title: Impact of reinforcement of diabetes self-care on poorly controlled diabetes: a randomized controlled trial.
abstract: The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education.
  
  
  
  In this randomized controlled trial, 134 participants (75% white, 51% female, 59 ± 9 years old, 13 ± 8 years with diabetes, A1C = 8.4% ± 1.2%) were randomized to either a group map-based program (intervention) or group education on cholesterol and blood pressure (control). Participants were assessed for A1C levels, diabetes self-care behaviors (3-day pedometer readings, 6-minute walk test, blood glucose checks, frequency of self-care), and psychosocial factors (distress, frustration, quality of life) at baseline, 3, 6, and 12 months post intervention and health literacy at baseline.
  
  
  
  Groups did not differ on baseline characteristics including A1C levels, health literacy, or self-care; however, the intervention group had more years of education than controls. Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up. Importantly, frequency of self-reported self-care, diabetes quality of life, diabetes-related distress, and frustration with diabetes self-care improved in both groups over time.
  
  
  
  Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care. The best method to accomplish reinforcement needs to be established.
authors: Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)|Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Elizabeth A
authors: EA
authors: Beverly
authors: Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Shane M
authors: SM
authors: Fitzgerald
authors: Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Kelly M
authors: KM
authors: Brooks
authors: Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Brittney A
authors: BA
authors: Hultgren
authors: Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Om P
authors: OP
authors: Ganda
authors: Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Medha
authors: M
authors: Munshi
authors: Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts (Dr Beverly, Mr Fitzgerald, Ms Brooks, Ms Hultgren, Dr Ganda, Dr Munshi, Dr Weinger)|Harvard Medical School, Boston, Massachusetts (Dr Beverly, Dr Ganda, Dr Munshi, Dr Weinger)
authors: Katie
authors: K
authors: Weinger
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D011615:Psychotherapy, Group / Q000379:methods*; D011788:Quality of Life; D012054:Reinforcement, Psychology; D012648:Self Care / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
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