Who Can Provide Diabetes Self-Management Support in Primary Care? Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States A Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients? Diabetes Self-Management Education: Miles to Go Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. A resilience intervention in African-American adults with type 2 diabetes. Comparison of a Mindful Eating Intervention to a Diabetes Self-Management Intervention Among Adults With Type 2 Diabetes Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community Enhancing Diabetes Self-care Among Rural African Americans With Diabetes Social Support Groups in the Maintenance of Glycemic Control after Community-Based Intervention Effect of a community-based diabetes self-management empowerment program on mental health-related quality of life: a causal mediation analysis from a randomized controlled trial Comparative Effectiveness of Peer Leaders and Community Health Workers in Diabetes Self-management Support: Results of a Randomized Controlled Trial Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Intensive Patient Education Improves Glycaemic Control in Diabetes Compared to Conventional Education: A Randomised Controlled Trial in a Nigerian Tertiary Care Hospital A randomized comparison of a commercially available portion-controlled weight-loss intervention with a diabetes self-management education program The diabetes nutrition education study randomized controlled trial: A comparative effectiveness study of approaches to nutrition in diabetes self-management education. Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes Effects of Music Therapy and Music-Assisted Relaxation and Imagery on Health-Related Outcomes in Diabetes Education Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention? 3-Year Follow-up of Clinical and Behavioral Improvements Following a Multifaceted Diabetes Care Intervention
Purpose The purpose of this comparative effectiveness study is to compare diabetes self-management support ( DSMS ) approaches and determine who can be most effective in helping patients maintain/improve clinical  outcomes  ,  self-care behaviors , distress , and satisfaction following  diabetes self-management education ( DSME )  delivered in primary care . Methods After receiving DSME , 141 participants were r and omized to receive DSMS delivered by a trained supporter :  educator , peer , practice staff , or usual education during a 6-month follow-up period . DSMS groups were compared to determine which supporter helped participants to maintain/improve A1C , blood pressure , lipids , weight , self-care , and distress . DSMS satisfaction was also examined . Results There was a significant improvement in A1C , empowerment , aspects of self-care , and distress following DSME at 6 weeks . Those in the educator DSMS group best sustained improved A1C while those in the other DSMS groups maintained glycemic improvements but began to show trends toward worsening . No significant differences or clear trends were seen in other clinical , behavioral , or psychosocial outcomes . The Program Reinforcement Impacts Self-Management ( PRISM ) study demonstrates that following DSME , participants maintained improved glycemia , lipid , weight , and self-care behaviors and reductions in distress throughout the delivery of DSMS interventions regardless of DSMS supporter . All of the participants reported satisfaction with DSMS . Conclusions These findings reaffirm the critical role of educators but suggest that others may serve as DSMS supporters . Results suggest that DSME delivered in primary care is effective and multiple DSMS agents are reasonable . As patient-centered self-management approaches are being explored in primary care , delivery of DSME and DSMS becomes paramount Background Type 2 diabetes ( T2D ) is a significant public health problem , with U.S. Pacific Isl and er communities — such as the Marshallese — bearing a disproportionate burden . Using a community-based participatory approach ( CBPR ) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D . Objectives Led by a collaborative community-academic partnership , the Family Model of Diabetes Self-Management Education ( DSME ) aim ed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family . Design To test the Family Model of DSME , a r and omized , controlled , comparative effectiveness trial with 240 primary participants was implemented . Half of the primary participants were r and omly assigned to the St and ard DSME and half were r and omly assigned to the Family Model DSME . Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period . Methods The Family Model DSME was a cultural adaptation of DSME , whereby the intervention focused on engaging family support for the primary participant with T2D . The St and ard DSME was delivered to the primary participant in a community-based group format . Primary participants and participating family members were assessed at baseline and immediate post-intervention , and will also be assessed at 6 and 12 months . Summary The Family Model of DSME aim ed to improve glycemic control in Marshallese with T2D . The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention 's success and sustainability Introduction Diabetes self-management education ( DSME ) is a fundamental element of type 2 diabetes care . Although 75 % of adults with diabetes worldwide live in low-income and middle-income countries ( LMICs ) , limited DSME research has been conducted in LMICs . The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala . Methods We conducted a prospect i ve study of a DSME intervention using a quasi-experimental , single-group pretest – posttest design . We enrolled 90 participants in the intervention , which consisted of 6 home visits ( May 2014–July 2016 ) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan population s. Primary outcomes were changes in mean hemoglobin A1c ( HbA1c ) and mean systolic and diastolic blood pressure at baseline and at 12 months . Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion . Results HbA1c decreased significantly from baseline to 12 months ( absolute mean change , −1.5 % ; 95 % confidence interval [ CI ] , −1.9 % to −1.0 % ; P < .001 ) . Systolic blood pressure also improved significantly at 12 months ( −6.2 mm Hg ; 95 % CI , −10.1 to −2.2 mm Hg ; P = .002 ) ; changes in diastolic blood pressure were not significant ( −1.6 mm Hg ; 95 % CI , −3.9 to −0.7 mm Hg ; P = .17 ) . We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion . Conclusion DSME interventions can be successfully delivered in a setting with an underre source d health system , high poverty rate , and unique cultural characteristics like Mayan Guatemala . Our findings point to the need for more DSME research in re source -limited setting s globally AIM 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 r and omized 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 the four intervention visits ( mean 3.4 ) , 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 This meta- analysis assessed how successfully Diabetes Self-Management Education ( DSME ) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels . We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in r and omized controlled trials . The training conditions result ed in significant reductions in A1c levels compared to control conditions . However , the impact of intervention was modest shifting of only 7.23 % more participants from diabetic to pre-diabetic or normal status , relative to the control condition . Most intervention participants did not achieve healthy A1c levels . Further , few DSME studies assessed long-term maintenance of A1c gains . Past trends suggest that gains are difficult to sustain over time . Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel . We suggest that DSME programs might do better by going beyond procedural interventions . Most DSME programs relied heavily on rules and procedures to guide decisions about diet , exercise , and weight loss . Future DSME may need to include cognitive self-monitoring , diagnosis , and planning skills to help patients detect anomalies , identify possible causes , generate corrective action , and avoid future barriers to maintaining healthy A1c levels . Finally , comprehensive descriptions of DSME programs would advance future efforts Purpose The purpose of this study was to determine the impact of diabetes self-management education ( DSME ) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c , in individuals with type 2 diabetes mellitus ( T2DM ) . Methods A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011–2012 from an accredited American Diabetes Association center at Intermountain Healthcare ( IH ) and had an HbA1c measurement within the prior 3 months and 2–6 months after completing their first DSME visit . Control patients were selected from the same clinics as case- patients using r and om number generator to achieve a 1 to 4 ratio . Case and control patients were included if 1 ) pre-education HbA1c was between 6.0%–14.0 % ; 2 ) their main provider was a primary care physician ; 3 ) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry . The IH diabetes bundle includes retinal eye exam , nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker ; blood pressure < 140/90 mmHg , LDL < 100 mg/dL , HbA1c < 8.0 % . Results DSME patients had a significant difference in achievement of the five element IH diabetes bundle and in HbA1c % compared to those without DSME . After adjusting for possible confounders in a multivariate logistic regression model , DSME patients had a 1.5 fold difference in improvement in their diabetes bundle and almost a 3 fold decline in HbA1c compared to the control group . Conclusion St and ardized DSME taught within an IH American Diabetes Association center is strongly associated with a substantial improvement in patients meeting all five elements of a diabetes bundle and a decline in HbA1c beyond usual care . Given the low operating cost of the DSME program , these results strongly support the value adding benefit of this program in treating T2DM patients Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus ( T2DM ) . This pilot study examined a 12-week church-based culturally targeted diabetes self-management education ( DSME ) intervention for middle-aged and older African Americans with T2DM . Quantitative data were collected at baseline and at 12 weeks and included question naires and anthropometric measures . There were significant increases in medication adherence ( p = .006 ) , healthy eating ( p = .009 ) , and foot care adherence ( p = .003 ) . The intervention had a clinical ly significant effect on systolic blood pressure , blood lipids , physical activity , and waist circumference . Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM . The authors discuss the value of community-based interventions that target behavioural changes in population s of chronically ill patients , particularly those who historically have been disenfranchised and /or underserved OBJECTIVES To explore the feasibility and outcomes of a resilience-based diabetes self-management education ( RB-DSME ) program to improve psychological and physiological health in African-American adults with type 2 diabetes . METHODS An experimental group ( N = 32 ) received RB-DSME and a comparison group ( N = 33 ) received st and ard DSME .  Psychological and physiological measures were taken at baseline and 6 months . ANCOVAs assessed whether the experimental group improved its overall outcome relative to the comparison group , while controlling for baseline scores . RESULTS The experimental group 's outcomes were significantly improved vis-à-vis the comparison group for diabetes knowledge , positive meaning , HDL cholesterol , and fasting blood glucose . CONCLUSIONS The RB-DSME shows feasibility and promise for enhancing health ; a full-scale r and omized trial is warranted Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues , improving eating regulation and dietary patterns , reducing symptoms of depression and anxiety , and promoting weight loss . Diabetes self-management education ( DSME ) , which addresses knowledge , self-efficacy , and outcome expectations for improving food choices , also may be an effective intervention for diabetes self-care . Yet few studies have compared the impact of mindful eating to a DSME-based treatment approach on patient outcomes . Adults 35 to 65 years old with type 2 diabetes for ≥1 year not requiring insulin therapy were recruited from the community and r and omly assigned to treatment group . The impact of a group-based 3-month mindful eating intervention ( MB-EAT-D ; n = 27 ) to a group-based 3-month DSME “ Smart Choices ” ( SC ) intervention ( n = 25 ) postintervention and at 3-month follow-up was evaluated . Repeated- measures ANOVA with contrast analysis compared change in outcomes across time . There was no significant difference between groups in weight change . Significant improvement in depressive symptoms , outcome expectations , nutrition and eating-related self-efficacy , and cognitive control and disinhibition of control regarding eating behaviors occurred for both groups ( all p < .0125 ) at 3-month follow-up . The SC group had greater increase in nutrition knowledge and self-efficacy than the MB-EAT-D group ( all p < .05 ) at 3-month follow-up . MB-EAT-D had significant increase in mindfulness , whereas the SC group had significant increase in fruit and vegetable consumption at study end ( all p < .0125 ) . Both SC and MB-EAT-D were effective treatments for diabetes self-management . The availability of mindful eating and DSME-based approaches offers patients greater choices in meeting their self-care needs PURPOSE We compared a 3-month diabetes self-management education ( DSME ) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin ( HbA1c ) . Secondary outcomes were risk factors for cardiovascular disease ( CVD ) , diabetes distress , and social support . METHODS We r and omized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support . Assessment s were conducted at baseline , 3 , 9 , and 15 months . RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group . The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months . At 15 months , the peer-support group had significantly lower low-density lipoprotein cholesterol levels ( −15 mg/dL , P = .03 ) , systolic blood pressure ( −10 mm Hg , P = .01 ) , diastolic blood pressure ( −8.3 mm Hg , P = .001 ) , and body mass index ( −0.8 kg/m2 , P = .032 ) than the DSME-alone group . CONCLUSIONS In this population of African American adults , an initial DSME program , whether or not followed by 12 months of peer support , had no effect on glycemic control . Participants in the peer-support arm of the trial did , however , experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined Purpose The purpose of this study is to test the feasibility of conducting a community-based r and omized controlled trial evaluating a culturally tailored community-based group diabetes self-management education ( DSME ) program among rural African Americans . Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study design ed to test the effectiveness of the “ Taking Care of Sugar ” DSME program for the 2-year follow-up . Participants were selected from rural central Virginia . Primary outcomes variables included average blood sugar levels , cardiovascular risk factors , and general physical and mental health . These outcomes were assessed at baseline , 3 months , 6 months , and 12 months post baseline . Results From baseline to 3-month follow-up assessment , participants exhibited significant improvement on several physiological and behavioral measures . Given the small sample size , hypothesis testing was limited . Results show change from baseline over time , illustrating that the primary outcome of A1C decreased , although not significant . Additionally , participants reported more knowledge about diabetes self-management and personal care skills ( ie , exercise and foot care ) that persisted over time . The feasibility of the culturally tailored DSME was established , and participation with the program was high . Conclusions A