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

  1. Bart Thoolen, MSc (B.J.Thoolen{at}fss.uu.nl)a,
  2. Denise De Ridder, Phda,
  3. Jozien Bensing, Phda,,b,
  4. Cora Maas, Phdc,
  5. Simon Griffin, MD,Phdd,
  6. Kees Gorter, MD,Phde and
  7. Guy Rutten, MD,Phde
  1. a Health Psychology, Utrecht University, Utrecht, the Netherlands
  2. b NIVEL: Netherlands institute for Health Services Research, Utrecht, the Netherlands
  3. c Methodology and Statistics, Utrecht University, Utrecht, the Netherlands
  4. d MRC Epidemiology Unit, Cambridge, UK
  5. e Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands

    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.

    Conclusion: ClinicalTrials.gov-Identifier: NCT00237549

    Footnotes

      • Received April 22, 2007.
      • Accepted July 20, 2007.

    This Article

    1. Published online before print July 31, 2007, doi: 10.2337/dc07-0777
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