HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: dc07-0777v1 30/11/2832    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thoolen, B. Articles by Rutten, G. Search for Related Content PubMed PubMed Citation Articles by Thoolen, B. Articles by Rutten, G. Social Bookmarking                What's this?

Effectiveness of a Self-Management Intervention in Patients With Screen-Detected Type 2 Diabetes

¹ Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands
² NIVEL: Netherlands Institute for Health Services Research, Utrecht, the Netherlands
³ Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
⁴ MRC Epidemiology Unit, Cambridge, U.K
⁵ Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands

Address correspondence and reprint requests to Bart Thoolen, Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, Netherlands. E-mail: b.j.thoolen{at}uu.nl

OBJECTIVE—To examine the effectiveness of a theory-driven self-management course in reducing cardiovascular risk in patients with screen-detected type 2 diabetes, taking ongoing medical treatment into account.

RESEARCH DESIGN AND METHODS—A total of 196 screen-detected patients, receiving either intensive pharmacological or usual-care treatment since diagnosis (3–33 months previously), were subsequently randomized to a control or intervention condition (self-management course). A 2 x 2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usualcare), using multilevel regression modeling to analyze changes in patients’ BMI, A1C, blood pressure (BP), and lipid profiles over 12 months, from the start of the 3-month course to 9-month follow-up.

RESULTS—The self-management course significantly reduced BMI (–0.77 kg/m²) and systolic BP (–6.2 mmHg) up until the 9-month follow-up, regardless of medical treatment. However, intensive medical treatment was also independently associated with lower BP, A1C, total cholesterol, and LDL before the course and further improvements in systolic BP (–4.7 mmHg). Patients receiving both intensive medical treatment and the self-management course therefore had the best outcomes.

CONCLUSIONS—This self-management course was effective in achieving sustained reductions in weight and BP, independent of medical treatment. A combination of behavioral and medical interventions is particularly effective in reducing cardiovascular risk in newly diagnosed patients.

Abbreviations: BP, blood pressure • ADDITION, Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Type 2 Diabetes in Primary Care

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?