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Akhter K, Bunn C, Graffy J, Donald S, Ward C, Simmons D. Empowerment-based education for established type 2 diabetes in rural England. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kalsoom Akhter
- Wolfson Diabetes & Endocrine Clinic, Institute of Metabolic Science; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
- City University London; Department of Psychology; City University London UK
| | - Christopher Bunn
- Wolfson Diabetes & Endocrine Clinic, Institute of Metabolic Science; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
- Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Jonathan Graffy
- Primary Care Unit, Department of Public Health and Primary Care; University of Cambridge; Cambridge UK
| | - Sarah Donald
- Wolfson Diabetes & Endocrine Clinic, Institute of Metabolic Science; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - Candice Ward
- Wolfson Diabetes & Endocrine Clinic, Institute of Metabolic Science; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
| | - David Simmons
- Wolfson Diabetes & Endocrine Clinic, Institute of Metabolic Science; Cambridge University Hospitals NHS Foundation Trust; Cambridge UK
- School of Medicine; Western Sydney University; Campbelltown New South Wales Australia
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152
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He X, Li J, Wang B, Yao Q, Li L, Song R, Shi X, Zhang JA. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55:712-731. [PMID: 27837440 DOI: 10.1007/s12020-016-1168-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed. METHODS Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911. RESULTS 42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I 2 = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I 2 = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I 2 = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44-0.82, P = 0.001; I 2 = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I 2 = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I 2 = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I 2 = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer). CONCLUSIONS The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.
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Affiliation(s)
- Xiaoqin He
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jie Li
- Department of Nephrology, Xi'an Central Hospital, Xi'an, 710003, China
| | - Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Ling Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Ronghua Song
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Xiaohong Shi
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Jin-An Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China.
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153
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Fløde M, Iversen MM, Aarflot M, Haltbakk J. Lasting impact of an implemented self-management programme for people with type 2 diabetes referred from primary care: a one-group, before-after design. Scand J Caring Sci 2017; 31:789-795. [DOI: 10.1111/scs.12398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mari Fløde
- Department of Nursing; Faculty of Health and Social Sciences; Bergen University College; Bergen Norway
| | - Marjolein M. Iversen
- Department of Nursing; Faculty of Health and Social Sciences; Bergen University College; Bergen Norway
- Department of Medicine; Section of Endocrinology; Stavanger University; Stavanger Norway
| | - Morten Aarflot
- Department of Nursing; Faculty of Health and Social Sciences; Bergen University College; Bergen Norway
| | - Johannes Haltbakk
- Department of Nursing; Faculty of Health and Social Sciences; Bergen University College; Bergen Norway
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154
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Moradi-Lakeh M, Forouzanfar MH, El Bcheraoui C, Daoud F, Afshin A, Hanson SW, Vos T, Naghavi M, Murray CJL, Mokdad AH. High Fasting Plasma Glucose, Diabetes, and Its Risk Factors in the Eastern Mediterranean Region, 1990-2013: Findings From the Global Burden of Disease Study 2013. Diabetes Care 2017; 40:22-29. [PMID: 27797926 DOI: 10.2337/dc16-1075] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/27/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The prevalence of diabetes in the Eastern Mediterranean Region (EMR) is among the highest in the world. We used findings from the Global Burden of Disease 2013 study to calculate the burden of diabetes in the EMR. RESEARCH DESIGN AND METHODS The burden of diabetes and burden attributable to high fasting plasma glucose (HFPG) were calculated for each of the 22 countries in the EMR between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, deaths, and disability-adjusted life years (DALYs). RESULTS The diabetes death rate increased by 60.7%, from 12.1 per 100,000 population (95% uncertainty interval [UI]: 11.2-13.2) in 1990 to 19.5 per 100,000 population (95% UI: 17.4-21.5) in 2013. The diabetes DALY rate increased from 589.9 per 100,000 (95% UI: 498.0-698.0) in 1990 to 883.5 per 100,000 population (95% UI: 732.2-1,051.5) in 2013. In 2013, HFPG accounted for 4.9% (95% UI: 4.4-5.3) of DALYs from all causes. Total DALYs from diabetes increased by 148.6% during 1990-2013; population growth accounted for a 62.9% increase, and aging and increase in age-specific DALY rates accounted for 31.8% and 53.9%, respectively. CONCLUSIONS Our findings show that diabetes causes a major burden in the EMR, which is increasing. Aging and population growth do not fully explain this increase in the diabetes burden. Programs and policies are urgently needed to reduce risk factors for diabetes, increase awareness of the disease, and improve diagnosis and control of diabetes to reduce its burden.
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Affiliation(s)
- Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.,Department of Community Medicine, Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Sarah Wulf Hanson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
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155
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Knowles SR, Lee K, Paterson JM, Shah BR, Mamdani MM, Juurlink DN, Gomes T. Self-Monitoring of Blood Glucose: Impact of Quantity Limits in Public Drug Formularies on Provincial Costs Across Canada. Can J Diabetes 2016; 41:138-142. [PMID: 27989494 DOI: 10.1016/j.jcjd.2016.08.225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/22/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES For most patients with diabetes, routine use of blood glucose test strips (BGTS) has not been shown to be beneficial, yet the economic implications of broad publicly funded reimbursement for BGTS are substantial. We assessed the potential impact of BGTS quantity limits on utilization and costs for 6 publicly funded drug plans across Canada. METHODS A cross-sectional analysis was conducted in 6 provinces (Alberta, Saskatchewan, Manitoba, Nova Scotia, Newfoundland and Labrador and Prince Edward Island) for patients who received at least 1 prescription for BGTS in 2014 through the public drug program. We determined the number of BGTS that would have exceeded the quantity limits and the associated costs to the provincial drug program. RESULTS A total of $38,051,026 was spent on BGTS reimbursed through public drug programs among the 6 provinces. In provinces where BGTS use is largely restricted to patients using insulin, the potential annual savings were minimal, ranging from 0.4% to 2.3%, whereas in provinces with more liberal listings, potential savings ranged from 12.4% to 19.8%. Combining these results with data from a previous analysis in Ontario and British Columbia, the cost savings associated with BGTS quantity limits for 8 provinces across Canada (capturing approximately three-quarters of the Canadian population) is estimated to be $30.3 million annually. CONCLUSIONS The national implementation of a quantity limit policy for BGTS that aligns with evidence of efficacy, optimal prescribing and patient safety can lead to considerable savings for most public drug plans across Canada.
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Affiliation(s)
- Sandra R Knowles
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada; Department of Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kathy Lee
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - J Michael Paterson
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Baiju R Shah
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; The Sunnybrook Research Institute and the Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Health Policy, Management, and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada; Department of Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Health Policy, Management, and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David N Juurlink
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; The Sunnybrook Research Institute and the Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine Health Policy, Management, and Evaluation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada; Department of Medicine and the Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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156
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Funnell MM. Patient empowerment: What does it really mean? PATIENT EDUCATION AND COUNSELING 2016; 99:1921-1922. [PMID: 27871730 DOI: 10.1016/j.pec.2016.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Martha M Funnell
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.
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157
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Kahlert D, Unyi-Reicherz A, Stratton G, Meinert Larsen T, Fogelholm M, Raben A, Schlicht W. PREVIEW Behavior Modification Intervention Toolbox (PREMIT): A Study Protocol for a Psychological Element of a Multicenter Project. Front Psychol 2016; 7:1136. [PMID: 27559319 PMCID: PMC4978707 DOI: 10.3389/fpsyg.2016.01136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/15/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Losing excess body weight and preventing weight regain by changing lifestyle is a challenging but promising task to prevent the incidence of type-2 diabetes. To be successful, it is necessary to use evidence-based and theory-driven interventions, which also contribute to the science of behavior modification by providing a deeper understanding of successful intervention components. OBJECTIVE To develop a physical activity and dietary behavior modification intervention toolbox (PREMIT) that fulfills current requirements of being theory-driven and evidence-based, comprehensively described and feasible to evaluate. PREMIT is part of an intervention trial, which aims to prevent the onset of type-2 diabetes in pre-diabetics in eight clinical centers across the world by guiding them in changing their physical activity and dietary behavior through a group counseling approach. METHODS The program development took five progressive steps, in line with the Public Health Action Cycle: (1) Summing-up the intervention goal(s), target group and the setting, (2) uncovering the generative psychological mechanisms, (3) identifying behavior change techniques and tools, (4) preparing for evaluation and (5) implementing the intervention and assuring quality. RESULTS PREMIT is based on a trans-theoretical approach referring to valid behavior modification theories, models and approaches. A major "product" of PREMIT is a matrix, constructed for use by onsite-instructors. The matrix includes objectives, tasks and activities ordered by periods. PREMIT is constructed to help instructors guide participants' behavior change. To ensure high fidelity and adherence of program-implementation across the eight intervention centers standardized operational procedures were defined and "train-the-trainer" workshops were held. In summary PREMIT is a theory-driven, evidence-based program carefully developed to change physical activity and dietary behaviors in pre-diabetic people.
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Affiliation(s)
- Daniela Kahlert
- Division Exercise and Sports, University of Education Schwäbisch GmündSchwäbisch Gmünd, Germany
| | - Annelie Unyi-Reicherz
- Chair Exercise and Health Science, Stuttgart Research Initiative Human Factors in Ageing, Technology, and Environment, University of StuttgartStuttgart, Germany
| | - Gareth Stratton
- Applied Sport, Technology, Exercise and Medicine Research Centre, Swansea UniversitySwansea, UK
| | - Thomas Meinert Larsen
- Department of Nutrition, Exercise, and Sports, University of CopenhagenCopenhagen, Denmark
| | - Mikael Fogelholm
- Department of Food and Environmental Science, University of HelsinkiHelsinki, Finland
| | - Anne Raben
- Department of Nutrition, Exercise, and Sports, University of CopenhagenCopenhagen, Denmark
| | - Wolfgang Schlicht
- Chair Exercise and Health Science, Stuttgart Research Initiative Human Factors in Ageing, Technology, and Environment, University of StuttgartStuttgart, Germany
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158
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Lorig K, Ritter PL, Turner RM, English K, Laurent DD, Greenberg J. Benefits of Diabetes Self-Management for Health Plan Members: A 6-Month Translation Study. J Med Internet Res 2016; 18:e164. [PMID: 27342265 PMCID: PMC4950850 DOI: 10.2196/jmir.5568] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/03/2016] [Accepted: 05/20/2016] [Indexed: 11/18/2022] Open
Abstract
Background Diabetes self-management education has been shown to be effective in controlled trials. However, few programs that meet American Association of Diabetes Educators standards have been translated into widespread practice. Objective This study examined the translation of the evidence-based Better Choices, Better Health-Diabetes program in both Internet and face-to-face versions. Methods We administered the Internet program nationally in the United States (n=1010). We conducted face-to-face workshops in Atlanta, Georgia; Indianapolis, Indiana; and St. Louis, Missouri (n=232). Self-report questionnaires collected health indicator, health behavior, and health care utilization measures. Questionnaires were administered on the Web or by mail. We determined hemoglobin A1c (HbA1c) from blood samples collected via mailed kits. Paired t tests determined whether changes between baseline and 6 months differed significantly from no change. Subgroup analyses determined whether participants with specific conditions benefited (high HbA1c, depression, hypoglycemia, nonadherence to medication taking, and no aerobic exercise). We calculated the percentage of participants with improvements of at least 0.4 effect size in at least one of the 5 above measures. Results Of the 1242 participants, 884 provided 6-month follow-up questionnaires. There were statistically significant improvements in 6 of 7 health indicators (including HbA1c) and in 7 of 7 behaviors. For each of the 5 conditions, there were significant improvements among those with the condition (effect sizes 0.59–1.1). A total of 662 (75.0%) of study participants improved at least 0.4 effect size in at least one criterion, and 327 (37.1%) improved in 2 or more. Conclusions The Diabetes Self-Management Program, offered in two modes, was successfully disseminated to a heterogeneous national population of members of either insured or administered health plans. Participants had small but significant benefits in multiple measures. The program appears effective in improving diabetes management.
