title: Adherence to self-care behavior and glycemic effects using structured education.
abstract: OBJECTIVE
  The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university-based hospital primary care clinic.
  
  
  METHODS
  This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes.
  
  
  RESULTS
  A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = -0.59% and Δ = -1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = -0.43% and Δ = -0.49%), based on an intention-to-treat analysis. A per-protocol analysis showed the significant change was maintained at 12 months (Δ = -0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem-solving, reducing risk and health coping.
  
  
  CONCLUSIONS
  In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan ; Institute of Medicine, School of Medicine, Chung Shan Medical University Shalu County, Taichung, Taiwan.
authors.forename: Yi-Sun
authors.initials: YS
authors.lastname: Yang
authors.affiliation: Department of Nursing, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Yueh-Chu
authors.initials: YC
authors.lastname: Wu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Ying-Li
authors.initials: YL
authors.lastname: Lu
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Edy
authors.initials: E
authors.lastname: Kornelius
authors.affiliation: Department of Nursing, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Yu-Tze
authors.initials: YT
authors.lastname: Lin
authors.affiliation: Department of Nursing, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Department of Nursing, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Ching-Lu
authors.initials: CL
authors.lastname: Li
authors.affiliation: Department of Nursing, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan.
authors.forename: Hui-Wen
authors.initials: HW
authors.lastname: Hsiao
authors.affiliation: Division of Basic Medical Science, HungKuang University Shalu County, Taichung, Taiwan.
authors.forename: Chiung-Huei
authors.initials: CH
authors.lastname: Peng
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital Shalu County, Taichung, Taiwan ; Institute of Medicine, School of Medicine, Chung Shan Medical University Shalu County, Taichung, Taiwan.
authors.forename: Chien-Ning
authors.initials: CN
authors.lastname: Huang
keywords: Diabetes conversation map; Self-care behavior; Structured education