community-based group DSME program using storytelling is feasible . This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population . If such a program is carried out , we can improve knowledge , reduce complications , and improve quality of life among rural African Americans 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 Background There is a paucity of evidence supporting the effectiveness of diabetes self-management education ( DSME ) in improving mental health-related quality of life ( HRQoL ) for African American and Latinos . Also , among studies supporting the favorable effects of DSME on mental HRQoL , the direct effect of DSME that is independent of improved glycemic control has never been investigated . The objectives of this study were to investigate the effect of community-based DSME intervention targeting empowerment on mental HRQoL and to determine whether the effect is direct or mediated by glycemic control . Methods We conducted secondary analyses of data from the Diabetes Self-Care Study , a r and omized controlled trial of a community-based DSME intervention . Study participants ( n = 516 ) were African Americans and Latinos 55 years or older with poorly controlled diabetes ( HbA1c ≥ 8.0 % ) recruited from senior centers and churches in Los Angeles . The intervention group received six weekly small-group self-care sessions based on the empowerment model . The control group received six lectures on unrelated geriatrics topics . The primary outcome variable in this secondary analysis was the change in Mental Component Summary score ( MCS-12 ) from the SF-12 Health Survey between baseline and six-month follow-up . We used the change in HbA1c during the study period as the main mediator of interest in our causal mediation analysis . Additionally , possible mediations via social support and perceived empowerment attributable to the program were examined . Results MCS-12 increased by 1.4 points on average in the intervention group and decreased by 0.2 points in the control group ( difference-in-change : 1.6 points , 95 % CI : 0.1 to 3.2 ) . In the causal mediation analysis , the intervention had a direct effect on MCS-12 improvement ( 1.7 points , 95 % CI : 0.2 to 3.2 ) with no indirect effects mediated via HbA1c change ( −0.1 points , 95 % CI : −0.4 to 0.1 ) , social support ( 0.1 points ) , and perception of empowerment ( 0.1 points ) . Conclusions This Diabetes Self-Care Study empowerment intervention had a modest positive impact on mental HRQoL not mediated by the improvement in glycemic control , as well as social support and perception of empowerment . This favorable effect on mental HRQoL may be a separate clinical advantage of this DSME intervention . Trial Registration Clinical Trial.gov NCT00263835 OBJECTIVE To compare a peer leader ( PL ) versus a community health worker ( CHW ) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education ( DSME ) program . RESEARCH DESIGN AND METHODS One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and r and omized to 1 ) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or 2 ) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs . The primary outcome was HbA1c . Secondary outcomes were cardiovascular disease risk factors , diabetes distress , and diabetes social support . Assessment s were conducted at baseline , 6 , 12 , and 18 months . RESULTS After DSME , the PL group achieved a reduction in mean HbA1c ( 8.2–7.5 % or 66–58 mmol/mol , P < 0.0001 ) that was maintained at 18 months ( −0.6 % or −6.6 mmol/mol from baseline [ P = 0.009 ] ) . The CHW group also showed a reduction in HbA1c ( 7.8 vs. 7.3 % or 62 vs. 56 mmol/mol , P = 0.0004 ) post–6 month DSME ; however , it was attenuated at 18 months ( −0.3 % or −3.3 mmol/mol from baseline , within-group P = 0.234 ) . Only the PL group maintained improvements achieved in blood pressure at 18 months . At the 18-month follow-up , both groups maintained improvements in waist circumference , diabetes support , and diabetes distress , with no significant differences between groups . CONCLUSIONS Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes , but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes .  Diabetes self-management education ( DSME ) is an essential component of effective self-care . Yet , little research has compared the effect of mindful eating to DSME-based treatment . This study compared the impact of these two interventions in adults with type 2 diabetes mellitus . A prospect i ve r and omized controlled trial with two parallel interventions was used . Participants included adults age 35 to 65 years with type 2 diabetes mellitus for 1 year or more , body mass index ( BMI ) of 27 or more , and hemoglobin A1c ( HbA1c ) of 7 % or more who were r and omly assigned to a 3-month mindful eating ( MB-EAT-D ; n=27 ) or Smart Choices ( SC ) DSME-based ( n=25 ) intervention . Follow-up occurred 3 months after intervention completion . Dietary intake , physical activity , weight , HbA1c and fasting plasma glucose , and fasting insulin were assessed using repeated measures analysis of variance with contrast analysis . There was no significant difference between groups in the change in weight or glycemia at study end . Significant difference occurred between groups in the change in dietary intake/1,000 kcal of trans fats , total fiber , and sugars ( all P<0.05 ) . Mean ( ± st and ard error ) reduction in weight ( -2.92 ± 0.54 