Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level

• Main Authors: Antonio Olry de Labry Lima, Clara Bermúdez Tamayo, Guadalupe Pastor Moreno, Julia Bolívar Muñoz, Isabel Ruiz Pérez, Mira Johri, Fermín Quesada Jiménez, Pilar Cruz Vela, Ana M. de los Ríos Álvarez, Miguel Ángel Prados Quel, Enrique Moratalla López, Susana Domínguez Martín, José Andrés Lopez de Hierro, Ignacio Ricci Cabello
• Format: Article
• Language: English
• Published: Elsevier 2017-01-01
• Series: Gaceta Sanitaria
• Subjects: Diabetes mellitus type 2; Primary health care; Health inequalities; Self care; Randomised controlled trial
• Online Access: http://www.sciencedirect.com/science/article/pii/S0213911116301236

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.