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The effectiveness of a self-management intervention in patients with screen-detected type-2 diabetes

^a Health Psychology, Utrecht University, Utrecht, the Netherlands
^b NIVEL: Netherlands institute for Health Services Research, Utrecht, the Netherlands
^c Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
^d MRC Epidemiology Unit, Cambridge, UK
^e Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands

B.J.Thoolen{at}fss.uu.nl

ABSTRACT

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.

Methods: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 2x2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usual-care), using multilevel regression modelling to analyse changes in patients' BMI, Hba1c%, 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 till 9-month follow-up, regardless of medical treatment. However, intensive medical treatment was also independently associated with lower BP, Hba1c%, 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

Conclusion: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.

ClinicalTrials.gov-Identifier: NCT00237549

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