Beyond Good Intentions: The effectiveness of a proactive self-management intervention in patients with screen-detected type 2 diabetes

Abstract

This prospective randomized controlled trial evaluated a theory-driven group-based self-management course for patients with screen-detected type 2 diabetes. 227 patients receiving either intensive pharmacological or usual-care treatment since diagnosis (3-33 months previously) agreed to participate and were subsequently randomized to a control or intervention condition (3-month, nurse-lead, self-management course). Based on self-regulation theory and proactive coping, the course incorporated elements of anticipation, goal-setting and planning in a proactive 5-step plan to help patients translate their good intentions into sustained self-management behaviors. A 2x2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usual-care) and included a baseline psychological assessment, a preliminary assessment of psychological outcomes at 3-months, and changes in self-management behaviors and cardiovascular outcomes (BMI, blood pressure, Hba1c and lipid profiles) from 0-12 months. At baseline, most patients experienced little emotional distress but also generally underestimated their condition and reported low self-management behavior. At 3-months, course completers evaluated the course and the 5-step plan very positively and showed significant improvements in their proactive coping, self-efficacy and goal-attainment. 12-month evaluations revealed that the intervention group experienced significant and sustained improvements in their self-management behaviors, BMI (-0.77 kg/m2) and systolic blood pressure (-6.2 mmHg). In all aspects, the self-management course was effective independent of medical treatment; however, those patients receiving both intensive pharmacological treatment and the course showed greatest reduction in their cardiovascular risk, suggesting that a combination of medical and behavioral treatments may be particularly effective in newly diagnosed type 2 diabetes.