Development and Evaluation of a Computer-Based, Self-Management Tool for People Recently Diagnosed with Type 2 Diabetes

Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes.Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups.Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the “knowledge and beliefs scale” of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand.Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management. This trial is registered with clinicaltrials.gov NCT numberNCT00877851.

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Influence of physical activity on periodontal health in patients with type 2 diabetes mellitus. A blinded, randomized, controlled trial

Clinical Oral Investigations ◽

10.1007/s00784-021-03908-6 ◽

2021 ◽

Author(s):

K. Wernicke ◽

J. Grischke ◽

M. Stiesch ◽

S. Zeissler ◽

K. Krüger ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Periodontal Health ◽

Randomized Controlled ◽

Hba1c Levels

Abstract Objectives The aim was to investigate the effect of physical activity on periodontal health and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) over a period of 6 months. Materials and methods Thirty-seven patients with non-insulin-dependent T2DM were included in the study. The intervention group (n=20) performed physical activity over a period of 6 months. The control group (n=17) did not receive any intervention. Baseline and final examinations included dental parameters and concentrations of glycosylated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hsCRP). Results Physical activity showed a positive effect on periodontal health. Both the BOP (p= 0.005) and the severity of periodontitis (p= 0.001) were significantly reduced in the intervention group compared to the control group. Furthermore, HbA1c levels were reduced (p= 0.010) significantly in the intervention group while hsCRP levels significantly increased in the control group (p= 0.04). Conclusions Within the limitations of this randomized, controlled trial, physical activity over a period of 6 months is a health-promoting measure for patients with T2DM and improves both periodontal health and HbA1c concentrations.

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Increasing Medical Adherence in Elderly With Type 2 Diabetes Mellitus: A Systematic Review

International Quarterly of Community Health Education ◽

10.1177/0272684x18819969 ◽

2018 ◽

Vol 39 (2) ◽

pp. 109-117

Author(s):

Seyed Mohammad Mehdi Hazavehei ◽

Sahar Khoshravesh ◽

Zahra Taheri-Kharameh

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Educational Intervention ◽

Controlled Trial ◽

Intervention Group ◽

The Elderly ◽

Risk Of Bias ◽

Control Group ◽

Medical Adherence

Background One of the most common problems that the elderly with chronic diseases, especially diabetes, faces is lack or poor medical adherence. The aim of this study was to determine the effect of interventions in increasing medical adherence in the elderly with type 2 diabetes. Methods The databases of Cochrane, Embase, PubMed, Scopus, Science Direct, and web of science were searched until April 2017 free from time and language limitation. In review, only randomized controlled trial (RCT) design studies were investigated. The studies of interest were evaluated from three perspectives: educational intervention with or without theories/models of health education and promotion, educational intervention (individual or group education), and noneducational intervention to increase medical adherence. The qualification of RCTs was evaluated through Cochrane Collaboration Risk of Bias Tool. Results Finally, five studies were considered in this systematic review. Educational interventions were used in all of the studies, and in three of these studies, noneducational interventions such as support group, psychiatric consultation, and phone consultation were implemented along with educational intervention. In all studies, medical adherence in the intervention group increased when compared with the control group or basic conditions ( p < .05). All RCTs had high risk of bias. Conclusion This review provides evidence which must be considered in the elderly with diabetes a combination of the educational and noneducational methods to increase medical adherence. It is necessary to conduct studies with higher quality to assess the efficacy of interventions.

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Effects of an Outpatient Diabetes Self-Management Education on Patients with Type 2 Diabetes in China: A Randomized Controlled Trial

Journal of Diabetes Research ◽

10.1155/2019/1073131 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Fan Zheng ◽

Suixin Liu ◽

Yuan Liu ◽

Lihua Deng

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Diabetes Education ◽

Fasting Blood Glucose ◽

Intervention Group ◽

Self Care ◽

Education Programme ◽

Self Management ◽

Control Group

Objective. This study is aimed 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 randomly 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, postprandial 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, postprandial 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.

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Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: results of a randomized controlled trial (TRIGGER study)

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000981 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000981 ◽

Cited By ~ 2

Author(s):

Anne Meike Boels ◽

Rimke C Vos ◽

Lioe-Ting Dijkhorst-Oei ◽

Guy E H M Rutten

Keyword(s):

