title: Changes in diabetes self-care behaviors make a difference in glycemic control: the Diabetes Stages of Change (DiSC) study.
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.
  
  
  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 1029 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 HbA(1c) 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, HbA(1c) 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 <or= 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.
authors.affiliation: Leadership Sinai Center for Diabetes, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Jones
authors.forename: Lynn
authors.initials: L
authors.lastname: Edwards
authors.forename: T Michael
authors.initials: TM
authors.lastname: Vallis
authors.forename: Laurie
authors.initials: L
authors.lastname: Ruggiero
authors.forename: Susan R
authors.initials: SR
authors.lastname: Rossi
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Rossi
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Greene
authors.forename: James O
authors.initials: JO
authors.lastname: Prochaska
authors.forename: Bernard
authors.initials: B
authors.lastname: Zinman
mesh_terms: D001786:Blood Glucose; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D040242:Risk Reduction Behavior; D012648:Self Care
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents