Effectiveness of a self-management intervention in patients with screen-detected type 2 diabetes.
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
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 x 2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usual-care), 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.
Thoolen
Bart
B
Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands. b.j.thoolen@uu.nl
De Ridder
Denise
D
Bensing
Jozien
J
Maas
Cora
C
Griffin
Simon
S
Gorter
Kees
K
Rutten
Guy
G
D017668:Age of Onset; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012044:Regression Analysis; D012648:Self Care / Q000592:standards
D006442:Glycated Hemoglobin; D008055:Lipids