title: Does low well-being modify the effects of PRISMA (Dutch DESMOND), a structured self-management-education program for people with type 2 diabetes?
abstract: OBJECTIVE
  Diabetes self-management education improves behavioural and clinical outcomes in type 2 diabetes patients, however little is known about the modifying effects of well-being. This is relevant given high prevalence of depression and distress among diabetes patients. We aimed to test whether low well-being modifies the effects of the PRISMA self-management education program (Dutch DESMOND).
  
  
  METHODS
  297 primary care type 2 diabetes patients participated in the PRISMA observational study with a pre-post measurement design. Patients were grouped in low (n=63) and normal well-being (n=234). Low well-being was defined as either low mood (WHO-5<50) and/or high diabetes-distress (PAID-5>8). Outcome measures were: diabetes self-efficacy (CIDS), illness perception (IPQ) and diabetes self-care activities (SDSCA).
  
  
  RESULTS
  Improvements were found in illness perception (b=1.586, p<0.001), general diet (b=1.508, p=0.001), foot care (b=0.678, p=0.037), weekly average diet (b=1.140, p=0.001), creating action plan (b=0.405, p=0.007). Well-being interaction effects were found for general diet (p=0.009), weekly average diet (p=0.022), and creating an action plan (p=0.002).
  
  
  CONCLUSIONS
  PRISMA self-management education seems as effective for people with normal well-being as for people with low well-being. Further research should examine whether addressing mood and diabetes-distress as part of self-management education could reduce attrition and maintain or improve well-being among participants.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, MF D-345, 1081BT Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: m.vanvugt@vumc.nl.
authors.forename: Michael
authors.initials: M
authors.lastname: van Vugt
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, MF D-345, 1081BT Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: de Wit
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, MF D-345, 1081BT Amsterdam, The Netherlands; Dietetics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bader
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, MF D-345, 1081BT Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004032:Diet / Q000009:adverse effects; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D010465:Perception; D011320:Primary Health Care; D040242:Risk Reduction Behavior; D012648:Self Care; D020377:Self Efficacy; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Education; Self-management; Type 2 diabetes mellitus; Well-being