title: Effectiveness of a training course for general practice nurses in motivation support in type 2 diabetes care: a cluster-randomised trial.
abstract: BACKGROUND
  Type 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population.
  
  
  METHODS
  Forty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory-based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40-74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed.
  
  
  RESULTS
  The differences between the intervention- and the control practices' mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: -0.02%-points (95% CI: -0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: -0.12%-points (-0.23 to -0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01.
  
  
  CONCLUSIONS
  Offering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention.
  
  
  BACKGROUND
  ClinicalTrials.gov (Identifier NCT01187069).
authors.affiliation: Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark; Department of Public Health, Section for Health Promotion and Health Services, Aarhus, University, Aarhus, Denmark.
authors.forename: Lise
authors.initials: L
authors.lastname: Juul
authors.affiliation: Department of Public Health, Section for Health Promotion and Health Services, Aarhus, University, Aarhus, Denmark.
authors.forename: Helle T
authors.initials: HT
authors.lastname: Maindal
authors.affiliation: Steno Diabetes Centre, Gentofte, Denmark; Nasjonal kompetansetjeneste for læring og mestring innen helse (NKLMH), Oslo University Hospital, Oslo, Norway.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Zoffmann
authors.affiliation: Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Frydenberg
authors.affiliation: Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark.
authors.forename: Annelli
authors.initials: A
authors.lastname: Sandbaek
mesh_terms: D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D016000:Cluster Analysis; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing* / Q000628:therapy*; D004506:Education, Nursing; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods; D009729:Nursing / Q000379:methods*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012042:Registries; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin