Patient education - evaluation of a complex intervention

Mühlhauser, Ingrid; Berger, Michael

doi:10.1007/s00125-002-0987-2

Cited by 84 publications

(10 citation statements)

References 48 publications

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“…Nonpharmacological interventions in general and diabetes self-management programs in particular are often complex, consisting of various interconnected components (motivation and competence of the health care team and organizational and financial conditions) on which the outcome is dependent (23). To compensate for these components, we included a control arm in our study design, which is a strength of our study compared with, for example, the DAFNE Study (3).…”

Section: Discussionmentioning

confidence: 99%

Use of an Automated Bolus Calculator in MDI-Treated Type 1 Diabetes

et al. 2012

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OBJECTIVETo investigate the effect of flexible intensive insulin therapy (FIIT) and an automated bolus calculator (ABC) in a Danish type 1 diabetes population treated with multiple daily injections. Furthermore, to test the feasibility of teaching FIIT in a 3-h structured course.RESEARCH DESIGN AND METHODSThe BolusCal Study was a 16-week randomized, controlled, open-label, three-arm parallel, clinical study of 51 adults with type 1 diabetes. Patients aged 18–65 years in poor metabolic control (HbA1c 8.0–10.5%) were randomized to the Control (n = 8), CarbCount (n = 21), or CarbCountABC (n = 22) arm. During a 3-h group teaching, the Control arm received FIIT education excluding carbohydrate counting. CarbCount patients were taught FIIT and how to count carbohydrates. CarbCountABC group teaching included FIIT and carbohydrate counting and patients were provided with an ABC.RESULTSAt 16 weeks, the within-group change in HbA1c was −0.1% (95% CI −1.0 to 0.7%; P = 0.730) in the Control arm, −0.8% (−1.3 to −0.3%; P = 0.002) in the CarbCount arm, and −0.7% (−1.0 to −0.4%; P < 0.0001) in the CarbCountABC arm. The difference in change in HbA1c between CarbCount and CarbCountABC was insignificant. Adjusting for baseline HbA1c in a regression model, the relative change in HbA1c was −0.6% (−1.2 to 0.1%; P = 0.082) in CarbCount and −0.8% (−1.4 to −0.1%; P = 0.017) in CarbCountABC. Treatment satisfaction measured by the Diabetes Treatment Satisfaction Questionnaire (status version) improved in all study arms, but the improvement was significantly greater in CarbCountABC.CONCLUSIONSFIIT and carbohydrate counting were successfully taught in 3 h and improved metabolic control and treatment satisfaction. Concurrent use of an ABC improved treatment satisfaction further.

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Section: Discussionmentioning

confidence: 99%

Use of an Automated Bolus Calculator in MDI-Treated Type 1 Diabetes

et al. 2012

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“…The Insulin Treatment and Training programs developed by Mühlhauser and Berger (100) have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia (101,102). These programs have been successfully delivered in other settings (103,104) with comparable reductions in hypoglycemic risk (105).…”

Section: What Strategies Are Known To Prevent Hypoglycemia and What mentioning

confidence: 99%

Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society

Seaquist

Anderson²,

Childs³

et al. 2013

Diabetes Care

1,242

955

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OBJECTIVETo review the evidence about the impact of hypoglycemia on patients with diabetes that has become available since the past reviews of this subject by the American Diabetes Association and The Endocrine Society and to provide guidance about how this new information should be incorporated into clinical practice.PARTICIPANTSFive members of the American Diabetes Association and five members of The Endocrine Society with expertise in different aspects of hypoglycemia were invited by the Chair, who is a member of both, to participate in a planning conference call and a 2-day meeting that was also attended by staff from both organizations. Subsequent communications took place via e-mail and phone calls. The writing group consisted of those invitees who participated in the writing of the manuscript. The workgroup meeting was supported by educational grants to the American Diabetes Association from Lilly USA, LLC and Novo Nordisk and sponsorship to the American Diabetes Association from Sanofi. The sponsors had no input into the development of or content of the report.EVIDENCEThe writing group considered data from recent clinical trials and other studies to update the prior workgroup report. Unpublished data were not used. Expert opinion was used to develop some conclusions.CONSENSUS PROCESSConsensus was achieved by group discussion during conference calls and face-to-face meetings, as well as by iterative revisions of the written document. The document was reviewed and approved by the American Diabetes Association’s Professional Practice Committee in October 2012 and approved by the Executive Committee of the Board of Directors in November 2012 and was reviewed and approved by The Endocrine Society’s Clinical Affairs Core Committee in October 2012 and by Council in November 2012.CONCLUSIONSThe workgroup reconfirmed the previous definitions of hypoglycemia in diabetes, reviewed the implications of hypoglycemia on both short- and long-term outcomes, considered the implications of hypoglycemia on treatment outcomes, presented strategies to prevent hypoglycemia, and identified knowledge gaps that should be addressed by future research. In addition, tools for patients to report hypoglycemia at each visit and for clinicians to document counseling are provided.

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“…A large literature exists on problem solving interventions that include goal setting and specific strategies for successfully navigating the daily challenges of diabetes management. Some of the formative work on these types of interventions, delivered in hospital and tertiary outpatient diabetes centers across Type 1 and Type 2 diabetes, was conducted by Muhlhauser and Berger [36]. Their work highlighted a synthesis of diabetes education and behavior change strategies.…”

Section: What Does Workmentioning

confidence: 99%

Effective strategies for encouraging behavior change in people with diabetes

Hood¹,

Hilliard²,

Piatt³

et al. 2015

Diabetes Management

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Behavioral management of diabetes leads to better health outcomes. This paper reviews the available literature on facilitators of behavior change in people with diabetes and highlights approaches and strategies diabetes care providers can utilize. The research and clinical evidence points to the critical nature of considering the content and structure of recommendations, and utilizing problem solving and teamwork approaches. Furthermore, close attention to individual and community factors will optimize behavior change. These Practice points• Consider the five characteristics of effective messaging for behavior change recommendations. They are clarity, personal meaningfulness, frequency of feedback, active guidance and support, and patient interpretation. Messages conveyed to people with diabetes (PWD) that consider these key characteristics will increase the chances of effective implementation of behavior change.• Also work to promote trust with PWD by facilitating discussions about the personal side of living with diabetes and barriers to change that may not be offered without direct questioning.• Consider teaching problem solving in all clinical encounters. Problem solving is a learned skill with documented benefits on behavioral management of diabetes and health outcomes. Teach a simple method of identifying problems, goal setting, brainstorming solutions and implementing and evaluating a solution.• Go beyond education and consider multiple components to behavior change recommendations. These include bringing in other caregivers and individuals from the community, and ensuring health literacy and numeracy have been considered and addressed.• Rarely provide a 'one-size-fits-all' recommendation, but instead offer a recommendation that considers the age, gender, ethnicity, community infrastructure and perceptions about diabetes in PWD.• Screen for psychological factors that may complicate PWD's ability to implement and sustain behavior change recommendations. These include consideration of disordered eating or eating disorder, depressive symptoms and diabetes distress, and worries and fears related to diabetes (immediate and long term).For reprint orders, please contact: reprints@futuremedicine.com

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Patient education - evaluation of a complex intervention

Cited by 84 publications

References 48 publications

Use of an Automated Bolus Calculator in MDI-Treated Type 1 Diabetes

Use of an Automated Bolus Calculator in MDI-Treated Type 1 Diabetes

Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society

Effective strategies for encouraging behavior change in people with diabetes

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