title: A nurse-led education and cognitive behaviour therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial.
abstract: OBJECTIVE
  Diabetes mellitus is associated with significant morbidity, mortality, and escalating health care costs. Research has consistently demonstrated the importance of glycaemic control in delaying the onset, and decreasing the incidence, of both the short-term and long-term complications of diabetes. Although glycaemic control is difficult to achieve and challenging to maintain, it is key to reducing negative disease outcomes. The aim of this study was to determine whether a nurse-led educational intervention alone or a nurse-led intervention using education and acceptance and commitment therapy (ACT) was effective in reducing hemoglobin A1c(HbA1c) in people living with uncontrolled type 2 diabetes compared to usual care.
  
  
  METHODS
  Adults over the age of 18 years, with a confirmed diagnosis of type 2 diabetes and HbA1coutside of the recommended range (4%-7%, 20-53 mmol/mol) for 12 months or more, were eligible to participate. Participants were randomised to either a nurse-led education intervention, a nurse-led education plus ACT intervention, or a usual care. One hundred and eighteen participants completed baseline data collection (N = 34 education group, N = 39 education plus ACT, N = 45 control group). An intention to treat analysis was used.
  
  
  RESULTS
  A statistically significant reduction in HbA1cin the education intervention group was found (P = .011 [7.48, 8.14]). At 6 months, HbA1cwas reduced in both intervention groups (education group -0.21 and education and ACT group -0.04) and increased in the control group (+0.32). A positive change in HbA1c(HbA1creduced) was noted in 50 participants overall. Twice as many participants in the intervention groups demonstrated an improvement as compared to the control group (56% of the education group, 51% education plus ACT, and 24% control group.
  
  
  CONCLUSIONS
  At 6 months post intervention, HbA1cwas reduced in both intervention groups with a greater reduction noted in the nurse-led education intervention.
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia.
authors.forename: Lisa C
authors.identifier: http://orcid.org/0000-0002-6395-0279
authors.initials: LC
authors.lastname: Whitehead
authors.affiliation: Centre for Postgraduate Nursing Studies & Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Crowe
authors.affiliation: Department of Psychology, University of Canterbury, Christchurch, New Zealand.
authors.forename: Janet D
authors.initials: JD
authors.lastname: Carter
authors.affiliation: Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Maskill
authors.affiliation: School of Health Sciences, University of Otago, Christchurch, New Zealand.
authors.forename: Dave
authors.initials: D
authors.lastname: Carlyle
authors.affiliation: School of Health Sciences, University of Stirling, Stirling, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Bugge
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Chris M A
authors.initials: CMA
authors.lastname: Frampton
mesh_terms: D001786:Blood Glucose; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D003941:Diagnostic Techniques, Ophthalmological; D004644:Emotions; D005260:Female; D006442:Glycated Hemoglobin; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008603:Mental Health; D009726:Nurses; D010353:Patient Education as Topic / Q000458:organization & administration*; D017060:Patient Satisfaction; D000073278:Self-Management / Q000193:education* / Q000523:psychology*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids
keywords: nursing; randomised controlled trial; type 2 diabetes mellitus