Type 2 Diabetes ◽

Dietary Habits ◽

Management Education ◽

Intervention Group ◽

Self Management ◽

Smartphone App ◽

Control Group ◽

Hypoglycemic Event ◽

Randomized Controlled

ObjectiveTo investigate the effect of diabetes self-management education and support via a smartphone app in individuals with type 2 diabetes on insulin therapy.Research design and methodsOpen two-arm multicenter parallel randomized controlled superiority trial. The intervention group (n=115) received theory and evidence-based self-management education and support via a smartphone app (optionally two or six times per week, once daily at different times). The control group (n=115) received care as usual. Primary outcome: HbA1c at 6 months. Other outcomes included HbA1c ≤53 mmol/mol (≤7%) without any hypoglycemic event, body mass index, glycemic variability, dietary habits and quality of life. We performed multiple imputation and regression models adjusted for baseline value, age, sex, diabetes duration and insulin dose.ResultsSixty-six general practices and five hospital outpatient clinics recruited 230 participants. Baseline HbA1c was comparable between groups (8.1% and 8.3%, respectively). At 6 months, the HbA1c was 63.8 mmol/mol (8.0%) in the intervention vs 66.2 mmol/mol (8.2%) in the control group; adjusted difference −0.93 mmol/mol (−0.08%), 95% CI −4.02 to 2.17 mmol/mol (−0.37% to 0.20%), p=0.557. The odds for achieving an HbA1c level ≤7% without any hypoglycemic event was lower in the intervention group: OR 0.87, 95% CI 0.33 to 2.35. There was no effect on secondary outcomes. No adverse events were reported.ConclusionsThis smartphone app providing diabetes self-management education and support had small and clinically not relevant effects. Apps should be more personalized and target individuals who think the app will be useful for them.Trial registration numberNTR5515.

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Health education improves referral compliance of persons with probable Diabetic Retinopathy: A randomized controlled trial

PLoS ONE ◽

10.1371/journal.pone.0242047 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242047

Author(s):

Zara Khair ◽

Md Moshiur Rahman ◽

Kana Kazawa ◽

Yasmin Jahan ◽

Abu S. G. Faruque ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Health Education ◽

Controlled Trial ◽

Compliance Rate ◽

Intervention Group ◽

Multivariate Logistic Regression Model ◽

Control Group ◽

Referral Compliance

Objective Lack of awareness about Diabetic Retinopathy (DR) is the most commonly cited reason why many persons with type 2 diabetes are non-compliant with referral instruction to undergo retinal screening. The purpose of this study was to evaluate the efficacy of a culturally, geographically and socially appropriate, locally adapted five-month-long health education on referral compliance of participants. Method A prospective randomized, open-label parallel group study was conducted on persons with type 2 diabetes who underwent basic eye screening at a diabetes hospital between September 2017 and August 2018. Participants who were noncompliant with referral instruction to visit a hospital for advanced DR management were randomly divided into health education intervention group (n = 143) and control group (n = 156). Both groups received information regarding DR and referral instruction at the diabetes hospital. The intervention group was provided personalized education followed by telephonic reminders. The primary endpoint was ‘increase in referral compliance’ and the secondary endpoint was ‘increase in knowledge of DR’. Multivariate logistic regression model was used to identify significant predictors of compliance to referral. Results A total of nine participants dropped and 290 completed the post intervention survey. The compliance rate in intervention group was found to be significantly higher than the control group (64.3% vs 28.2%; OR 4.73; 95% CI 2.87–7.79; p<0.001). Participants in the intervention group acquired better knowledge on DR (p<0.05). Apart from intervention, referral compliance rate was also found to be significantly associated with participants’ self-perception of vision problem (OR 2.02; 95% CI 1.02–4.01; p = 0.045) and participants’ income (OR 1.24; 95% CI 1.06–1.44; p = 0.008). Discussion Our results suggest that intensive health education on DR should be integrated with diabetes education as it may result in significantly improved referral compliance. Outcomes may be sustainable if interventions are institutionalized at referral point. Trial registration Clinical Trials.gov (Registration # NCT03658980); https://clinicaltrials.gov/ct2/show/NCT03658980.

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A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness

Journal of Medical Internet Research ◽

10.2196/16629 ◽

2020 ◽

Vol 22 (5) ◽

pp. e16629 ◽

Cited By ~ 2

Author(s):

Aikaterini Kassavou ◽

Venus Mirzaei ◽

James Brimicombe ◽

Simon Edwards ◽

Efthalia Massou ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Randomized Controlled Trial ◽

