Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .
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
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
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .