Group Visits Improve Metabolic Control in Type 2 Diabetes

Trento, Marina; Passera, P; Tomalino, M.; Bajardi, M.; Pomero, Fulvio; Allione, Attilio; Vaccari, P; Molinatti, G. M.; Porta, Massimo

doi:10.2337/diacare.24.6.995

Cited by 262 publications

(294 citation statements)

References 21 publications

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“…Diabetes education groups and group visits that foster observational learning have been shown to be effective for improving intermediate outcomes and long-term self-management practices. 30, 31 …”

Section: Discussionmentioning

confidence: 99%

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Madden

Tomsik

Terchek

et al. 2011

Journal of the National Medical Association

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Objective To determine how medically uninsured patients with limited material resources successfully manage diabetes. Methods Clinicians at 5 safety net practices enrolled uninsured adult patients (N=26) with prior diagnosis of diabetes for 6 months or longer. Patients were interviewed about enabling factors, motivations, resources, and barriers. Chart reviews and clinician surveys supplemented interview data. Interview, survey, and chart review data were analyzed and findings were summarized. Results Two distinct groups of patients were investigated: 1) “successful,” defined as those with an HbA1c of ≤7% or a recent improvement of at least 2% (n=17); and 2) “unsuccessful,” defined as patients with HbA1c of ≥9% (n=9) without recent improvement. In comparison to unsuccessful patients, successful patients more often reported having friends or family with diabetes, sought information about the disease, used evidence-based self-management strategies, held an accurate perception of their own disease control, and experienced “turning point” events that motivated increased efforts in disease management. Conclusions Uninsured safety net patients who successfully managed diabetes learned from friends and family with diabetes and leveraged disease-related events into motivational turning points. It may be beneficial for clinicians to incorporate social learning and motivational enhancement into diabetes interventions to increase patients’ motivation for improved levels of self-management.

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Section: Discussionmentioning

confidence: 99%

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Madden

Tomsik

Terchek

et al. 2011

Journal of the National Medical Association

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“…The systemic approach [8,9] to group care, including procedures, programme and evaluation of efficacy [11] has been described [6,7]. Educational sessions were held every 3 months, with one to two physicians and an educationist (MTr) acting as facilitators.…”

Section: Methodsmentioning

confidence: 99%

“…Correct answers scored 1 and wrong answers scored 0. Health behaviours were measured with a purpose-built 16-item questionnaire ("Condotte di Riferimento" = CdR) [6,7] proposing real-life situations in the "What would you do if ..." format to test whether patients could identify underlying problems and react appropriately. Correct answers scored 1 and wrong ones scored 0.…”

Section: Methodsmentioning

confidence: 99%

“…QoL was measured using the DQOL questionnaire [14] translated into Italian [15] and modified by omitting six questions addressed to young insulin-dependent subjects. The modified version (DQOL/Mod) included 39 items and was re-validated [7]. Answers were along a 5-point Likert scale, from 1 (very satisfied) to 5 (very dissatisfied).…”

Section: Methodsmentioning

confidence: 99%

“…However, scarcity of time and resources prevent ordinary clinics from adopting the optimal standards of individual care delivered during dedicated trials. We have developed a clinical approach [6,7] in which diabetes care is routinely delivered as group sessions built upon a systemic education programme [8,9] whereas individual care is reserved to emerging problems, yearly checks for complications or patients' explicit requests. The working hypothesis was that longer interaction of patients among themselves and with health care providers within a group setting would modify lifestyle favourably.…”

mentioning

confidence: 99%

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Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial

et al. 2002

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Aims/hypothesis. Metabolic control worsens progressively in Type II (non-insulin-dependent) diabetes mellitus despite intensified pharmacological treatment and lifestyle intervention, when these are implemented on a one-to-one basis. We compared traditional individual diabetes care with a model in which routine follow-up is managed by interactive group visits while individual consultations are reserved for emerging medical problems and yearly checks for complications. Methods. A randomized controlled clinical trial of 56 patients with non-insulin-treated Type II diabetes managed by systemic group education and 56 control patients managed by individual consultations and education. Results. Observation times were 51.2±2.1 months for group care and 51.2±1.8 for control subjects. Glycated haemoglobin increased in the control group but not in the group of patients (p<0.001), in whom BMI decreased (p<0.001) and HDL-cholesterol increased (p<0.001). Quality of life, knowledge of diabetes and health behaviours improved with group care (p<0.001, all) and worsened among the control patients (p=0.004 to p<0.001). Dosage of hypoglycaemic agents decreased (p<0.001) and retinopathy progressed less (p<0.009) among the group care patients than the control subjects. Diastolic blood pressure (p<0.001) and relative cardiovascular risk (p<0.05) decreased from baseline in group patients and control patients alike. Over the study period, group care required 196 min and 756.54 US $ per patient, compared with 150 min and 665.77 US $ for the control patients, resulting in an additional 2.12 US $ spent per point gained in the quality of life score. Conclusion/interpretation. Group care by systemic education is feasible in an ordinary diabetes clinic and cost-effective in preventing the deterioration of metabolic control and quality of life in Type II diabetes without increasing pharmacological treatment. [Diabetologia (2002)

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Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics

Naik¹,

Palmer²,

Petersen³

et al. 2011

Arch Intern Med

164

228

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Background Diabetes group clinics can effectively control hypertension, but data to support glycemic control is equivocal. This study evaluated the comparative effectiveness of two diabetes group clinic interventions on glycosolated hemoglobin (HbA1c) levels in primary care. Methods Participants (n = 87) were recruited from a diabetes registry of a single regional VA medical center to participate in an open, randomized comparative effectiveness study. Two primary care based diabetes group interventions of three months duration were compared. Empowering Patients in Care (EPIC) was a clinician-led, patient-centered group clinic consisting of four sessions on setting self-management action plans (diet, exercise, home monitoring, medications, etc.) and communicating about progress with action plans. The comparison intervention consisted of group education sessions with a diabetes educator and dietician followed by an additional visit with one’s primary care provider. HbA1c levels were compared post-intervention and at one-year follow-up. Results Participants in the EPIC intervention had significantly greater improvements in HbA1c levels immediately following the active intervention (8.86 to 8.04 vs. 8.74 to 8.70, mean [SD] between-group difference 0.67±1.3, P=.03) and these differences persisted at 1 year follow-up (.59±1.4, P=.05). A repeated measures analysis using all study time points found a significant time-by-treatment interaction effect on HbA1c levels favoring the EPIC intervention (F(2,85) =3.55, P= .03). The effect of the time-by-treatment interaction appears to be partially mediated by diabetes self-efficacy (F(1,85) =10.39, P= .002). Conclusions Primary care based diabetes group clinics that include structured goal-setting approaches to self-management can significantly improve HbA1c levels post-intervention and maintain improvements for 1-year. Trial registration ClinicalTrials.gov Identifier: NCT00481286

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Group Visits Improve Metabolic Control in Type 2 Diabetes

Cited by 262 publications

References 21 publications

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial

Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics

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