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Affiliation(s)
- Kate Lorig
- Stanford School of Medicine, Stanford University, Palo Alto, CA, United States
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159
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Kim SH. Educational attainment moderates the associations of diabetes education with health outcomes. Int J Nurs Pract 2016; 22:444-450. [PMID: 27325382 DOI: 10.1111/ijn.12454] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 11/30/2022]
Abstract
Diabetes education is a critical element of care for people with diabetes. However, the associations between diabetes education and self-care or health outcomes have not been clearly demonstrated at a national level. The aims of this study were to examine the associations of attendance of diabetes education classes with health behaviours and glycaemic control, and to understand whether these associations were moderated by level of educational attainment. Data were analysed for 456 adults from the 2012 Korea National Health and Nutrition Examination Survey V, collected from January 2010 to December 2012. No significant differences were observed between patients who had attended diabetes education classes and those who had never attended for factors such as smoking, drinking, exercise, nutrition therapy or glycaemic control. There was a significant interaction effect between receiving diabetes education and level of educational attainment on obtaining optimal glycaemic control. Attending diabetes education was positively associated with optimal glycaemic control among patients with more than a high school education but was negatively associated with it among those with less than middle school education. Diabetes education programmes need to be tailored to the needs and cognitive capacities of the target population.
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Affiliation(s)
- Su Hyun Kim
- Associate Professor, College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea.
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160
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Balducci S, Sacchetti M, Haxhi J, Orlando G, Zanuso S, Cardelli P, Cavallo S, D'Errico V, Ribaudo MC, Di Biase N, Salvi L, Vitale M, Bollanti L, Conti FG, Nicolucci A, Pugliese G. The Italian Diabetes and Exercise Study 2 (IDES-2): a long-term behavioral intervention for adoption and maintenance of a physically active lifestyle. Trials 2015; 16:569. [PMID: 26651484 PMCID: PMC4676117 DOI: 10.1186/s13063-015-1088-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity (PA)/exercise have become an integral part of the management of type 2 diabetes mellitus (T2DM). However, current guidelines are difficult to put into action in this population due to a number of barriers, especially the lack of acceptable, feasible, and validated behavioral intervention strategies. The present manuscript reports the rationale, study design and methods, and design considerations of the Italian Diabetes and Exercise Study (IDES)-2, a randomized controlled trial testing the efficacy of a behavior change strategy in increasing total daily PA and reducing sedentary time (SED-time) in patients with T2DM. METHODS/DESIGN Starting 7 January 2014, the IDES_2 began enrolling 300 patients with known T2DM of at least 1-year duration in three tertiary referral outpatient Diabetes Clinics in Rome. Additional requirements are age 40 to 80 years, body mass index 27 to 40 kg/m(2), sedentary lifestyle, and physically inactive for at least 6 months, ability to walk 1.6 km without assistance, and eligibility after cardiovascular evaluation. Patients are randomized by center and within each center, by age and type of diabetes treatment to either the intervention or the control group. Patients in the intervention (INT) group (n = 150) receive theoretical and practical exercise counseling consisting of aggregated behavior change techniques (one individual theoretical counseling session plus eight twice-a-week individual theoretical and practical exercise counseling sessions) once a year for 3 years. Patients in the control (CON) group (n = 150), receive standard care, including general physician recommendations for daily PA. The primary outcomes are total daily PA and SED-time, as measured objectively by the use of an accelerometer. Secondary outcomes include physical fitness, modifiable cardiovascular risk factors, musculoskeletal disturbances, well-being/depression, and health-related quality of life. DISCUSSION The behavioral intervention strategy tested in the IDES_2 is based on solid theoretical grounds and uses several behavioral change techniques, two factors which were found to improve effectiveness of behavioral intervention. In addition, physicians and exercise specialists have been specifically trained for counselling/prescribing and supervising PA/exercise, respectively, in subjects suffering from metabolic disorders. Finally, the large sample size, the long study duration, and the objective measurement of PA allow statistically significant and scientifically robust conclusions to be drawn on the feasibility and efficacy of this intervention in T2DM patients. TRIAL REGISTRATION ClinicalTrials.gov; NCT01600937 ; 10 October 2012.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | - Jonida Haxhi
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, "Foro Italico" University, Rome, Italy.
| | | | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
| | - Stefano Cavallo
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Laboratory of Clinical Chemistry, Sant'Andrea Hospital, Rome, Italy.
| | - Valeria D'Errico
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
- Metabolic Fitness Association, Monterotondo, Rome, Italy.
| | | | | | - Laura Salvi
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
| | | | | | - Francesco G Conti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology (CORE), Pescara, Italy.
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Via di Grottarossa, 1035-1039 - 00189, Rome, Italy.
- Diabetes Unit, Sant'Andrea Hospital, Rome, Italy.
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