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

  1. Bart Thoolen, PHD1,
  2. Denise De Ridder, PHD1,
  3. Jozien Bensing, PHD12,
  4. Cora Maas, PHD3,
  5. Simon Griffin, MD, PHD4,
  6. Kees Gorter, MD, PHD5 and
  7. Guy Rutten, MD, PHD5
  1. 1Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands
  2. 2NIVEL: Netherlands Institute for Health Services Research, Utrecht, the Netherlands
  3. 3Department of Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
  4. 4MRC Epidemiology Unit, Cambridge, U.K
  5. 5Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
  1. 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

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.

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 × 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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 31 July 2007. DOI: 10.2337/dc07-0777.

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

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted July 20, 2007.
    • Received April 22, 2007.
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  1. doi: 10.2337/dc07-0777 Diabetes Care November 2007 vol. 30 no. 11 2832-2837
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