Rethink Organization to iMprove Education and Outcomes (ROMEO)

Trento, Marina; Gamba, S; Gentile, Luigi; Grassi, Giorgio; Miselli, V.; Morone, G.; Passera, P; Tonutti, Laura; Tomalino, M.; Bondonio, Piervincenzo; Cavallo, Franco; Porta, Massimo

doi:10.2337/dc09-2024

Cited by 141 publications

(139 citation statements)

References 15 publications

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“…Cost-effectiveness analysis of the DPP concluded that interventions are recommended considering long-term outcomes in the prevention of DM. In agreement to our findings, in a 4-year prospective study conducted in individuals with type 2 DM, the subset submitted to group sessions had more favorable effects in glycemic control and QoL than that followed exclusively by medical visits [35]. Binge eating may reach high prevalence rates particularly in individuals with DM or in weight loss samples [11,36], in which this behavior represents a difficulty for weight control [37].…”

Section: Discussionsupporting

confidence: 82%

Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus

et al. 2011

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Objective To evaluate whether an interdisciplinary intervention program on lifestyle results in better quality of life (QoL) and lower frequencies of depression and binge eating disorder (BED) in individuals at risk for type 2 diabetes mellitus. Methods A total of 177 individuals (32.2% men, age 55.4 ± 12.5 years) at risk for diabetes were allocated to a 9-month traditional (TI) or intensive interdisciplinary intervention (II) on dietary habits and physical activity including psychoeducative groups. They were submitted to questionnaires and clinical and laboratory examinations. Predictors of non-adherence were analyzed by logistic regression. Results Only individuals submitted to II had blood pressure and plasma glucose levels reduced. Frequencies of depression reduced in both interventions but of BED only in II (28.0-4.0%, P \ 0.001). Increments in the scores of SF-36 domains (physical functioning: 11.1 ± 14.0 vs. 5.3 ± 13.0, role-emotional: 20.4 ± 40.2 vs. 6.2 ± 43.8, P = 0.05) were greater in the II than in TI, respectively. Changes in SF-36 correlated with decreases in anthropometry, blood pressure and glucose levels, depression and BED scores. Male gender was independently associated with non-adherence to the II. Conclusions In addition to metabolic benefits, an interdisciplinary approach may induce desirable extrametabolic effects, favoring the control of psychiatric disorders and improving the QoL of individuals at risk for diabetes.

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Section: Discussionsupporting

confidence: 82%

Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus

et al. 2011

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“…1 and Table 2). [30][31][32][33][34][35] We summarize the key study characteristics for these studies [30][31][32][33][34][35] in Appendix Table 5. No study evaluated mortality as a primary outcome.…”

Section: Long-term Clinical Outcomesmentioning

confidence: 99%

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

et al. 2014

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BACKGROUND: Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control. METHODS: Electronic databases were searched from inception through November 2011. Of 16,290 citations, two independent reviewers identified 138 randomized trials comparing PAIs to usual care/control groups in adults with DM2 that reported intermediate or longterm outcomes or harms. For meta-analyses of continuous outcomes, we used a random-effects model to derive pooled weighted mean differences (WMD). For allcause mortality, we calculated the pooled odds ratio (OR) using Peto's method. We assessed statistical heterogeneity using the I 2 statistic and conducted meta-regression using a random-effects model when I 2 >50 %. A priori meta-regression primary variables included: intervention strategies, intervention leader, baseline outcome value, quality, and study duration. RESULTS: PAIs modestly reduced intermediate outcomes [A1c: WMD 0.37 %, CI 0.28-0.45 %, I 2 83 %; SBP: WMD 2.2 mmHg, CI 1.0-3.5 mmHg, I 2 72 %; body weight: WMD 2.3 lbs, CI 1.3-3.2 lbs, I 2 64 %; and LDLc: WMD 4.2 mg/dL, CI 1.5-6.9 mg/dL, I 2 64 %]. The evidence was moderate for A1c, low/very low for other intermediate outcomes, low for long-term mortality and very low for complications. Interventions had no effect on hypoglycemia (evidence: low) or short-term mortality (evidence: moderate). Higher baseline A1c, pharmacistled interventions, and longer follow-up were associated with larger A1c improvements. No intervention strategy outperformed any other in adjusted meta-regression. CONCLUSIONS: PAIs modestly improve A1c in adults with DM2 without increasing short-term mortality. These results support integration of these interventions into primary care for adults with uncontrolled glycemia, and provide evidence to insurers who do not yet cover these programs. INTRODUCTIONType 2 diabetes is common and contributes to excess morbidity, mortality, and health care costs, accounting for approximately one in five U.S. health care dollars. 1,2 Behavioral interventions are one important way to improve patient outcomes, 3 yet less is known about a subset of novel behavioral interventions focused on engaging patients in care 4-6 (often termed "patient activation" 7,8 ). Hibbard et al. 7,9 have described patient activation interventions as those that promote motivation, knowledge, and disease self-management skills. 7,9 Despite the growing evidence suggesting improved patient outcomes by engaging patients, 4-6,10 these interventions are often not integrated into practice due to uncertainty about benefit, lack of resources needed for integration, lack of health insurance coverage across insurers, and lack of clarity on the best strategies to incorporate. 11,12 Understanding the imp...

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“…These include goal-setting, action-planning, self-monitoring, progress feedback, problem-solving, and reviewing goals. Group-based interventions have been shown to be effective for diabetes prevention, self-management and support, providing an environment that facilitates peer discussions about problems and personal experiences, resulting in significant benefits, including weight loss, improved fasting glucose levels, improved energy, and improved emotional state (Katula et al, 2011;Trento et al, 2010;Holma et al, 2008).…”

Section: Study Setting: Living Well Taking Control Programme Structumentioning

confidence: 99%

Implementation fidelity of a voluntary sector-led diabetes education programme

Kok

Jones

Solomon-Moore³

et al. 2018

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Purpose: The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. This paper reports on the fidelity assessment of Living Well, Taking Control (LWTC) -a voluntary sector-led, community-based education programme in England focusing on the prevention and management of type 2 diabetes.Design/methodology/approach: This fidelity of implementation study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of groupbased lifestyle education sessions -implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence.Findings: Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3% for adherence (moderate inter-rater agreement, κ=0.60) and 95.1% for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings.Originality/value: An appropriate level of implementation fidelity was delivered for the LWTC groupbased education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the fidelity of implementation in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.

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Rethink Organization to iMprove Education and Outcomes (ROMEO)

Cited by 141 publications

References 15 publications

Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus

Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

Implementation fidelity of a voluntary sector-led diabetes education programme

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