Effects of a problem‐solving counseling program to facilitate intensified walking on Koreans with type 2 diabetes

Abstract

Aim: This study aimed to evaluate the immediate and long-term effects of a 12 week problem-solving (PS) counseling program to facilitate intensified walking with machinery monitoring on persons with type 2 diabetes mellitus in Korea. Methods:The study used a quasi-experimental design. The participants were 57 patients with diabetes from three endocrinology or internal medicine clinics in an urban city of South Korea. Moderate-intensity walking and PS counseling were recommended to both groups. The difference between the two groups was whether the intensity of the exercise was monitored by an ambulatory heart rate monitor (experimental group) or was self-regulated (comparison group). Those programs were evaluated in relation to BMI, glycemic control (blood glucose level, glycosylated hemoglobin [HbA1c]), a vascular complication index (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, tissue plasminogen activator [t-PA], plasminogen activator inhibitor-1 [PAI-1], Parma Cardiovascular Risk Index), and coping strategies at 3 and 6 months. Results: The experimental group members showed dramatic decreases in their glucose and HbA1c levels at 3 months. The values of t-PA decreased significantly at baseline, compared to at 3 months. The levels of PAI-1 continuously declined and the Parma Cardiovascular Risk Index score did not change significantly from baseline to at 3 months, but showed significant effects at 6 months. Conclusion: A combined program of intensified walking, using a heart rate monitor, with PS counseling is more helpful to prevent complications than self-regulated exercise for persons with type 2 diabetes in Korea.

Problem solving interventions for diabetes self-management and control: A systematic review of the literature

“…The 24 intervention studies applied the following research designs: randomized controlled trial (n = 17) [7-23] and quasi-experimental or preintervention/postintervention design (n = 8) [24-32]. …”

“…Race/ethnicity of study participants was not reported in 3 (13%) studies [18,22,31]. One study examined Caucasians [32], 12 (50%) studies included multiple ethnicities (generally Caucasian, African American, and Latino)[7,11,12,14-16,19,21,23,25,26,30], 5 (21%) studies were African American only [8,9,20,27,28], 2 study samples were Latino[13,17], and 1 study sample was South Korean [24]. …”

“…One study reported an intervention that was solely problem-solving-based [8]. In five (29%) of the studies, problem-solving was one component of a larger intervention that utilized other treatment approaches [9,12,16,24]. In seven (41%) of the studies, only certain steps of problem-solving were included in the intervention (e.g., goal setting or action planning) [13-15,18,19,25,26].…”

“…In the remaining three studies (18%), the intervention did not consist of problem-solving skills training, but rather a problem-solving based support group [17,27,28] or was included as one of multiple components of an intervention package [20,30]. Interventions were delivered in varying formats, including individual face-to-face [9,12,16,18,20,24,25], group face-to-face [8,13,14,17,18,20,25-28,30], phone-based [12,13,16,25], DVD-based [30], internet-based [15], and video-conferencing [19]. Four sets of outcomes were reviewed for each intervention study: physiological outcomes, self-management behaviors, problem solving, and psychosocial outcomes.…”

“…With regard to outcomes, 7 (50%) studies reported significant improvements in HbA1c following intervention [8,13,15,17,24,27,29], ranging from -0.09 to -0.93. These improvements in HbA1c were seen over 3 to 12 months of follow-up.…”