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 Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes Nurse Case Management To Improve Glycemic Control in Diabetic Patients in a Health Maintenance Organization Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults Family Interactions Among African Americans Diagnosed With Type 2 Diabetes Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Effects of an Outpatient Diabetes Self-Management Education on Patients with Type 2 Diabetes in China: A Randomized Controlled Trial An Ecological Perspective on Diabetes Self-care Support, Self-management Behaviors, and Hemoglobin A1C Among Latinos A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. Mexican American trial of community health workers: a randomized controlled trial of a community health worker intervention for Mexican Americans with type 2 diabetes mellitus. Adherence to diabetes control recommendations: impact of nurse telephone calls. Explaining engagement in self-monitoring among participants of the DESMOND Self-monitoring Trial: a qualitative interview study. 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. Tailored Case Management for Diabetes and Hypertension (TEACH-DM) in a community population: study design and baseline sample characteristics. Effect of a Pharmacist-Led Program on Improving Outcomes in Patients with Type 2 Diabetes Mellitus from Northern Cyprus: A Randomized Controlled Trial. Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients? Design and Methods for a Comparative Effectiveness Pilot Study: Virtual World vs. Face-to-Face Diabetes Self-Management Effectiveness of nurse practitioner coordinated team group visits for type 2 diabetes in medically underserved Appalachia Practice network-based care management for patients with type 2 diabetes and multiple comorbidities (GEDIMAplus): study protocol for a randomized controlled trial A resilience intervention in African-American adults with type 2 diabetes. Diabetes Self-Management Education: Miles to Go Who Can Provide Diabetes Self-Management Support in Primary Care?
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 OBJECTIVE To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes . RESEARCH DESIGN AND METHODS A prospect i ve , r and omized , repeated measures study was conducted on the Texas-Mexico border in Starr County . A total of 256 r and omly selected individuals with type 2 diabetes between 35 and 70 years of age , diagnosed with type 2 diabetes after 35 years of age , and accompanied by a family member or friend were included . The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses , dietitians , and community workers . The intervention involved 3 months of weekly instructional sessions on nutrition , self-monitoring of blood glucose , exercise , and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes . The approach was culturally competent in terms of language , diet , social emphasis , family participation , and incorporation of cultural health beliefs . Outcomes included indicators of metabolic control ( HbA(1c ) and fasting blood glucose ) , diabetes knowledge , and diabetes-related health beliefs . RESULTS Experimental groups showed significantly lower levels of HbA(1c ) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores . At 6 months , the mean HbA(1c ) of the experimental subjects was 1.4 % below the mean of the control group ; however , the mean level of the experimental subjects was still high ( > 10 % ) . CONCLUSIONS This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans , particularly for those individuals with HbA(1c ) levels > 10 % Background : Diabetes mellitus ( DM ) requires continuous medical care , patients ’ self-management , education , and adherence to prescribed medication to reduce the risk of long-term complications . The aim of this study was to assess the benefits of an education program on diabetes , patient self-management , adherence to medication , anxiety , depression and glycemic control in type 2 diabetics in Saudi Arabia . Material s and Methods : This was a prospect i ve study , conducted among 104 diabetic patients at a major tertiary hospital in Riyadh , Saudi Arabia , between May 2011 and October 2012 .  Education material s given to diabetic patients included pamphlets/h and outs written in Arabic , the national language . Special videotapes about DM were made and distributed to all participants . In addition , specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged . Patients were interviewed using a structured interview schedule both during the baseline , and after 6 months of the program . The interview schedule included , socio-demographics , clinical characteristics , diabetes self-management , adherence to medication , anxiety , and depression . Glycemic control was considered poor , if hemoglobin A1c ( HbA1c ) was ≥ 7 % . Results : The mean age of the study population was 57.3 ± 14.4 years . Seventy one were males ( 68.3 % ) and 33 ( 31.7 % ) were females . After six months of the diabetes education program , there were significant improvements in patients ’ dietary plan ( P = 0.0001 ) , physical exercise ( P = 0.0001 ) , self-monitoring of blood glucose ( SMBG ) ( P = 0.0001 ) , HbA1c ( P = 0.04 ) , adherence to medication ( P = 0.007 ) , and depression ( P = 0.03 ) . Conclusions : Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan , physical exercise , SMBG , adherence to medication , HbA1c and depression The Diabetes Control and Complications Trial ( DCCT ) and the Kumamoto study [ 1 , 2 ] showed that near-normal glycemic control reduces the development and progression of microvascular and neuropathic complications by approximately 50 % in type 1 and type 2 diabetes mellitus . Additional analyses [ 3 - 5 ] indicate that therapy to achieve near normalization of blood glucose levels is cost-effective compared with other treatments . Thus , the American Diabetes Association has recommended that all persons with diabetes attempt to achieve near normalization of blood glucose levels [ 6 ] . This recommendation is not routinely followed in medical practice . In a 1989 national survey of physician practice behaviors in the United States , 64 % of physicians agreed that achieving target HbA1c values is very important but only 18 % reported that they ordered HbA1c tests every 2 to 3 months for patients with type 1 diabetes [ 7 ] . Although 98 % agreed that patient education improves glucose control , only 55 % reported that they routinely used a dietitian or a diabetes educator in patient care . Studies indicate that bringing clinical practice into line with scientific knowledge can be difficult . Methods used to achieve diabetes control in clinical trials are re source intensive . The American Diabetes Association currently recommends that patients with diabetes see their primary care physicians two to four times per year . Data from the National Health Interview Survey , a nationally representative survey [ 8 ] , indicate that most patients with diabetes are seen by nonspecialists and that 69 % of physician visits last less than 15 minutes . Algorithms for diabetes care exist but may be complex and difficult for physicians to follow , given patient load , diversity of patients seen , lack of information systems , and time constraints . Simple , low-cost methods of translating guidelines into clinical care are required . One solution may be to make greater use of personnel other than physicians . Nurse case management was an integral part of intensive therapy in the DCCT and has proven to be effective in reducing smoking and cholesterol levels after acute myocardial infa rct ion [ 3 , 9 ] . A nonr and omized study [ 10 ] of more than 700 patients with diabetes in a health maintenance organization suggests that nurse case management may be effective in improving metabolic control . Other studies [ 11 , 12 ] show a strong association between algorithm-directed nurse interventions and improved glycemic control . To our knowledge , no r and omized , controlled clinical trial of nurse case management in diabetes has yet been published . In a 12-month r and omized , controlled trial , we compared a nurse case management model of diabetes care with usual diabetes management in a primary care setting . Methods Patients Our study was approved by the institutional review board of the Prudential Center for Health Care Research , and all patients gave written informed consent . Participants were recruited from two of the largest clinics within the Jacksonville Health Care Group , which is the largest provider of primary care services for the Prudential HealthCare HMO plan of Jacksonville , Florida . The Jacksonville Health Care Group is a group of 43 primary care physicians who provide care in eight clinics to more than 75 000 Prudential HealthCare plan members . Potential study participants were identified through a data base used to support quality -improvement activities . Prudential HealthCare HMO members who had diabetes were included in the data base if they had visited a physician for diabetes ( International Classification of Diseases , 9th Revision , codes 250.0 to 250.9 ) , had had a hospital cl aim processed for diabetes , had been seen by the utilization management nurse , or had been referred to an ophthalmologist for a diabetic retinal examination . This data base is up date d regularly . A list with each member 's name , address , telephone number , medical record number , member identification number , age , sex , physician , and clinic was generated by merging the data from the data base with enrollment information . In addition , a list of members who may have had diabetes was created by using pharmacy data . Adult members with diabetes who were potential study participants each received a recruitment call and were invited to schedule an appointment with a research assistant to discuss participation in the study . We made a total of 14 calls at different times and on different days before coding a member as unavailable . After consent was given and the eligibility assessment was completed , baseline information was obtained and an HbA1c test was ordered if the result of one given within the previous 60 days was not available . Patients were ineligible for the study if they had a recent HbA1c value less than 7.0 % ; had uncontrolled hypertension ( blood pressure > 180/110 mm Hg ) ; had unstable angina ( class 4 ) ; had had a myocardial infa rct ion in the past 3 months ; had had two or more episodes of seizures ; had alcoholism or drug abuse documented in the chart ; had late-stage complications of diabetes or other chronic conditions , such as severe immunodeficiency or cirrhosis ; were pregnant or were planning to become pregnant in the next 12 months ; or were unable to perform self-management . Patients were r and omly assigned in blocks to either the nurse case management ( intervention ) group or the usual care group . R and omization was based on a 1:1 allocation ratio and a block size of three . Each block contained six patients , three in each study group . This r and omization scheme ensured that the desired allocation ratio-one intervention patient to one usual care patient-was maintained after sequential enrollment of every sixth patient . Outcome Measures Change in HbA1c value was the primary outcome measure . Decreased HbA1c values correlate directly with reduced risk for diabetes-related microvascular and neuropathic complications in type 1 and type 2 diabetes [ 1 , 3 ] . We also assessed health-related quality of life by using four generic questions developed by the Centers for Disease Control and Prevention for the Behavioral Risk Factor Surveillance System ( BRFSS ) [ 13 , 14 ] . These questions evaluate key conceptual domains of health-related quality of life : 1 ) patient-perceived general health status , 2 ) patient-perceived physical dysfunction during the previous 30 days , 3 ) patient-perceived mental dysfunction during the previous 30 days , and 4 ) patient-perceived functional incapacity during the previous 30 days for either mental or physical reasons . The BRFSS quality -of-life measures have been vali date d in a national sample of adults in the United States [ 15 ] . Patient-perceived health was found to be a good proxy indicator for chronic disease conditions . The other three domains further characterize general health functioning and quality of life [ 15 ] . In this analysis , we report findings related to the patient-perceived general health status domain . Intervention and Follow-up The nurse case manager was a registered nurse and a certified diabetes educator . She was trained to follow a set of detailed management algorithms under the direction of a board-certified family medicine physician and an endocrinologist who were responsible for all diabetes management decisions for patients in the intervention group but were not primary care providers for these patients . The algorithms were specific for type of diabetes and were developed by a multidisciplinary team on which endocrinology , family medicine , nursing , pharmacy , health services research , and epidemiology were represented . The algorithms progressively moved a patient toward improvement of glycemic control through adjustments in medication , meal planning , and reinforcement of exercise ( Figure 1 ) . Figure 1 . Algorithm for management of type 2 diabetes mellitus . Patients assigned to receive nurse case management met with the nurse for an initial assessment , were instructed about a blood glucose monitoring schedule , and returned for a follow-up visit 2 weeks later . The initial visit with the nurse averaged 45 minutes . At the 2-week follow-up visit , the nurse review ed the patient 's blood glucose log ; explained the algorithm step to which the patient had been assigned ; and used this information as the baseline for subsequent medication adjustments , meal planning , and exercise reinforcement . Patients receiving nurse case management  were also referred to a 5-week , 12-hour diabetes education program that included individual counseling by a dietitian , individual counseling by an exercise therapist , and group diabetes education classes . Subsequent in-person follow-up visits occurred quarterly . Patients in the nurse case management group  who were taking insulin  received weekly follow-up telephone calls . After the nurse review ed the blood glucose log and discussed glucose values with the patient , medication regimens were adjusted as needed and meal planning and exercise were reinforced . Patients treated with oral agents or diet and exercise  received follow-up telephone calls every 2 weeks . The nurse case manager met at least biweekly with the family medicine physician and the endocrinologist to review patient progress , medication adjustments , and other issues related to diabetes care . All medication adjustments or changes were communicated to the patients ' regular primary care physicians . Patients assigned to receive usual care were given blood glucose meters and strips , were encouraged to discuss enrollment in the diabetes education class with their physicians if they had not done so in the past year , and continued to receive diabetes care and follow-up from their primary care physicians . The 5-week diabetes education program is a st and ard , free-of-charge benefit for all HMO members with diabetes . All Jacksonville Health Care Group primary care physicians participate in an annual diabetes care seminar and undergo regular peer review of their adherence to published diabetes care st and ards . Tests to 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 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 