title: Reducing resistance to treatment, through group intervention, improves clinical measurements in patients with type 2 diabetes.
abstract: BACKGROUND
  Studies have shown that group Therapeutic Patient Education (TPE) may empower patients with type 2 diabetes to better manage their disease. The mechanism of these interventions is not fully understood. A reduction in resistance to treatment may explain the mechanism by which TPE empowers participants to improve self-management. The Objective of this study was to examine the effectiveness of diabetes groups in reducing resistance to treatment and the association between reduced resistance and better management of the disease.
  
  
  METHODS
  In a program evaluation study, we administered validated questionnaires to measure resistance to treatment (RTQ) in 3 time periods: before the intervention (T1), immediately after the intervention (T2) and six months later (T3). Clinical measures (HbA1C, blood pressure, HDL, LDL and total cholesterol, Triglycerides and BMI) were retrieved from Maccabi Healthcare Services computerized systems, for T1;T2 and a year post intervention (T3). Linear mixed models were used adjusting for age, gender, social support and family status.
  
  
  RESULTS
  157; 156 and 106 TPE participants completed the RTQ in T1; T2 and T3 respectively. HbA1C and systolic and diastolic blood pressure were significantly reduced in the group which achieved a reduction in three out of the five RTQ components. For the other clinical measurements no significant changes were observed.
  
  
  CONCLUSIONS
  Our findings suggest that reducing resistance to treatment, through an educational program for patients with diabetes, is associated with a better disease control. Identifying patients with higher resistance to treatment, and including components that reduce resistance in patient education programs, have the potential to increase the effectiveness of these programs.
authors.affiliation: Department of Clinical Quality, Meuhedet Health Care, 124 Ibn-Gvirol St, Tel Aviv, Israel. liora.v@meuhedet.co.il.
authors.forename: Liora
authors.initials: L
authors.lastname: Valinsky
authors.forename: Moshe
authors.initials: M
authors.lastname: Mishali
authors.forename: Ronit
authors.initials: R
authors.lastname: Endevelt
authors.forename: Rachel
authors.initials: R
authors.lastname: Preiss
authors.forename: Keren
authors.initials: K
authors.lastname: Dopelt
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Heymann