Medication Adherence ◽

Controlled Trial ◽

Intervention Group ◽

Clinical Effectiveness ◽

Control Group ◽

Randomized Controlled

Background The efficacy of a highly tailored digital intervention to support medication adherence and feasibility to support clinical effectiveness as an adjunct to the primary care setting has not been evaluated. Objective This trial aimed to assess the behavioral efficacy of a highly tailored digital intervention to support medication adherence and to evaluate the feasibility of its clinical effectiveness, in patients with either or both hypertension and type 2 diabetes. We also examined quality of life and mechanisms of behavior change. Intervention fidelity, engagement, and satisfaction were also explored. Methods This was a multicenter, individually randomized controlled trial of 2 parallel groups: an intervention group that received a highly tailored text message and interactive voice response intervention for 12 weeks, and a control group that received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of a repeat prescription. Systolic blood pressure and glucose levels were assessed by nurses blinded to group allocation during practice visits at 3 months follow-up. Questionnaires obtained data to assess intervention mechanisms of action and satisfaction and digital log files captured data to evaluate fidelity and engagement. Results A total of 135 nonadherent patients (62/135, 46% female; 122/135, 90.3%; aged above 50 years) were randomly allocated in the intervention (n=79) or in the control group (n=56); of whom 13% (18/135) were lost at follow-up. Medication adherence was significantly improved in the intervention group compared with the control group (t116=2.27; P=.02, 2-tailed). Systolic blood pressure was 0.6 mmHg (95% CI −7.423 to 6.301), and hemoglobin A1c was 4.5 mmol/mol (95% CI −13.099 to 4.710) lower in the intervention group compared with the control group. Changes in intentional nonadherence and nonintentional nonadherence explained the improvements in medication adherence in the intervention group (beta=.074, SE=0.464; P=.04), but not in the control group (beta=.00, SE 1.35; P=.37). The intervention had 100% fidelity, a median of 12 days of engagement, and 76% overall satisfaction. Conclusions Our trial is the first that has been conducted in the United Kingdom and showed that among nonadherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was effective at improving treatment adherence and feasible to obtain clinically meaningful outcomes. Changes in intentional and nonintentional nonadherence predicted the improvements in medication adherence. The intervention had high fidelity, engagement, and satisfaction. Future research using a rigorous design is needed to evaluate the clinical effectiveness and cost-effectiveness of the intervention in primary care. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149.

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The Effect of Diabetes Self-Management Education on Body Weight, Glycemic Control, and Other Metabolic Markers in Patients with Type 2 Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2014/789761 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Chuang Yuan ◽

Christopher W. K. Lai ◽

Lawrence W. C. Chan ◽

Meyrick Chow ◽

Helen K. W. Law ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Body Weight ◽

Management Education ◽

Intervention Group ◽

Intima Media Thickness ◽

Self Management ◽

Control Group ◽

Metabolic Markers

Aims.To comprehensively evaluate the effect of a short-term diabetes self-management education (DSME) on metabolic markers and atherosclerotic parameters in patients with type 2 diabetes.Methods.76 patients with type 2 diabetes were recruited in this study. They were divided into the intervention group(n=36)and control group(n=40). The patients in the intervention group received a 3-month intervention, including an 8-week education on self-management of diabetes mellitus and subsequent 4 weeks of practice of the self-management guidelines. The patients in the control group received standard advice on medical nutrition therapy. Metabolic markers, carotid intima-media thickness (CIMT), and carotid arterial stiffness (CAS) of the patients in both groups were assessed before and after the 3-month intervention.Results.There was a significant reduction in hemoglobin A1c (HbA1c,-0.2±0.56% versus0.08±0.741%;P<0.05) and body weight (-1.19±1.39 kg versus-0.61±2.04 kg;P<0.05) in the intervention group as compared to the control group. However, no significant improvements were found in other metabolic markers, CIMT and CAS(P>0.05).Conclusions.DSME can improve HbA1c and body weight in patients with type 2 diabetes.

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Health Education Based on Internet Platform for Improving Cognitive Function of Patients with Type 2 Diabetes

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2020.3232 ◽

2020 ◽

Vol 10 (12) ◽

pp. 2920-2924

Author(s):

Shuqing Jia ◽

Linghua Zhang

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Cognitive Function ◽

Health Education ◽

Intervention Group ◽

Postprandial Blood Glucose ◽

Self Management ◽

Control Group ◽

Internet Platform

Objective : There is cognitive impairment in patients with type 2 diabetes mellitus (T2DM), and the cognitive ability is related to self-management behavior. The aim of this study was to explore the effect of individualized health education based on internet platform in the cognitive function of patients with T2DM. Method : A total of 60 patients with T2DM were divided into control group and intervention group. The control group received regular diabetes knowledge education during hospitalization. The intervention group received further cognitive and behavioral intervention through internet platform after discharge. After six months of follow-up, the changes of fasting blood glucose (FBG), 2 hours postprandial blood glucose (2hBG), glycosylated hemoglobin (HbA1c), cognitive function, self management of patients with T2DM were observed and compared between two groups. Result : Compared with the data before intervention, FBG, 2hBG and HbAlc of all patients were significantly reduced, and delayed memory score was significantly increased, especially in the intervention group. Compared with that before intervention, the scores of diet control, exercise compliance, drug compliance, monitoring compliance, foot care and smoking in the intervention group were significantly improved after intervention, and the improvement level was significantly higher than that in the control group. Conclusion: Health education based on internet platform can significantly reduce the blood glucose and HbA1c level of patients with T2DM, improve the level of self-management and cognitive function of T2DM patients, especially in the aspect of delayed memory, which is conducive to disease control and health recovery.

