Individualized Enhanced Adherence Intervention Study in Adults with Diabetes

We would like to report an individualized enhanced adherence intervention study in adults with diabetes. Adherence to a diabetes regimen has led to investigations of behavior in the form of interventions designed to promote self-management. Bandura's social cognitive theory provides a comprehensive theoretical framework for the examination of human behavior.1 Self-efficacy, defined by Bandura2 is a belief in one's capabilities to successfully overcome the demands of a situation in order to achieve a desired outcome. It is a significant predictor of regimen adherence, including areas of blood glucose testing, exercise and diet, and glycemic control.4–6 We utilized a framework of social cognitive theory for our study, Bringing Diabetes General Education to Life (BRIDGE). We compared the effects of an individualized enhanced adherence intervention (IEAI) for individuals with Type 2 diabetes. We evaluated the effects of the adherence-based intervention (BRIDGE) on glucose control by analyzing SMBG, glycosylated hemoglobin (A1C), and fasting laboratory glucose in this pilot study. An intervention emphasizing follow-up SMBG, exercise and self-management techniques was utilized. Subjects were randomized into an attention control group or the IEAI group. In each of the months 1, 3, and 5, control group participants received a 1-hour educational session that emphasized material previously presented in diabetes education classes. Educational material was also mailed to these participants in the form of a newsletter during months 2 and 4. In contrast, those randomized into the IEAI group received a 6-month behavioral intervention consisting of a series of group and individual sessions. The aim of the program was to employ strategies and techniques for enhancing self-efficacy in carrying out a personal diabetes treatment plan. Blood glucose monitors (Accu-Chek Advantage®, Mannheim, Germany) were provided to the participants and uploaded by computer. Laboratory glucose and A1C by venipuncture were obtained at baseline, 3, and 6 month visits. We analyzed data using SPSS (Version 11.5). Descriptive statistics were employed to characterize the sample, and simple independent measured t-tests were used to examine potential differences between the intervention and control groups at baseline. Analyses of covariance were performed for intervention versus control group at 3 and 6 months using baseline data as the covariate. In Table 1 we present our baseline (no statistical difference between groups) and outcome variables. The A1C averages reveal that the control group increased from baseline by an average of approximately 0.5% compared to the intervention group's decreased average of about 0.2%. Morning glucose labs in the control group were at an average value of 144.8 ± 54 mg/dl compared to the intervention group that decreased to 101.5 ± 23.8 mg/dl. The intervention group performed SMBG 2.33 times per day, while the control group tested 1.39 times per day. A significant difference was found between groups at 3 months (p<0.05). Those who underwent the intervention demonstrated greater mean SMBG daily testing (2.47 times per day) at month 3, in comparison to the control group (1.03 times per day, p<0.05). This study indicates that an intervention based on social cognitive theory can have an impact on the behaviors necessary to improve glycemic control. According to Bandura, self-efficacy not only predicts behavior, but also the extent to which the behavior is executed. To read this study in its entirety, visit: http://www1.wfubmc.edu/NR/rdonlyres/10A98B0F-21D4-4C49-83C1-071BB0E0B803/0/BRIDGE12407.pdf Table 1. Glycemia data for control and intervention (Mean ± SD with 95% CI)