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 Objective This study is aim ed at assessing the effectiveness of a simple outpatient diabetes self-management education programme . Methods In the study , 60 patients with type 2 diabetes mellitus were r and omly allocated into the control group ( n = 30 ) and intervention group ( n = 30 ) . Regular and 2-session health education programmes were provided . The summary of diabetes self-care activity measure , problem areas in the diabetes scale , fasting blood glucose , postpr and ial 2 h blood glucose , and HbA1c were measured before and after the intervention to assess the effects of this 2-session diabetes education programme . Results The total mean score of the summary of diabetes self-care activities measure was 17.60 ± 6.63 points . The problem areas in the diabetes scale revealed that the total mean score was 29.82 ± 15.22 points ; 27 % of the patients had diabetes-related distress , while 9 % suffered from severe emotional distress . Compared with the control group , scores of the summary of diabetes self-care activities measure and problem areas in the diabetes scale , fasting blood glucose , postpr and ial 2 h blood glucose , and HbA1c were significantly improved in the intervention group after the intervention ( P < 0.01 ) . Conclusion This study showed that the 2-session diabetes education programme could effectively improve the level of self-reported self-management , psychological distress , and glycemic control in patients with type 2 diabetes mellitus Purpose The purpose of this study was to examine the role of self , interpersonal ( ie , family/friend ) , and organizational ( ie , health care ) support in performing diabetes-related self-management behaviors and hemoglobin A1C ( A1C ) levels among rural Latinos with type 2 diabetes . Methods Cross-sectional data from baseline interviews and medical records were used from a r and omized controlled trial conducted in rural Southern California involving a clinic sample of Latinos with type 2 diabetes ( N = 317 ) .  Self-management behaviors included  fruit and vegetable intake , fat intake , physical activity , glucose monitoring , daily examination of feet , and medication adherence . Multivariate linear and logistic regression models were used to assess the relationships of sources of support with self-management behaviors and A1C . Results Higher levels of self-support were significantly associated with eating fruits and vegetables most days/week , eating high-fat foods few days/week , engaging in physical activity most days/week , daily feet examinations , and self-reported medication adherence . Self-support was also related to A1C . Family/friend support was significantly associated with eating fruits and vegetables and engaging in physical activity most days/week . Health care support was significantly associated with consuming fats most days/week . Conclusions Health care practitioners and future interventions should focus on improving individuals ’ diabetes management behaviors , with the ultimate goal of promoting glycemic control . Eliciting family/friend support should be encouraged to promote fruit and vegetable consumption and physical activity 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 We assessed whether community health workers ( CHWs ) could improve glycemic control among Mexican Americans with diabetes . METHODS We recruited 144 Mexican Americans with type 2 diabetes between January 2006 and September 2008 into the single-blinded , r and omized controlled Mexican American Trial of Community Health Workers ( MATCH ) and followed them for 2 years . Participants were assigned to either a CHW intervention , delivering self-management training through 36 home visits over 2 years , or a bilingual control newsletter delivering the same information on the same schedule . RESULTS Intervention participants showed significantly lower hemoglobin A1c levels than control participants at both year 1 Δ = -0.55 ; P = .021 ) and year 2 ( Δ = -0.69 ; P = .005 ) . We observed no effect on blood pressure control , glucose self-monitoring , or adherence to medications or diet . Intervention participants increased physical activity from a mean of 1.63 days per week at baseline to 2.64 days per week after 2 years . CONCLUSIONS A self-management intervention delivered by CHWs result ed in sustained improvements in glycemic control over 2 years among Mexican Americans with diabetes . MATCH adds to the growing body of evidence supporting the use of CHWs to reduce diabetes-related health disparities BACKGROUND Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications . AIM The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin ( HbA1c ) levels and adherence to diabetes control recommendations . METHODS A r and omized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls .  Twenty patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA1c < 7 % ) . The intervention was applied to the intervention group for 12 weeks , and consisted of continued education and reinforcement of diet , exercise , medication adjustment recommendations , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month and then weekly for the second and third month . Participants were requested to write self-management logs including blood glucose levels , diet and an exercise diary . A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail . All medication adjustments were communicated to participants ' doctors . The HbA1c and diabetes adherence were measured before and after the intervention . RESULTS Patients in the intervention group had a mean decrease of 1.2 % in HbA1c levels and those in the control group had a mean increase of 0.6 % in HbA1c levels . The intervention group had greater diet and blood glucose testing adherence than the control group . CONCLUSION These findings indicate that a nurse telephone intervention can improve HbA1c , and diet and blood glucose testing adherence BACKGROUND The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed ( DESMOND ) Self-monitoring Trial reported that people with newly diagnosed type 2 diabetes attending community-based structured education and r and omized to self-monitoring of blood glucose ( SMBG ) or urine monitoring  had comparable improvements in biomedical outcomes , but differences in satisfaction with , and continued use of monitoring method , well-being and perceived threat from diabetes . OBJECTIVES To explore experiences of SMBG and urine monitoring following structured education . We specifically addressed the perceived usefulness of each monitoring method and the associated well-being . METHODS Qualitative semi-structured interviews with 18 adults with newly diagnosed type 2 diabetes participating in the DESMOND Self-monitoring Trial ( SMBG , N=10 ; urine monitoring , N=8)~12 months into the trial . Analysis was informed by the constant comparative approach . RESULTS Interviewees reported SMBG as accurate , convenient and useful . Declining use was explained by having established a pattern of managing blood glucose with less frequent monitoring or lack of feedback or encouragement from health care professionals . Many initially positive views of urine monitoring progressively changed due to perceived inaccuracy , leading some to switch to SMBG . Perceiving diabetes as less serious was attributable to lack of symptoms , treatment with diet alone and -in the urine-monitoring group-consistently negative readings . Urine monitoring also provided less visible evidence of diabetes and of the effect of behaviour on glucose . CONCLUSIONS The findings highlight the importance for professionals of considering patients ' preferences when using self-monitoring technologies , including how these change over time , when supporting the self-care behaviours of people with type 2 diabetes 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 Despite recognition of the benefits associated with well-controlled diabetes and hypertension , control remains suboptimal . Effective interventions for these conditions have been studied within academic setting s , but interventions targeting both conditions have rarely been tested in community setting s. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension . METHODS Tailored Case Management for Diabetes and Hypertension ( TEACH-DM ) is a 24-month r and omized , controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control . The study recruited from nine community practice s. The nurse-administered intervention targets 3 areas : 1 ) cultivation of healthful behaviors for diabetes and hypertension control ; 2 ) provision of fundamentals to support attainment of healthful behaviors ; and 3 ) identification and correction of patient-specific barriers to adopting healthful behaviors . Hemoglobin A1c and blood pressure measured at 6 , 12 , and 24 months are co- primary outcomes . Secondary outcomes include self-efficacy , self-reported medication adherence , exercise , and cost-effectiveness . RESULTS Of 377 r and omized patients , 193 were allocated to the intervention and 184 to attention control .  The cohort is balanced in terms of gender , race , education level , and income . The cohort 's mean baseline hemoglobin A1c and blood pressure are above goal , and mean baseline body mass index falls in the obese range . Baseline self-reported non-adherence is high for diabetes and hypertension medications . Trial results are pending . CONCLUSIONS If effective , the TEACH-DM intervention 's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community setting BACKGROUND The management of type 2 diabetes mellitus is complex , requiring continuous medical care by health care professionals and considerable self-care efforts by patients . Pharmacist-led care programs have been shown to help patients with diabetes succeed in achieving treatment goals and improving outcomes . Pharmacist-led care is a new health care concept in Northern Cyprus . OBJECTIVE To evaluate the effect of a pharmacist-led care program on glycemic control , determined by hemoglobin A1c ( A1c ) , and secondarily on blood pressure , lipid profile , body mass index ( BMI ) , waist circumference , medication adherence , and self-care activities , for patients with type 2 diabetes over a 12-month period . METHODS This was a prospect i ve , r and omized controlled study conducted in a public hospital 's outpatient diabetes clinic , with 152 patients who had been