title: Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level.
abstract: OBJECTIVE
  To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level.
  
  
  METHODS
  12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted.
  
  
  RESULTS
  The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference.
  
  
  CONCLUSIONS
  In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Olry de Labry Lima
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: clara.bermudez.easp@juntadeandalucia.es.
authors.forename: Clara
authors.initials: C
authors.lastname: Bermúdez Tamayo
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Pastor Moreno
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Bolívar Muñoz
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Granada, Spain; Instituto de Investigación Biosanitaria de Granada; Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ruiz Pérez
authors.affiliation: Division of Global Health, University of Montreal; Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
authors.forename: Mira
authors.initials: M
authors.lastname: Johri
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: Fermín
authors.initials: F
authors.lastname: Quesada Jiménez
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Cruz Vela
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: de Los Ríos Álvarez
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Prados Quel
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Moratalla López
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Domínguez Martín
authors.affiliation: Centro de Salud Cartuja, Granada, Spain.
authors.forename: José Andrés
authors.initials: JA
authors.lastname: Lopez de Hierro
authors.affiliation: CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ricci Cabello
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D000073278:Self-Management; D016896:Treatment Outcome
keywords: Atención primaria de salud; Autocuidado; Desigualdades en salud; Diabetes mellitus tipo 2; Diabetes mellitus type 2; Ensayo clínico controlado aleatorizado; Health inequalities; Primary health care; Randomised controlled trial; Self care