title: No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial.
abstract: OBJECTIVE
  To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices.
  
  
  METHODS
  Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting.
  
  
  METHODS
  Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m². Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires).
  
  
  RESULTS
  Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI 20.8-0.35) and diet (fat (difference between groups = 0.19; CI 20.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = 20.02; CI 20.26-0.22)), and physical activity (difference between groups = 21.15; CI 212.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life.
  
  
  CONCLUSIONS
  A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.
authors: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. r.jansink@iq.umcn.nl
authors: Renate
authors: R
authors: Jansink
authors: Jozé
authors: J
authors: Braspenning
authors: Ellen
authors: E
authors: Keizer
authors: Trudy
authors: T
authors: van der Weijden
authors: Glyn
authors: G
authors: Elwyn
authors: Richard
authors: R
authors: Grol
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016000:Cluster Analysis; D019033:Delivery of Health Care, Integrated; D003920:Diabetes Mellitus / Q000523:psychology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D009426:Netherlands; D057184:Practice Patterns, Nurses'; D015397:Program Evaluation; D011788:Quality of Life
chemical_list: D006442:Glycated Hemoglobin
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