diagnosed with type 2 diabetes . Of these , 75 patients were in the intervention group , and 77 patients were in the usual care group . The intervention group participated in a pharmacist-led care program with a clinical pharmacist who provided 5 face-to-face educational sessions over a period of 12 months . The main outcome measure was change in A1c , and secondary outcome measures were changes in fasting blood glucose , systolic and diastolic blood pressure , lipid values ( total cholesterol , low-density lipoprotein cholesterol [ LDL-C ] , high-density lipoprotein cholesterol [ HDL-C ] , and serum levels of triglycerides [ TGs ] ) , BMI , waist circumference , self-reported medication adherence ( Morisky-Green test ) , and self-care activities . Changes in outcome measures from baseline to the end of the study were assessed using the Mann-Whitney U-test and Wilcoxon test . RESULTS At the end of the 12-month study period , the intervention patients showed a greater reduction in A1c values than the usual care patients ( -0.74 % vs. -0.04 % ; P < 0.001 ) . Both groups showed significant reductions in fasting blood glucose levels between baseline and the end of 12 months ; the difference between the groups was statistically nonsignificant ( P = 0.410 ) . When comparing the intervention and usual care groups , there was a significant decrease in systolic ( P = 0.01 ) and diastolic blood pressure ( P = 0.04 ) at the end of the trial . No significant differences were found between the groups in LDL-C , HDL-C , or TG values ; however , total cholesterol levels did decrease significantly ( P = 0.063 , 0.331 , 0.896 , and 0.04 , respectively ) . Significant reductions occurred in BMI ( P < 0.001 ) and waist circumference ( P < 0.001 ) , and improvements were observed in self-reported medication adherence and self-care activities in the intervention group . CONCLUSIONS A clinical pharmacist-led care program in a public hospital 's outpatient diabetes clinic was associated with significant improvements in reducing A1c and other secondary outcomes in a 12-month r and omized controlled study . DISCLOSURES This study was conducted as a PhD thesis by Korcegez under the supervision of Sancar for the clinical pharmacy program at Near East University , Health Sciences Institute , Northern Cyprus , and received no external funding . The authors have no potential conflicts of interest to report . Study concept and design were contributed by Korcegez , with assistance from Sancar and Demirkan . Korcegez took the lead in data collection , and data interpretation was performed by Korcegez , along with Sancar and Korcegez . The manuscript was written and revised by Korcegez , along with Sancar , and with assistance from Demirkan 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 Background Type 2 diabetes ( diabetes ) is a serious threat to public health in the United States and disproportionally affects many racial/ethnic minority groups , including African Americans . Limited access to treatment and high attrition rates further contribute to health disparities in diabetes-related morbidity and mortality among minorities . Greater opportunities for increasing access and decreasing barriers to treatment are needed . Technology-based interventions have potential for accomplishing this goal but evidence of feasibility and potential effectiveness is lacking , especially for population s that traditionally have limited educational attainment and low computer literacy . Objective This paper describes the design and methods of a pilot r and omized clinical trial that will compare the feasibility and potential efficacy of delivering a diabetes self-management intervention via a virtual world vs. a face-to-face format . Methods Study participants ( n=100 ) will be African American women with uncontrolled type 2 diabetes recruited from primary care practice s and affiliated health centers at a large safety net hospital in Massachusetts . Participants will be r and omized into a virtual world-based ( VW ) intervention condition or a face-to-face control condition . Both conditions provide the same theory-based curriculum and equivalent exposure to the self-management program ( eight group sessions ) , and both will be delivered by a single intervention team ( a dietitian and a diabetes educator ) . Assessment s will be conducted at baseline and 4 months . Feasibility will be determined by evaluating the degree to which participants engage in the VW-based intervention compared to face to face ( number of sessions completed ) . Potential efficacy will be determined by comparing change in physiological ( glycemic control ) and behavioral ( self-reported dietary intake , physical activity , blood glucose self-monitoring , and medication adherence ) outcomes between the experimental and control groups . Results The primary outcomes of interest are feasibility of the VW intervention and its potential efficacy on glucose control and diabetes self-management behaviors , compared to the face-to-face condition . Analysis will use a two- sample Kolmogorov-Smirnov test for changes in variable distribution . P values will be calculated using binomial tests for proportions and t tests for continuous variables . Conclusions If the intervention is found to be feasible and promising , it will be tested in a larger RCT Purpose : To study the effectiveness of multidisciplinary nurse practitioner coordinated team ( NPCT ) group visits  in medically underserved Appalachia on the health , knowledge , and self‐efficacy of patients with type 2 diabetes ( DM ) . The study also identified perceived barriers to participating in the diabetes programs . Data sources : A research er‐developed tool was used to assess demographic data , clinical data , and barriers to care . The participants completed the Diabetes Knowledge Tests and the Diabetes Empowerment Scales . Two groups were assessed . One group participated in the diabetes intervention , and the other received usual care . Both groups completed the instruments prior to the intervention and after the intervention was completed . Conclusions : The group that participated in the intervention had better clinical outcomes ( blood glucose and A1Cs ) , greater knowledge , and better self‐efficacy following the intervention than the usual care groups . This suggests that the intervention was important in improving outcomes of patients with type 2 DM .  Barriers to care included fuel , time , family , work , and transportation . Barriers need to be addressed in order to have more patients participate in such programs . Implication s for practice : NPCT group visits may represent an effective means of integrating diabetes self‐management education and medical management in a family practice clinic in medically underserved areas Background Care management interventions in the German health-care system have been evaluated with promising results , but further research is necessary to explore their full potential in the context of multi-morbidity . Our aim in this trial is to assess the efficacy of a primary care practice network – based care management intervention in improving self-care behaviour among patients with type 2 diabetes mellitus and multiple co-occurring chronic conditions . Methods / Design The study is design ed as a prospect i ve , 18-month , multicentre , investigator-blinded , two-arm , open-label , individual-level , r and omized parallel-group superiority trial . We will enrol 582 patients with type 2 diabetes mellitus and at least two severe chronic conditions and one informal caregiver per patient . Data will be collected at baseline ( T0 ) , at the primary endpoint after 9 months ( T1 ) and at follow-up after 18 months ( T2 ) . The primary outcome will be the differences between the  intervention and control groups  in changes of diabetes-related self-care behaviours from baseline to T1 using a German version of the revised Summary of Diabetes Self-Care Activities ( SDSCA-G ) . The secondary outcomes will be the differences between the intervention and control groups in : changes in scores on the SDSCA-G subscales , glycosylated haemoglobin A level , health-related quality of life , self-efficacy , differences in ( severe ) symptomatic hypoglycaemia , cost-effectiveness and financial family burden . The intervention will be delivered by trained health-care assistants as an add-on to usual care and will consist of three main elements : ( 1 ) three home visits , including structured assessment of medical and social needs ; ( 2 ) 24 structured telephone monitoring contacts ; and ( 3 ) self-monitoring of blood glucose levels after T1 in 3-month intervals . The control group will receive usual care . The confirmatory primary analysis will be performed following the intention-to-treat ( ITT ) principle . The efficacy of the intervention will be quantified using two-level linear regression stratified by type of medical treatment adjusted for baseline values on the SDSCA-G. Secondary analyses will be performed according to the ITT principle . In health economic evaluations , we will estimate the incremental cost-effectiveness ratios . Discussion We hope that the results of this study will provide insights into the efficacy of practice network – based care management among patients with complex health-care needs . Trial registration Current Controlled Trials IS RCT N83908315 ( IS RCT N assigned 25 February 2014 ) 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 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 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
Overall , family support had a positive impact on healthy diet , increased perceived support , higher self-efficacy , improved psychological well-being and better glycemic control .
This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients .
The rate of type-2 diabetes mellitus ( T2D ) is dramatically increasing worldwide .
Continuing diabetes mellitus ( DM ) care needs effective self-management education and support for both patients and family members .
This study aim ed to review and describe the impacts of diabetes mellitus self-management education ( DSME ) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence , blood glucose monitoring , diet and exercise changes , health outcomes including psychological well-being and self-efficacy , and physiological markers including body mass index , level of blood pressure , cholesterol level and glycemic control .