kg for SC vs -1.53 ± 0.54 kg for MB-EAT-D ) and HbA1c ( -0.67 ± 0.24 % for SC and -0.83 ± 0.24 % for MB-EAT-D ) were significant ( P<0.01 ) . Significant reduction in energy intake and glycemic load occurred ( all P<0.0001 ) for both groups . Training in mindful eating and diabetes self-management  facilitate improvement in dietary intake , modest weight loss , and glycemic control . The availability of effective treatments gives patients with diabetes choices in meeting their self-care needs Background Diabetes is now a global epidemic , but most cases are now in low- and middle-income countries . Diabetes self-management education ( DSME ) is key to enabling patients to manage their chronic condition and can reduce the occurrence of costly and devastating complications . However , there is limited evidence on the effectiveness of different DSME programmes in re source limited setting s. Methods We conducted an unblinded , parallel-group , individually-r and omised controlled trial at the University of Calabar Teaching Hospital ( Nigeria ) to evaluate whether an intensive and systematic DSME programme , using structured guidelines , improved glycaemic control compared to the existing ad hoc patient education ( clinical practice was unchanged ) . Eligible patients ( ≥18 years , HbA1c > 8.5 % and physically able to participate ) were r and omly allocated by permuted block r and omisation to participate for six months in either an intensive or conventional education group . The primary outcome was HbA1c ( % ) at six-months . Results We r and omised 59 participants to each group and obtained six-month HbA1c outcomes from 53 and 51 participants in the intensive and conventional education groups , respectively . Intensive group participants had a mean six-month HbA1c ( % ) of 8.4 ( 95 % CI : 8 to 8.9 ) , while participants in the conventional education group had a mean six-month HbA1c ( % ) of 10.2 ( 95 % CI : 9.8 to 10.7 ) . The difference was statistically ( P < 0.0001 ) and clinical ly significant , with intensive group participants having HbA1c outcomes on average -1.8 ( 95 % CI : -2.4 to -1.2 ) percentage points lower than conventional group participants . Results were robust to adjustment for a range of covariates and multiple imputation of missing outcome data . Conclusions This study demonstrates the effectiveness of a structured , guideline -based DSME intervention in a LMIC setting versus a pragmatic comparator . The intervention is potentially replicable at other levels of the Nigerian healthcare system and in other LMICs , where nurses/diabetes educators can run the programme . Trial Registration Pan African Clinical Trial Registry Objective : This study examined the efficacy of a commercially available , portion-controlled diet ( PCD ) on body weight and HbA1c over 6 months in obese patients with type 2 diabetes . Research Design and Methods : One-hundred participants with a mean±s.d . age of 55.6±10.6 year , body weight of 102.9±18.4 kg and HbA1c of 7.7±1.3 % were r and omly assigned to a 9-session group lifestyle intervention that included a PCD or to a 9-session group program of diabetes self-management education ( DSME ) . Participants in the two groups were prescribed the same goals for energy intake ( 1250–1550 kcal per day ) and physical activity ( 200 min per week ) . Results : While both groups produced significant improvements in weight and HbA1c after 6 months of treatment , PCD participants lost 7.3 kg [ 95 % confidence interval ( CI ) : −5.8 to −8.8 kg ] , compared with 2.2 kg ( 95 % CI : −0.7 to −3.7 kg ) in the DSME group ( P<0.0001 ) . Significantly more PCD than DSME participants lost ⩾5 % of initial weight ( 54.0 % vs 14.0 % , P<0.0001 ) and ⩾10 % ( 26.0 % vs 6.0 % , P<0.0001 ) . HbA1c declined by 0.7 % ( 95 % CI : −0.4 to −1.0 % ) in the PCD group , compared with 0.4 % ( 95 % CI : −0.1 to −0.7 % ) in DSME ( P<0.026 ) . Across both groups , larger weight losses were associated with greater reductions in HbA1c ( r=0.52 , P<0.0001 ) . Conclusions : These findings demonstrate that a commercially available portion-controlled meal plan can induce clinical ly meaningful improvements in weight and glycemic control in obese individuals with type 2 diabetes . These data have implication s for the management of obesity in primary care , as now provided by the Centers for Medicare and Medicaid Services 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 Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans . Social Cognitive Theory provided the framework for the study . Methods Twenty-two participants were recruited and r and omly assigned to either Group or Individual diabetes self-management ( DSME ) . Group DSME included story-telling , h and s-on activities , and problem-solving exercises . Individual DSME sessions focused on goal - setting and problem-solving strategies . Sessions were offered in an accessible community center over a 10-week period . Results Outcomes included glycosylated hemoglobin ( A1C ) , self-care actions , self-efficacy level , goal attainment , and satisfaction with DSME . Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities , A1C level , and goal attainment . Although differences were not statistically significant , trends indicate improved scores on dietary actions , foot care , goal attainment , and empowerment for those experiencing Group DSME . Conclusions The culturally tailored approach was well received by all participants . Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control . Additional testing among more participants over a longer time period is recommended Purpose The purpose of the feasibility study was to compare the effects of music-assisted relaxation and imagery , administered via compact disc recording ( MARI CD ) without therapeutic intervention , to the effects of music therapy ( MT ) , facilitated by a board-certified music therapist , on selected health outcomes of patients enrolled in diabetes self-management education/training ( DSME/T ) . Methods A 3-group , parallel , r and omized controlled trial with 199 patients , aged 30 to 85 years with type 1 , type 2 , or prediabetes was employed . Patients were enrolled in a study from 2 hospital sites and r and omly assigned to : DSME/T alone , DSME/T plus MARI CD , or DSME/T plus MT . The MARI CD included research er-selected music and spoken suggestions , while MT included therapeutic experiences with personally preferred relaxing and energizing music . Outcome measures included blood pressure , glycosylated hemoglobin ( A1C ) , body mass index ( BMI ) , trait anxiety , state anxiety , and stress . Results There were no statistically significant differences among the 3 conditions in blood pressure , A1C , BMI , trait anxiety , or stress . Significant changes over time were evident in the MT condition from pre- to post-each session in systolic blood pressure , state anxiety , and stress . Blood pressure changes were compared pre- to postprogram for those patients with a comorbidity of hypertension between DSME/T alone and a combined music intervention group ( MT and MARI CD ) . It was found that the music intervention group had a significantly larger decrease in systolic blood pressure . Themes derived from patient narratives further informed the data . Conclusions The study results support the relationship between DSME/T and improvement on all measured outcomes except blood pressure . Results suggest the feasibility of integrating MARI and MT with DSME/T to potentially lower systolic blood pressure of patients with diabetes and a comorbidity of hypertension . Collaboration between diabetes educators and board-certified music therapists is recommended OBJECTIVE To evaluate the efficacy of ongoing group based diabetes self-management education ( DSME ) for patients with type 2 diabetes . METHODS 146 patients were r and omised to either group education or waiting list control . Primary outcomes were A1C and patient activation measured with patient activation measure ( PAM ) . RESULTS There were no differences in the primary outcomes between the groups at 12 months , but the control group had an increase in A1C of 0.3 % points during follow-up . Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group . A sub group analysis was conducted for the quartile with the highest A1C at baseline ( > 7.7 , n=18 in both groups ) . There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control . CONCLUSIONS The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level . PRACTICE IMPLICATION S Locally developed programs may be less effective than programs developed for studies 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 Purpose The purpose of this study was to determine if improvements observed in clinical , behavioral , and psychosocial outcomes measured at 12 months following a multifaceted diabetes care intervention were sustained at 3-year follow-up . Methods This study was a multilevel , nonblinded , cluster design , r and omized controlled trial that took place in an under-served suburb of Pittsburgh , Pennsylvania , between 1999 and 2005 . Eleven primary care practice s , and their patients , were r and omly assigned to 3 groups :  chronic care model ( CCM ) intervention ( n = 30 ) , provider education only ( PROV ) ( n = 38 ) , and usual care ( UC ) ( n = 51 ) . Subjects were followed for 3 years . Results Improvements observed at 12-month follow-up in glycemic ( —0.5 % ) and blood pressure control ( —4.8 mm Hg ) , and the proportion of participants who self-monitor their blood glucose ( 86.7%-100 % ) , were sustained at 3-year follow-up in the CCM group . Additional improvements occurred in non-HDLc levels in all study groups and quality of well-being scores in the CCM intervention group . All associations remained after controlling for medication treatment intensification . Conclusions We have demonstrated that improvements in outcomes can be sustained over time following a multifaceted diabetes care intervention . Future research in this area is necessary to underst and if improvements in outcomes can be sustained following diabetes self-management education ( DSME ) and what type of patient fares the best from multifaceted diabetes care interventions
There were no differences between the groups in mortality rate , body mass index , blood pressure and lipid profile .
Conclusions Group-based DSME in people with type 2 diabetes results in improvements in clinical , lifestyle and psychosocial outcomes
Background Diabetes self-management education ( DSME ) can be delivered in many forms .
Group based DSME is widespread due to being a cheaper method and the added advantages of having patient meet and discuss with each other .
assess effects of group-based DSME compared to routine treatment on clinical , lifestyle and psychosocial outcomes in type-2 diabetes patients .