at three time points . Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial , behavioral and clinical outcomes .  Participants were predominantly female , middle-aged , moderately acculturated and in poor glycemic control . Experimental group participants ( n = 39 ) significantly improved glycemic control , blood pressure , symptoms , knowledge , self-efficacy , empowerment and quality of life . Post intervention focus groups reported satisfaction with the symptom focus . Addressing symptoms led to clinical and psychosocial improvements . Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications PURPOSE To evaluate the effects of a collaborative case management intervention for patients with poorly controlled type 2 diabetes on glycemic control , intermediate cardiovascular outcomes , satisfaction with care , and re source utilization . METHODS We conducted a r and omized controlled trial at two Department of Veterans Affairs Medical Centers involving 246 veterans with diabetes and baseline hemoglobin A(1C ) ( HbA(1C ) ) levels > or=7.5 % . Two nurse practitioner case managers worked with patients and their primary care providers , monitoring and coordinating care for the intervention group for 18 months through the use of telephone contacts , collaborative goal setting , and treatment algorithms . Control patients received educational material s and usual care from their primary care providers . RESULTS At the conclusion of the study , both case management and control patients remained under poor glycemic control and there was little difference between groups in mean exit HbA(1C ) level ( 9.3 % vs. 9.2 % ; difference = 0.1 % ; 95 % confidence interval : -0.4 % to 0.7 % ; P = 0.65 ) . There was also no evidence that the intervention result ed in improvements in low-density lipoprotein cholesterol level or blood pressure control or greater intensification in medication therapy . However , intervention patients were substantially more satisfied with their diabetes care , with 82 % rating their providers as better than average compared with 64 % of patients in the control group ( P = 0.04 ) . CONCLUSION An intervention of collaborative case management did not improve key physiologic outcomes for high-risk patients with type 2 diabetes . The type of patients targeted for intervention , organizational factors , and program structure are likely critical determinants of the effectiveness of case management . Health systems must underst and the potential limitations before expending substantial re sources on case management , as the expected improvements in outcomes and downstream cost savings may not always be realized BACKGROUND type 2 diabetes mellitus continues to increase in prevalence worldwide . Many factors have been cited as contributing to compliance , such as family and social support , education , number of tablets per dose , frequency of administration and health care provider communication . Toward these goals , the present study was developed to measure the effect offactors on glycemic control such as diabetes education by pharmacists , a diabetes disease booklet and special medication containers . MATERIAL AND METHOD A total of 360 volunteers with type 2 DM patients were recruited , participants were simple r and omized to control 180 and intervention 180 patients . Which intervention categorized to 4 groups ; all intervention groups received diabetes drug counseling by a pharmacist , one group received plus a diabetes booklet , one received plus special medical containers and the last group received all of them . The interventions were done at the 1st time of visit . Both the control and intervention groups were monitored for fasting plasma glucose and HbA1c at 0 , 3 , 6 months and glycemic level in both groups was compared . RESULTS After 3 months , mean fasting plasma glucose and HbA1c decreased wiih the intervention group vs. control group ( 152.36 + /- 39.73 to 131.52 + /- 35.22 mg% ) and ( 150.16 + /- 41.78 to 153.98 + /- 47.95 mg% ) respectively ; ( p < 0.001 ) . HbA1c level 8.16 + /- 1.44 to 7.72 + /- 1.26 vs 8.01 + /- 1.51 to 8.38 + /- 1.46 respectively ; ( p < 0.001 ) . After 6 months , mean fasting plasma glucose and HbA1c decreased with the intervention group vs. control group ( 152.36 + /- 39.73 to 145.20 + /- 46.07 mg% ) and ( 150.16 + /- 41.78 to 159.16 + /- 54.90 mg% ) respectively ; ( p < 0.013 ) . HbA1c level 8.16 + /- 1.44 to 7.91 + /- 1.27 vs. 8.01 + /- 1.51 to 8.80 + /- 1.36 respectively ; ( p < 0.001 ) . The most favorable glycemic outcome was the group that received all of the interventions ; mean FPG was reduced from 147.46 + /- 36.07 to 125.38 + /- 31.12 mg% ( p < 0.000 ) in 1nd visit ( 3 months later ) and still reducing effect on the 2nd visit ( 6 month later ) mean FPG from 147.46 + /- 36.07 to 130.21 + /- 33.96 mg% ( p < 0.016 ) also the same way in HbA 1c level . The group that received only drug counseling by pharmacist had no significant reduction in FPG and HbA1c . ( p > 0.05 ) . CONCLUSION Drug counseling by a pharmacist has little beneficial effect on diabetes management outcome compared to the diabetes booklet and special drug container . To improve glycemic control of type 2 DM is to integrate self-management in daily life , wide a variety of education , drug taken behavior and health care provider available communication produce improvement in patient management and is somewhat better when used in combination BACKGROUND Although maintaining nearly normal glycemia delays onset and slows progression of diabetes complications , many patients with diabetes and their physicians struggle to achieve glycemic targets . The best methods to support patients as they follow diabetes prescriptions and recommendations are unclear . METHODS To test the efficacy of a behavioral diabetes intervention in improving glycemia in long- duration , poorly controlled diabetes , we r and omized 222 adults with diabetes ( 49 % type 1 ) ( mean [ SD ] age , 53 [ 12 ] years ; mean [ SD ] disease duration 18 [ 12 ] years ; mean [ SD ] hemoglobin A(1c ) [ HbA(1c ) ] concentration , 9.0 % [ 1.1 % ] ) to attend ( 1 ) a 5-session manual-based , educator-led structured group intervention with cognitive behavioral strategies ( structured behavioral arm ) ; ( 2 ) an educator-led attention control group education program ( group attention control ) ; or ( 3 ) unlimited individual nurse and dietitian education sessions for 6 months ( individual control ) . Outcomes were baseline and 3- , 6- , and 12-month postintervention HbA(1c ) levels ( primary ) and frequency of diabetes self-care , 3-day pedometer readings , 24-hour diet recalls , average number of glucose checks , physical fitness , depression , coping style , self-efficacy , and quality of life ( secondary ) . RESULTS Linear mixed modeling found that all groups showed improved HbA(1c ) levels ( P < .001 ) . However , the structured behavioral arm showed greater improvements than the group and individual control arms ( 3-month HbA(1c ) concentration changes : -0.8 % vs -0.4 % and -0.4 % , respectively ( P = .04 for group × time interaction ) . Furthermore , participants with type 2 disease showed greater improvement than those with type 1 ( P = .04 for type of diabetes × time interaction ) . Quality of life , glucose monitoring , and frequency of diabetes self-care did not differ by intervention over time . CONCLUSIONS A structured , cognitive behavioral program is more effective than 2 control interventions in improving glycemia in adults with long- duration diabetes . Educators can successfully use modified psychological and behavioral strategies . TRIAL REGISTRATION clinical trials.gov Identifier : NCT000142922 OBJECTIVE To assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients . DESIGN A partially r and omized controlled trial involving two groups of patients : Group A , subjects who received an education program followed by 18 months of support group sessions ; Group B , only the diabetes education program . A third convenience sample , Group C , received neither intervention . Groups A and B were assessed before and immediately after the education program , and all groups were assessed 2 years after the education program . SETTING Diabetes clinic at a Veterans Affairs Medical Center . PATIENTS All subjects were male ( mean age = 68 + /- 1.3 years , range = 57 - 82 years ; duration of diabetes = 10 + /- 2 years , range 3 - 16 ) . Sample sizes were 11 in Group A , 13 in Group B , and 8 in Group C. INTERVENTION The education program consisted of six weekly sessions covering aspects of diabetes self-care . The support group consisted of 18 monthly sessions for continuing education , discussion , and structured social activities . OUTCOME MEASURES Diabetes knowledge , psychosocial factors ( self-care-related quality of life , stress , family involvement in care , and social involvement ) , depression , and glycemic control . RESULTS Group A scored better ( at least P less than 0.05 ) on knowledge , quality of life , and depression than the other groups . Groups A and B showed less stress , greater family involvement , better glycemic control , but less involvement in social activities than Group C. CONCLUSION Diabetes education programs can have long term benefits on knowledge , psychosocial functioning , and glycemic control for older diabetic patients . The addition of support groups enhances diabetes knowledge and psychosocial functioning In recent years , great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes . Studies have reported that nurses , compared to other healthcare professionals , are more likely to promote preventive healthcare seeking behaviors . The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin . A two-arm parallel-group r and omized controlled trial with the blinded outcome assessors was design ed . One hundred forty-two adults with type 2 diabetes were r and omized to receive either usual diabetes care ( control group ) or usual care plus a nurse-led diabetes self-management education ( intervention group ) . Duration of the intervention was 12 weeks . The primary outcome was glycosylated hemoglobin ( HbA1c values ) . Secondary outcomes were changes in blood pressure , body weight , lipid profiles , self-efficacy ( efficacy expectation and outcome expectation ) , self-management behaviors , quality of life , social support , and depression . Outcome measures were assessed at baseline and at 12-week and 24-week postr and omizations . Patients in the intervention group showed significant improvement in HbA1c , blood pressure , body weight , efficacy expectation , outcome expectation , and diabetes self-management behaviors . The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial result ing in sustained improvements in clinical , lifestyle , and psychosocial outcomes . This trial is registered with I RCT 2016062528627N1 OBJECTIVE To compare the effectiveness of different approaches to nutrition education in diabetes self-management education and support ( DSME/S ) . METHODS We r and omized 150 adults with type 2 diabetes to either certified diabetes educator (CDE)-delivered DSME/S with carbohydrate gram counting or the modified plate method versus general health education . The primary outcome was change in HbA1C over 6 months . RESULTS At 6 months , HbA1C improved within the plate method [ -0.83 % ( -1.29 , -0.33 ) , P<0.001 ] and carbohydrate counting [ -0.63 % ( -1.03 , -0.18 ) , P=0.04 ] groups but not the control group [ P=0.34 ] . Change in HbA1C from baseline between the control and intervention groups was not significant at 6 months ( carbohydrate counting , P=0.36 ; modified plate method , P=0.08 ) . In a pre-specified subgroup analysis of patients with a baseline HbA1C 7 - 10 % , change in HbA1C from baseline improved in the carbohydrate counting [ -0.86 % ( -1.47 , -0.26 ) , P=0.006 ] and plate method groups [ -0.76 % ( -1.33 , -0.19 ) , P=0.01 ] compared to controls . CONCLUSION CDE-delivered DSME/S focused on carbohydrate counting or the modified plate method improved glycemic control in patients with an initial HbA1C between 7 and 10 % . PRACTICE IMPLICATION S Both carbohydrate counting and the modified plate method improve glycemic control as part of
This systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels .
PRACTICE IMPLICATION S The data suggest mode of delivery , hours of engagement , and baseline A1C can affect the likelihood of achieving statistically significant and clinical ly meaningful improvement in A1C
OBJECTIVE Assess effect of diabetes self-management education and support methods , providers , duration , and contact time on glycemic control in adults with type 2 diabetes .