title: Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial.
abstract: BACKGROUND
  Diabetes has become a major public health problem in China. Support of patient self-management is a key component of effective diabetes care and improved patient outcomes. A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999. However, the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai. This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai.
  
  
  METHODS
  208 patients with type 2 diabetes aged 35-80 years were randomly assigned to the intervention group (n=119) of 12 monthly group visit sessions or to a control group (n=89) of usual care. The trial was undertaken in two rural communities in Shanghai, China. Randomization and allocation to study group were carried out by using a random number table. Analysis of covariance was used to compare changes in the 17 self-management behavior, self-efficacy and health status related variables in two groups at 12 months' follow-up based on 176 patients (n=98; n=78).
  
  
  RESULTS
  Compared with controls, the intervention patients, on average, increased their duration of aerobic exercise by more than 40 minutes per week (p=0.001); had significant increase of 0.71 in mean score on self-efficacy to manage diabetes (p=0.02); and had significant improvements in measures of illness intrusiveness and systolic blood pressure. The intervention patients attended an average of 10.1 of the 12 program sessions with 75.6% of them attended 10 and more sessions.
  
  
  CONCLUSIONS
  The Chinese diabetes group visit model is a feasible, acceptable and effective alternative for supporting diabetes patient self-management in Chinese rural communities. The model requires larger studies to determine its effect on blood glucose control and health care utilization.
  
  
  BACKGROUND
  ISRCTN87909028.
authors.affiliation: Department of Preventive Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 20032, China.
authors.forename: Shengsheng
authors.initials: S
authors.lastname: Liu
authors.forename: Anhua
authors.initials: A
authors.lastname: Bi
authors.forename: Dongbo
authors.initials: D
authors.lastname: Fu
authors.forename: Hua
authors.initials: H
authors.lastname: Fu
authors.forename: Wei
authors.initials: W
authors.lastname: Luo
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Ma
authors.forename: Liyan
authors.initials: L
authors.lastname: Zhuang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D020377:Self Efficacy