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Effectiveness of a clinic-based randomized controlled intervention for type 2 diabetes management: an innovative model of intensified diabetes management in Mainland China (C-IDM study)

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001030 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001030 ◽

Cited By ~ 1

Author(s):

Qinglin Lou ◽

Qing Ye ◽

Haidi Wu ◽

Zhiyong Wang ◽

Robert S Ware ◽

...

Keyword(s):

Type 2 Diabetes ◽

Large Scale ◽

Diabetes Management ◽

Controlled Trial ◽

Intervention Group ◽

Mainland China ◽

Outcome Variable ◽

Control Group ◽

Randomized Controlled

ObjectivesHighly efficient diabetes management programs are needed for tackling diabetes in China. This study aimed to assess the effectiveness of a clinic-based intensified diabetes management model (C-IDM) in Mainland China.Research design and methodsA 2-year clinic-based randomized controlled trial was conducted among patients with type 2 diabetes in Nanjing, China. The C-IDM intervention components comprised four domains (disease targeting management, express referral channel, expert visit, patients’ self-management) and an integrated running system (disease control centers, general hospitals and local clinics). Control group participants received their usual care, while intervention participants received both the C-IDM package and the usual services. The primary outcome variable was change of hemoglobin A1c (HbA1c). Mixed-effects models were used to compute effect estimates and 95% CI with consideration of both individual and cluster-level confounders.ResultsOverall, 1095 of 1143 participants were assessed at study completion. The mean change in HbA1c was significantly greater in the intervention group than in the control group (mean difference (MD)=−0.57, 95% CI −0.79 to –0.36). Similar results were observed for change in body mass index (MD=−0.29, 95% CI −0.49 to –0.10). Participants in the intervention group were more likely to achieve normal HbA1c and body weight compared with their counterparts in control group after adjusting for potentially confounding variables (adjusted OR=1.94, 95% CI 1.35 to 2.81 and 1.79, 95% CI 1.13 to 2.85, respectively).ConclusionsThe C-IDM model is feasible and effective in large-scale management of patients with type 2 diabetes in China. It has public health implications for tackling the burden of diabetes in China.Trial registration numberChiCTR-IOR-15006019.

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The Teach-Back Effect on Self-Efficacy in Patients with Type 2 Diabetes

The Review of Diabetic Studies ◽

10.1900/rds.2020.16.46 ◽

2020 ◽

Vol 16 (1) ◽

pp. 46-50

Author(s):

Marhamat Farahaninia ◽

Tahere Sarboozi Hoseinabadi ◽

Rasool Raznahan ◽

Shima Haghani

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Self Efficacy ◽

Intervention Group ◽

Self Management ◽

Control Group ◽

Training Procedure ◽

Treatment Regimens ◽

The Impact

BACKGROUND: Diabetes is a chronic, metabolic disease, which is commonly associated with increased blood glucose levels caused by impaired secretion or function of insulin. Therefore, daily blood glucose control, adherence to a dietary and pharmaceutical regimen, regular physical activity, and foot care are fundamental components of disease management. In order to optimize effective self-management, patients need to be trained. Teach-back is a method which aims to improve patients' understanding and perception of treatment regimens based on the interaction between patient and caregiver. AIM: This study was conducted to investigate the impact of the teach-back method on the effectiveness of self-management in patients with type 2 diabetes (T2D). METHODS: A total of 74 patients with T2D were included in the study by convenience sampling at the Endocrine and Metabolism Clinic. The subjects were assigned to control or intervention group. Data collection was performed by using a demographic data form and a self-efficacy questionnaire that were provided to the patients before and 1 month after training. The patients in the intervention group received a 5-session training program using the teach-back method. The control group received only routine programs. One month after completion of the training sessions, the questionnaires were completed by the subjects in the 2 groups, and the data obtained were analyzed. RESULTS: In contrast to the control group, mean and standard deviation of self-efficacy were significantly higher in the intervention group one month after training by the teach-back method than before training. The two groups did not significantly differ regarding mean score of self-efficacy before training, but there was a significant difference one month after training: the mean score of self-efficacy in the intervention group was significantly higher than in the control group (p < 0.001). CONCLUSIONS: Teach-back is a training procedure aimed at improving patients' understanding of treatment regimens. This study showed that teach-back significantly improved patients' self-efficacy even over as short a period as one month. It may be interesting to study the long-term effects of this simple but effective training method.

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