title: A Diabetes Self-Management Program: 12-Month Outcome Sustainability From a Nonreinforced Pragmatic Trial.
abstract: Diabetes self-management education has been shown to be effective in controlled trials. The 6-week Better Choices, Better Health-Diabetes (BCBH-D) self-management program was also associated with an improvement in health outcomes in a 6-month translation study.
  
  
  
  The objective of this study was to determine whether a national translation of the BCBH-D self-management program, offered both Web-based and face-to-face, was associated with improvements in health outcomes (including HbA1c) and health behaviors (including recommended medical tests) 1 year after intervention.
  
  
  
  Web-based programs were administered nationally, whereas face-to-face workshops took place in Atlanta, Indianapolis, and St Louis. Self-report questionnaires were either Web-based or administered by mail, at baseline and 1 year, and collected health and health-behavior measures. HbA1c blood samples were collected via mailed kits. A previous 6-month study found statistically significant improvements in 13 of 14 outcome measures, including HbA1c. For this study, paired t test compared baseline with 1-year outcomes. Subgroup analyses determined whether participants with specific conditions improved (high HbA1c, depression, hypoglycemia, nonadherence to medication, no aerobic exercise). The percentage of participants with improvements in effect size of at least 0.4 in at least 1 of the 5 measures was calculated.
  
  
  
  A total of 857 participants with 1-year data (69.7% of baseline participants) demonstrated statistically significant 1-year improvements in 13 of 15 outcome measures; 79.9% (685/857) of participants showed improvements in effect size of 0.4 or greater in at least 1 of the 5 criterial measures.
  
  
  
  Participants had small but significant benefits in multiple measures. Improvements previously noted at 6 months were maintained or amplified at 1 year.
authors.affiliation: Stanford Patient Education Research Center, Medicine, Stanford University, Palo Alto, CA, United States.
authors.forename: Kate
authors.identifier: 0000-0001-6516-2308
authors.initials: K
authors.lastname: Lorig
authors.affiliation: Stanford Patient Education Research Center, Medicine, Stanford University, Palo Alto, CA, United States.
authors.forename: Philip L
authors.identifier: 0000-0002-2528-6354
authors.initials: PL
authors.lastname: Ritter
authors.affiliation: HealthCore, Wilmington, DE, United States.
authors.forename: Ralph M
authors.identifier: 0000-0001-6324-2283
authors.initials: RM
authors.lastname: Turner
authors.affiliation: Anthem Inc, Indianapolis, IN, United States.
authors.forename: Kathleen
authors.identifier: 0000-0002-2786-1076
authors.initials: K
authors.lastname: English
authors.affiliation: Stanford Patient Education Research Center, Medicine, Stanford University, Palo Alto, CA, United States.
authors.forename: Diana D
authors.identifier: 0000-0002-5925-465X
authors.initials: DD
authors.lastname: Laurent
authors.affiliation: NCOA Services, LLC, Arlington, VA, United States.
authors.forename: Jay
authors.identifier: 0000-0002-7759-640X
authors.initials: J
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D012648:Self Care / Q000379:methods*; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: patient education; self-management; type 2 diabetes