Self-monitoring of blood glucose--psychological aspects relevant to changes in HbA1c in type 2 diabetic patients treated with diet or diet plus oral antidiabetic medication.
OBJECTIVE
To investigate the influence of psychological aspects on glycemic control in type 2 diabetic patients treated with diet alone or diet plus oral antidiabetic medication using meal-related self-monitoring of blood glucose (SMBG). These psychological aspects refer to the process of self-management including the tendency to structure situations and activate resources (self-perception), to accept options for action (self-reflection) and to believe in self-efficacy (self-regulation).


METHODS
In a randomized controlled 6-month group comparison study, one group (n = 113; mean age 58.7 years) used a blood glucose monitoring device, kept a blood glucose/eating diary and received standardized counseling focusing on self-perception, self-reflection and self-regulation. A control group (n = 110; mean age 60.5 years) received non-standardized counseling on diet and lifestyle.


RESULTS
Statistically significant endpoint differences between the SMBG and the control group were seen in glycemic control (p = 0.0086) and the well-being item 'depression' (p = 0.032). All aspects of counseling were influenced by SMBG with the extent of self-perception and self-reflection gradually increasing over time. Three HbA1c response types were identified among SMBG patients: continuous-achievers, late-achievers and non-achievers.


CONCLUSIONS
This study identified processes (structuring the situation and activating resources, accepting options for action and believing in self-efficacy) which lead to a change in the metabolic profile. SMBG coupled with structured counseling provided patients with a tool for taking on more self-control and resulted in an improved outlook on life.


CONCLUSIONS
This short-term intervention involved a structured counseling algorithm which requires 5-10 min of physician-patient contact and a structured documentation of metabolic control by the patient and can be taught by a diabetes training team within 4 h. The identification of the different response types might be of importance in clinical practice as it enables the physician to determine the right counseling option.
Siebolds
Marcus
M
Catholic University of Applied Sciences Nordrhein Westfalen, Department of Health Care Systems, Woerthstrasse 10, D-50668 Köln, Cologne, Germany. M.Siebolds@KFHNW.de
Gaedeke
Oliver
O
Schwedes
Ulrich
U
D000284:Administration, Oral; D000368:Aged; D001294:Attitude to Health; D001317:Austria; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000523:psychology*; D003131:Combined Modality Therapy; D003376:Counseling / Q000458:organization & administration; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000523:psychology* / Q000628:therapy; D003927:Diet, Diabetic; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000458:organization & administration; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents