title: Effectiveness of tailored support for people with Type 2 diabetes after a first acute coronary event: a multicentre randomized controlled trial (the Diacourse-ACE study).
abstract: OBJECTIVE
  To evaluate the effectiveness of a tailored, supportive intervention strategy in influencing diabetes-related distress, health status, well-being and clinical outcomes in people with Type 2 diabetes shortly after a first acute coronary event.
  
  
  METHODS
  People with Type 2 diabetes and a recent first acute coronary event (n = 201) were randomized to the intervention group (three home visits by a diabetes nurse) or the attention control group (one telephone consultation). Outcomes were measured after discharge (baseline) and at 5 months (follow-up) using validated questionnaires for diabetes-related distress (Problem Areas in Diabetes), well-being (WHO Well-Being Index) and health status (Euroqol 5 Dimensions; Euroqol Visual Analogue Scale). ancova was used to analyse change-over-time differences between groups.
  
  
  RESULTS
  Follow-up data were available for 81 participants in the intervention group (66.0 ± 9.3 years, 76% male) and 80 in the control group (65.6 ± 9.4 years, 75% male) participants. Mean diabetes-related distress was low after hospital discharge (intervention group: 8.2 ± 10.1; control group: 9.2 ± 12.4) and did not change after 5 months (intervention group: 9.2 ± 12.4; control group: 9.0 ± 11.2). Baseline well-being was less favourable but improved significantly in the intervention group (baseline: 58.5 ± 28.0; follow-up: 65.5 ± 23.7; P = 0.005), but not in the control group (baseline: 57.5 ± 25.2; follow-up: 59.6 ± 24.4; P = 0.481). Health status also improved in the intervention group (baseline: 69.9 ± 17.3; follow-up: 76.8 ± 15.6; P < 0.001) but not in the control group (baseline: 68.6 ± 15.9; follow-up: 69.9 ± 16.7; P = 0.470). A significant group effect was found for health status (F = 7.9; P = 0.006).
  
  
  CONCLUSIONS
  Although the intervention had no effect on diabetes-related distress, this might be at least partially attributable to very low levels of diabetes-related distress at baseline. Interestingly, health status scores and well-being, which were less favourable at baseline, both improved after the tailored support intervention.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Kasteleyn
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: R C
authors.initials: RC
authors.lastname: Vos
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Rijken
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: F G
authors.initials: FG
authors.lastname: Schellevis
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: G E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000150:complications* / Q000517:prevention & control / Q000523:psychology / Q000534:rehabilitation; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D058065:Diabetic Cardiomyopathies / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006701:Home Nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance; D057285:Precision Medicine; D012008:Recurrence; D057566:Self Report; D018454:Spouses / Q000193:education; D013315:Stress, Psychological / Q000150:complications / Q000517:prevention & control*