Approximately 45% of patients with diabetes have not achieved an A1C level of less than 7%. Studies show that improved glycemia helps delay or prevent serious diabetes complications. However, poor adherence to medication prescriptions and selfmanagement and lifestyle recommendations can negatively impact glycemic control. Numerous adherence and lifestyle interventions for diabetes are available, but few have been effectively adopted in clinical practice.
Testing a Novel Intervention
In the December 12, 2011 Archives of Internal Medicine, my colleagues and I had a study published that assessed the efficacy of a 5-week, highly structured behavioral diabetes education program aimed at helping patients with poorly controlled diabetes improve glycemic control. Those who received this care (Arm 1) were compared with those who received curriculum-based standard group diabetes education without as much structure (Arm 2) and with those who received one-on-one education with diabetes educators for 6 months (Arm 3). All patients received supplies to check glucose levels, but those in Arm 1 were instructed to do so 6 to 8 times per day, write their levels in a log, and make notes about what they ate, if they exercised, and medications they took and when. Each week, Arm 1 diabetes educators reviewed the logs with the group to help patients understand the impact of these factors on glucose levels.
Significant Benefits for Patients
Findings from our study revealed that patients valued the approach of Arm 1 and reported that it helped them gain a better understanding of how the disease affected their body. Arm 1 patients were discouraged from using negative language and instructed to focus on problem-solving, planning ahead, and using mishaps as learning experiences.
Arm 1 educators used cognitive restructuring techniques to help address patients’ self-blaming or negative statements. These educators also focused on helping patients plan what they would do differently to manage their diabetes. Arm 1 patients were required to set broad goals first and then set more specific, achievable goals. Next, they wrote specific steps for meeting these goals. Each week, they evaluated the progress toward their short-term goals and developed new steps for those that did not work. This approach can empower patients to take better control of their disease.
Although all arms in our study saw improvements in glycemic control, those in Arm 1 improved more than those in other arms. They also maintained these improvements over 12 months. Using a structured approach can enhance the likelihood of achieving specific goals and following recommendations for self care. Additionally, facilitating strong communication that fosters a teamwork approach can go a long way toward helping patients with diabetes improve glycemic control.
Readings & Resources (click to view)
Weinger K, Beverly E, Lee Y, et al. The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Arch Intern Med. 2011;22:1990-1999.
Naik A, Palmer N, Petersen N, et al. Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Arch Intern Med. 2011;17:453-459.
Lin E, Rutter C, Katon W, et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010;33:264-269.
Weinger K, McMurrich Greenlaw S. Behavioral strategies for improving self-management. In: Childs B, Cypress M, Spollett G, eds. Complete nurse’s guide to diabetes care. 2nd ed. Alexandria, VA: American Diabetes Association; 2009.
Lin E, Heckbert S, Rutter C, et al. Depression and increased mortality in diabetes: unexpected causes of death. Ann Fam Med. 2009;7:414-421.
van der Feltz-Cornelis C, Nuyen J, Stoop C, et al. Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2010;32:380-395.