The "Health Care Reform" series of the Archives of Internal Medicine has published three randomized controlled trials Online First, assessing the effectiveness of behavioral and educational interventions for patients with poorly controlled diabetes.
The first report, conducted by Katie Weinger, Ed.D. of the Joslin Diabetes Center in Boston and her team assessed the efficacy of a behavioral intervention for improving glycemic control of patients with long-duration poorly controlled diabetes. In the trial researchers randomized 222 diabetic adults who were split into three treatment groups: The structured behavioral therapy group received a five-session manual-based structural intervention with cognitive behavioral strategies led by an educator whilst the group attention control group underwent a group education program held by an educator. The individual control group received unlimited individual education sessions by a nurse and dietitian for the duration of 6 months.
According to the findings, all participants demonstrated a glycemic improvement irrespective of treatment group, however, in comparison to the other two groups, the structured behavioral group showed greater improvements. Researchers also noted that those suffering from type 2 diabetes made better progress than patients with type 1 diabetes.
Although there was no difference over time regarding the number of daily glucose meter checks, quality of life and frequency of diabetes self-care, type 2 diabetes patients displayed a higher quality of life score compared with type 1 diabetes patients.
In a concluding statement the authors note that, "a structured, cognitive behavioral program is more effective than two control interventions in improving glycemia in adults with long-duration diabetes."
In the second study JoAnn Sperl-Hillen, M.D., of HealthPartners Research Foundation and HealthPartners Medical Group in Minneapolis and their team assessed a total of 623 adult participants from Minnesota and New Mexico who suffered from type 2 diabetes and glycosylated hemoglobin (HbA1c) concentrations of 7% or higher.
The researchers randomized participants into three groups again, such as those receiving group education, individual education or usual care (no assigned education; control group) and discovered that individual education achieved better results in terms of improved glucose control in patients with established suboptimally controlled diabetes compared with those receiving group education.
Even though average (mean) HbA1c concentrations decreased amongst all treatment groups, the levels of the individual education group decreased substantially more with -0.51% compared with -.27% in the group education and -.024% in the usual care group. In addition, HbA1c levels of participants in the individual education group were potentially more at or below 7% compared with those in the two other groups.
In a final statement the researchers write:
"In conclusion, among patients with type 2 diabetes of relatively long duration and HbA1c levels of 7 percent or higher, short-term glucose control improved more in those receiving individual diabetes education than in those receiving group diabetes education or assigned to no education."
The third study, conducted by Dominick L. Frosch, Ph.D., of the Palo Alto Medical Foundation Research Institute in Palo Alto, Calif., and his team evaluated the effectiveness of disease management programs amongst socially and economically disadvantaged patients with poorly controlled diabetes. Their study involved a total of 201 patients with poorly controlled diabetes; 72% of participants were African American or Latino and 74% had an annual incomes of less than or equal to $15,000.
Researchers randomized the participants into two separate groups. The treatment group received an intervention package that consisted of a 24-minute video behavior support intervention accompanied by a workbook and five sessions of telephone coaching by a trained diabetes nurse whilst the control group received a 20-page brochure that was developed by the National Diabetes Education Program.
94.3% of the treatment group and 93.5% of the control group participants had received the assigned treatment materials and at the one-month follow up, the majority of participants, i.e. 88.5% in the treatment group and 89.8% in the control group rated the clarity of information they received either as 'good', 'very good', or 'excellent'.
Researchers observed a substantial overall reduction in mean HbA1c levels from study initiation to six-month follow-up in both treatment groups, however, the differences were comparable between both groups. They also discovered non-significant differences in other clinical measures, such as blood lipid levels and blood pressure as well as diabetes knowledge and self-care behavior.
In a concluding statement the authors comment:
"More intensive and therefore more expensive interventions may be a worthwhile investment to lower the high costs associated with poorly managed diabetes in the long term; however, larger structural interventions also may be necessary to overcome the many challenges faced by these severely disadvantaged patients."
Written by Petra Rattue