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Torres HDC, Pace AE, Chaves FF, Velasquez-Melendez G, Reis IA. Evaluation of the effects of a diabetes educational program: a randomized clinical trial. Rev Saude Publica 2018; 52:8. [PMID: 29412378 PMCID: PMC5802646 DOI: 10.11606/s1518-8787.2018052007132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/09/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Evaluate the effectiveness of a diabetes mellitus educational program in primary health care. METHODS This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T0), three (T3), six (T6) and nine (T9) months after the beginning of the intervention. RESULTS After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T3, T6 and T9 times were significantly lower among the people in the intervention group (p < 0.05). CONCLUSIONS The educational program model developed was effective to improve the glycemic control of the intervention group participants.
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Affiliation(s)
- Heloísa de Carvalho Torres
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Aplicada. Belo Horizonte, MG, Brasil
| | - Ana Emília Pace
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Departamento de Enfermagem Geral e Especializada. Ribeirão Preto, SP, Brasil
| | - Fernanda Figueredo Chaves
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Programa de Pós-Graduação em Enfermagem. Belo Horizonte, MG, Brasil
| | - Gustavo Velasquez-Melendez
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Materno-Infantil e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
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Genz J, Haastert B, Müller H, Verheyen F, Cole D, Rathmann W, Nowotny B, Roden M, Giani G, Ohmann C, Icks A. Socioeconomic factors and effect of evidence-based patient information about primary prevention of type 2 diabetes mellitus--are there interactions? BMC Res Notes 2014; 7:541. [PMID: 25134530 PMCID: PMC4148532 DOI: 10.1186/1756-0500-7-541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Having shown in a recent randomized controlled trial that evidence-based patient information (EBPI) significantly increased knowledge on primary prevention of diabetes compared to standard patient information, we now investigated interaction between socioeconomic status (SES) and the effect of an EBPI. FINDINGS 1,120 visitors (aged 40-70 years, without known diabetes) to the "Techniker Krankenkasse" and the "German Diabetes Center" websites were randomized. The intervention group received a newly developed on-line EBPI, the control group standard on-line information. The primary outcome measure was knowledge, classified as "good/average/poor". We analyzed associations of knowledge with socioeconomic variables (education, vocational training, employment, subjective social status) combined with intervention effect including interactions, adjusted for possible confounding by knowledge before intervention, self-reported blood glucose measurements, blood pressure, blood lipid levels, age and gender. Logistic regression models were fitted to the subpopulation (n = 647) with complete values in these variables.Education (high vs. low) was significantly associated with knowledge (good vs. average/poor); however, there was no significant interaction between education and intervention. After adjustment, the other socioeconomic variables were not significantly associated with knowledge. CONCLUSIONS Socioeconomic variables did not significantly change the effect of the intervention. There was a tendency towards a lower effect where lower educated individuals were concerned. Possibly the power was too low to detect interaction effects. Larger studies using SES-specific designs are needed to clarify the effect of SES. We suggest considering the socioeconomic status when evaluating a decision aid, e.g. an EBPI, to ensure its effectiveness not only in higher socioeconomic groups. TRIAL REGISTRATION Current Controlled Trials ISRCTN22060616 (Date assigned: 12 September 2008).
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Affiliation(s)
- Jutta Genz
- />Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute at the Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | | | - Hardy Müller
- />WINEG - TK - Scientific Institute for Benefit and Efficiency in Health Care, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Frank Verheyen
- />WINEG - TK - Scientific Institute for Benefit and Efficiency in Health Care, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Dennis Cole
- />WINEG - TK - Scientific Institute for Benefit and Efficiency in Health Care, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Wolfgang Rathmann
- />Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute at the Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Bettina Nowotny
- />Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute at the Heinrich Heine University, Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- />Department of Endocrinology and Diabetology, University Clinics Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Michael Roden
- />German Center for Diabetes Research (DZD), Neuherberg, Germany
- />Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute at the Heinrich Heine University, Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- />Department of Endocrinology and Diabetology, University Clinics Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Guido Giani
- />Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute at the Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Christian Ohmann
- />Heinrich Heine University Düsseldorf, Coordination Centre for Clinical Trials (KKS), Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Andrea Icks
- />Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute at the Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- />German Center for Diabetes Research (DZD), Neuherberg, Germany
- />Faculty of Medicine, Department of Public Health, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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