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.
Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands. b.j.thoolen@uu.nl
Bart
B
Thoolen
Denise
D
De Ridder
Jozien
J
Bensing
Cora
C
Maas
Simon
S
Griffin
Kees
K
Gorter
Guy
G
Rutten
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