Changes in Diabetes Self-Care Behaviors Make a Difference in Glycemic Control

The Diabetes Stages of Change (DiSC) study

  1. Helen Jones, RN, MSN1,
  2. Lynn Edwards, PDT, MHSA2,
  3. T. Michael Vallis, PHD3,
  4. Laurie Ruggiero, PHD4,
  5. Susan R. Rossi, RN, PHD5,
  6. Joseph S. Rossi, PHD6,
  7. Geoffrey Greene, RD, PHD7,
  8. James O. Prochaska, PHD6 and
  9. Bernard Zinman, MD8
  1. 1Leadership Sinai Center for Diabetes, Mount Sinai Hospital and University of Toronto, Toronto, Canada
  2. 2QEII Diabetes Management Centre, Queen Elizabeth II Health Sciences Center, Halifax, Canada
  3. 3Department of Psychology & Diabetes Management Center, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
  4. 4University of Illinois at Chicago, School of Public Health, Chicago, Illinois
  5. 5College of Nursing, University of Rhode Island, Kingston, Rhode Island
  6. 6Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island
  7. 7Department of Nutrition and Food Science, University of Rhode Island, Kingston, Rhode Island
  8. 8Division of Endocrinology and Metabolism, Leadership Sinai Center for Diabetes, Mount Sinai Hospital, University of Toronto, Toronto, Canada

    Abstract

    OBJECTIVE—This study compared diabetes Treatment As Usual (TAU) with Pathways To Change (PTC), an intervention developed from the Transtheoretical Model of Change (TTM), to determine whether the PTC intervention would result in greater readiness to change, greater increases in self-care, and improved diabetes control.

    RESEARCH DESIGN AND METHODS—Participants were stratified by diabetes treatment and randomized to treatment with PTC or TAU as well as being randomized regarding receipt of free blood testing strips. The PTC consisted of stage-matched personalized assessment reports, self-help manuals, newsletters, and individual phone counseling designed to improve readiness for self-monitoring of blood glucose (SMBG), healthy eating, and/or smoking cessation. A total of 1,029 individuals with type 1 and type 2 diabetes who were in one of three pre-action stages for either SMBG, healthy eating, or smoking were recruited.

    RESULTS—For the SMBG intervention, 43.4% of those receiving PTC plus strips moved to an action stage, as well as 30.5% of those receiving PTC alone, 27.0% of those receiving TAU plus strips, and 18.4% of those receiving TAU alone (P < 0.001). For the healthy eating intervention, more participants who received PTC than TAU (32.5 vs. 25.8%) moved to action or maintenance (P < 0.001). For the smoking intervention, more participants receiving PTC (24.3%) than TAU (13.4%) moved to an action stage (P < 0.03). In intention-to-treat (ITT) analysis of those receiving the SMBG intervention, PTC resulted in a greater reduction of HbA1c than TAU, but this did not reach statistical significance. However, in those who moved to an action stage for the SMBG and healthy eating interventions, HbA1c was significantly reduced (P < 0 0.001). Individuals who received the healthy eating intervention decreased their percentage of calories from fat to a greater extent (35.2 vs. 36.1%, P = 0.004), increased servings of fruit per day (1.89 vs. 1.68, P = 0.016), and increased vegetable servings (2.24 vs. 2.06, P = 0.011) but did not decrease weight. However, weight loss for individuals who received the healthy eating intervention and who increased SMBG frequency as recommended was significantly greater, with a 0.26-kg loss in those who remained in a pre-action SMBG stage but a 1.78-kg loss in those performed SMBG as recommended (P ≤ 0. 01).

    CONCLUSIONS—This study demonstrates that this intervention has the potential of positively impacting the health of broad populations of individuals with diabetes, not just the minority who are ready for change.

    Footnotes

    • Address correspondence and reprint requests to Helen Jones, MSN, CDE, Leadership Sinai Center for Diabetes, Mount Sinai Hospital, Suite 786, 600 University Avenue, Toronto, Ontario, M5G 1X5 Canada.

      Received for publication 12 June 2002 and accepted in revised form 14 November 2002.

      H.J. and B.Z. have participated on an Advisory Board of LifeScan and have received honoraria from LifeScan for participation in symposia and workshops. M.V. has received grant/research support from LifeScan. L.E. is a member of the LifeScan Educational Institute Advisory Panel for LifeScan Canada, has received honoraria for her participation in this Advisory Panel, and has been hired as a consultant for LifeScan Canada on numerous projects. J.S.R. has received an honorarium for a speaking engagement from LifeScan. L.R. has received honoraria for speaking engagements and research and educational grants from LifeScan. H.J., B.Z., M.V., L.E., J.S.R, and S.R.R. received funding through an unrestricted grant for completion of the Diabetes Stages of Change (DiSC) study from LifeScan, a Johnson and Johnson Company. Successful results of this project may lead to the development of products by LifeScan, which may result in royalties for J.S.R and S.R.R. as contributing authors and developers of such products, as well as their employer, the University of Rhode Island.

      A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    « Previous | Next Article »Table of Contents

    This Article

    1. doi: 10.2337/diacare.26.3.732 Diabetes Care March 2003 vol. 26 no. 3 732-737
    1. » Abstract
    2. Full Text
    3. Full Text (PDF)

    Current Issue

    1. December 2009, 32 (12)
    1. Current Issue
    1. Alert me to new issues of Diabetes Care