Effectiveness of Nurse-coordinated Follow-up Program in Primary Care for People at Risk for T2DM
Condition: Pre-diabetes; Cardiovascular Risk Factor; T2DM (Type 2 Diabetes Mellitus); Primary Health Care
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2; Prediabetic State; Glucose Intolerance
Study type: Interventional

Summary: 
      Previous Icelandic studies regarding prevalence of diabetes have mostly used data from the
      capital area. Information on the proportion of people at risk at developing T2DM or having
      undiagnosed T2DM among people living in rural Northern Iceland is unknown. Clinical
      guidelines recommend that patients with prediabetes (diabetes warning signs) should be
      referred to a counselling program. The study will evaluate effectiveness of nurse-coordinated
      Guided Self-Determination (GSD) follow up program toward health promotion, for people at risk
      of T2DM.
    

Detailed description: 
      Prevalence of type 2 Diabetes Mellitus (T2DM) a major health problem is rising. This
      metabolic disease characterized by the inability to effectively metabolize glucose, and often
      also a silent and sneaky onset. A lag is often found between diagnose and onset of the
      disease. Diabetes related complications are expensive for the society, and reduce quality of
      life for the individual.

      Around one out of three with T2DM in an Icelandic study were unaware of their T2DM when
      fasting blood glucose was measured. In the U.S.A., the average interval between onset of the
      disease and diagnose is seven years, and the authors claimed that 30% of people with T2DM are
      undiagnosed, with increased risk for chronic diabetes complications higher Cardiovascular
      risk factors (CVR), and higher premature death for people with early onset of T2DM compared
      to late onset of T2DM.

      Research have shown 1.83-fold higher risk of CVD for those with prediabetes and 2.26-fold
      higher risk for individuals with undiagnosed diabetes compared to individuals with normal
      HbA1c. These results highlight the pivotal need to prevent development of diabetes, as there
      is an association between increased obesity and increased prevalence of T2DM as Type 2
      diabetes (T2DM) is also found to be a major risk factor for cardiovascular diseases.

      Icelandic people and especially men are becoming more overweight. From the years 1968-2012,
      body mass index (BMI) increased by 11%, from 25.8 kg/m2 to 28.7 kg/m2 for men between 50-69
      years. In women 50-69 years, the BMI increased from 25.2 kg/m2 to 27.2 kg/m2, or 8%. These
      results highlight the pivotal need to prevent development of diabetes in Iceland, as there is
      an association between increased obesity and increased prevalence of type 2 Diabetes Mellitus
      (T2DM).

      A Guided Self-Determination (GSD) is based on a strong theoretical value and is a well
      establish nurse-led interventional method for people diagnosed with T2DM and other diseases.
      To our knowledge this is the first time that GSD is used in Iceland. Nurses working in
      primary care, at The Health Care Institution of North Iceland (HSN), in Akureyri, Husavik and
      Sauðarkrokur, will offer the GSD intervention. Before the intervention the nurses will
      receive teaching and consultation from an experienced GSD diabetic nurse. During their use of
      the GSD method they will have counseling from the experienced GSD nurse and the PhD student.
      A systematic review claimed, that multi-professional interventions are more effective in
      improving diabetes care compared to single professional interventions.

      A recent Cochrane review using data from 18 trials, investigated the impact of nurses working
      as substitutes for primary care doctors. The results demonstrate that using the capacity and
      skills of nurses to deliver primary healthcare services leads to similar or better patient
      health and higher patient satisfaction. As such, this might be an important strategy to
      improve access, efficiency, and quality of care, and at the same time strengthen health
      promotion aspects of care and management of chronic diseases and increase teamwork in primary
      care.

      This study is a part of doctoral student study. This PhD project is collaboration between
      University of Akureyri, Iceland (UNAK), Western Norway University of Applied Sciences (HVL)
      and the Health Care Institution of North Iceland (HSN). HVL has a considerably experience in
      researching diabetes through the Diabetes Research Group for BEST Practice (DiaBEST). The
      research group DiaBEST consist of researchers from Bergen University Collage, the University
      of Bergen and the University of Stavanger. The projects contribute to increase knowledge
      about and implementation of evidence-based practice within primary care.
    

Intervention name(s): Guided Self Determination
Intervention type(s): Behavioral
Intervention description(s): Nurse lead intervention in primary care
Other intervention name(s): GSD
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 groups one intervention group and one control group
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Pre-diabetes; Cardiovascular Risk Factors; Guided Self Determination; Intervention; Primary Health Care