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Patient-centered diabetes self-management education

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Abstract

Diabetes self-management education (DSME) has been shown to improve health outcomes. Yet, relatively little is known about how DSME has its effects. Literature reviewed from the past 3 years indicates that if DSME is to become more effective interventions need to be theory-based, to increase patient involvement in their care, and to encompass a broader array of evidenced-based outcomes. Outcomes reviewed go beyond knowledge and glycemic control to include prevention of diabetes, quality of life, and reduction of cardiovascular risk. The ability of practitioners and health care systems to implement, adopt, and maintain patient-centered interventions over time is discussed. By linking theory to behavior, and broadening the outcomes examined, advances can continue to be made in closing the gap between the scientific base for the treatment of diabetes, and the care and outcomes patients experience. Further research on patient-centered approaches that promote self-management is seen as critical in closing this gap.

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References and Recommended Reading

  1. Brown SA: Interventions to promote diabetes selfmanagement: state of the science. Diabetes Educ 1999, 25(6 suppl):52–61. Excellent summary of DSME interventions through 1999. Twenty years of prior research supports the effectiveness of DSME in improving psychosocial and health outcomes. However, many limitations in the research base were identified, including the poor descriptions of interventions used in studies and the lengthening of interventions used, when shorter and more practically applicable interventions are needed.

    PubMed  CAS  Google Scholar 

  2. Nicolucci A, Cavaliere D, Scorpiglione N, et al.: A comprehensive assessment of the avoidability of long-term complications of diabetes. Diabetes Care 1996, 19:927–933.

    Article  PubMed  CAS  Google Scholar 

  3. Berger M, Muhlhauser I: Diabetes care and patient-oriented outcomes. JAMA 1999, 281:1676–1678. Offers a concise summary of patient-oriented outcomes presented in evidence-based format. For example, tight control of hypertension for type 2 diabetes reduces mortality by 6.6% (NNT 10 y = 15), and reduces microvascular complications by 7.2% (NNT 10 y = 14). These effects are larger than that of intensive management of blood glucose alone.

    Article  PubMed  CAS  Google Scholar 

  4. Anderson RM, Funnell MM: Theory is the cart, vision is the horse: reflections on research in diabetes patient education. Diabetes Educ 1999, 25(6 suppl):43–51.

    PubMed  CAS  Google Scholar 

  5. Peyrot M: Behavior change in diabetes education. Diabetes Educ 1999, 25(|6 suppl):62–73.

    PubMed  CAS  Google Scholar 

  6. Glasgow RE: Outcomes of and for diabetes education research. Diabetes Educ 1999, 25(6 suppl):74–88. An excellent summary of DSME outcomes prior to 1999 that identifies the limited number of individual patient outcomes typically reported. Diabetes and its management is more than tight control of HbA1c, as reducing cardiovascular risk is at least as important as preventing microvascular complications with tighter glycemic control. The RE-AIM framework to assess the public health impact of an intervention is explained.

    Article  PubMed  CAS  Google Scholar 

  7. Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Executive summary of the clinical guidelines on the identification evaluation, and treatment of overweight and obesity in adults [no authors listed]. Arch Intern Med 1998, 158:1855.

  8. Harris MI, Flegal KM, Cowie CC: Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults: the third national health and nutrition examination survey, 1988-1994. Diabetes Care 1998, 2:518–524.

    Article  Google Scholar 

  9. McGinnis MJ, Foege WH: Actual causes of death in the United States. JAMA 1993, 270:2207–2212.

    Article  PubMed  CAS  Google Scholar 

  10. Woolf SH: The need for perspective in evidence-based medicine. JAMA 1999, 282:2358–2365.

    Article  PubMed  CAS  Google Scholar 

  11. Berger M: To bridge science and patient care in diabetes. Diabetologia 1996, 39:749–757.

    Article  PubMed  CAS  Google Scholar 

  12. Pearson TA, Peters TD: The treatment gap in coronary artery disease and heart failure: community standards and the post-discharge patient. Am J Cardiol 1997, 80:45H-52H.

    Article  PubMed  CAS  Google Scholar 

  13. Diabetes Control and Complications Trial. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus [no authors listed]. N Engl J Med 1993, 329:977.

  14. Trocha AK, Schmidtke C, Didjurgeit U, et al.: Effects of intensified antihypertensive treatment in diabetic nephropathy: mortality and morbidity results of a prospective controlled 10-year study. J Hypertens 1999, 17:1497–1503.

    Article  PubMed  CAS  Google Scholar 

  15. UK Prospective Diabetes Study Group: Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998, 352:837.

    Article  Google Scholar 

  16. UK Prospective Diabetes Study Group: UK Prospective Study 17: a nine-year update of a randomized, controlled trial on the effect of improved metabolic control on complication in non-insulin-dependent diabetes mellitus. Ann Intern Med 1996, 124:136–145.

    Google Scholar 

  17. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ 1998, 317:703–713.

    Google Scholar 

  18. Pyorala K, Pedersen TR, Kjekshus J, et al.: Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. Diabetes Care 1997, 20:614–620.

    Article  PubMed  CAS  Google Scholar 

  19. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.

  20. Fiore MC, Bailey WC, Cohen SJ, et al.: Treating tobacco use and dependence. In Clinical Practice Guideline. Rockville, MD: U.S. DHHS, Public Health Service; 2000.

    Google Scholar 

  21. Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350. Demonstrates a 58% reduction in the development of type 2 diabetes in obese, glucose-intolerant patients over 4 years. The intervention consisted of individualized counseling to increase exercise, reduce weight, and reduce fat intake. The core intervention is consistent with DSME, and perhaps could be generalized to high-risk patients through diabetes treatment centers.

    Article  PubMed  CAS  Google Scholar 

  22. Muller UA, Femerling M, Reinauer KM, et al.: Intensified treatment and education of type 1 diabetes as clinical routine. Diabetes Care 1999, 22(suppl 2):B29-B34. Illustrates the effectiveness of the adoption and implementation of a practical patient-centered intervention for type 1 patients throughout Germany. Intensified treatment significantly improved HbA1c, while reducing the incidence of severe hypoglycemia, ketoacidosis, and hospital days. The process of implementation and adoption of IT at the system level is described in detail, shedding some light on how practitioners' behavior may be changed effectively.

    PubMed  Google Scholar 

  23. Piette JD, Weinberger M, McPhee SJ: The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized controlled trial. Med Care 2000, 38:218–230.

    Article  PubMed  CAS  Google Scholar 

  24. Glasgow RE, Toobert DJ: Brief, computer-assisted diabetes dietary self-management counseling: effects on behavior, physiologic, and quality of life. Med Care 2000, 38:1062–1073.

    Article  PubMed  CAS  Google Scholar 

  25. Kinmouth AL, Woodcock A, Griffin S, et al.: Randomised controlled trial of patient centered care of diabetes in general practice: impact on current wellbeing and future disease risk. BMJ 1998, 317:1202–1208.

    Google Scholar 

  26. Pill R, Stott NC, Rollnick SR, Rees M: A randomized controlled trial of an intervention designed to improve the care given in general practice to type II patients: patient outcomes and professional ability to change behavior. Fam Pract 1998, 15:229–235. Documents the difficulty in translating DSME interventions into care of patients with diabetes. Initial enthusiasm for adopting MI was not maintained enough to test the study hypotheses over the 2 years of the study. Further understanding of how practitioners change is needed to integrate DSME into clinical care.

    Article  PubMed  CAS  Google Scholar 

  27. Clark M, Hampson SE: Implementing a psychological intervention to improve lifestyle self-management in patients with type 2 diabetes. Patient Educ Counseling 2001, 42:247–256.

    Article  CAS  Google Scholar 

  28. Muhlhauser I, Brukner J, Berger M, et al.: Evaluation of an intensified insulin treatment programme as routine management of type 1 (insulin-dependent) diabetes: The Bucharest-Dusseldorf Study. Diabetologia 1987, 30:681–690.

    Article  PubMed  CAS  Google Scholar 

  29. Miller WR, Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford; 1991.

    Google Scholar 

  30. Rollnick S, Mason P, Butler S: Health Behavior Change: A Guide for Practitioners. New York: Churchill Livingstone; 1999.

    Google Scholar 

  31. Glasgow RE, La Chance P, Toobert DJ, et al.: Long-term effects and costs of brief behavioral dietary interventions delivered in the medical office. Patient Educ Counseling 1997, 32:175–184.

    Article  CAS  Google Scholar 

  32. Woodcock AJ, Kinmouth A, Campbell MJ, et al.: Diabetes care from diagnosis: effects of training in patient-centered care on beliefs, attitudes and behavior of primary care professionals. Patient Educ Counseling 1999, 37:65–79.

    Article  CAS  Google Scholar 

  33. Doherty Y, Hall D, James PT, et al.: Change counseling in diabetes: the development of a training program for the diabetes team. Patient Educ Counseling 2000, 40:263–278.

    Article  CAS  Google Scholar 

  34. Piette JD, Weinberger M, McPhee SJ, et al.: Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes? A randomized controlled trail. Am J Med 2000, 108:20–27. This study adds to a growing body of research validating automated telephone-based interventions for diabetes and other chronic diseases. Effective automated interventions become more important as health care systems reduce clinical staff for DSME, and as cost-effectiveness is emphasized.

    Article  PubMed  CAS  Google Scholar 

  35. Ciechanowski PS, Katon WJ, Russo JE, Walker EA: The provider-patient relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 2001, 158:29–35. Highlights the interaction between patient attachment style and provider style to predict glycemic control. One practical application of this work involves assessment of patient style and having practitioners adjust their communication style if a patient is found to have a dismissive style.

    Article  PubMed  CAS  Google Scholar 

  36. Bandura A: Self-efficacy: The Exercise of Control. New York: Freeman; 1997.

    Google Scholar 

  37. Williams GC, Freedman Z, Deci EL: Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care 1998, 21:1644–1651.

    Article  PubMed  CAS  Google Scholar 

  38. Senecal C, Nouwen A, White D: Motivation and dietary self-care in adults with diabetes: are self-efficacy and autonomous self-regulation complementary or competing constructs? Health Psychol 2000, 19:452–457. Results from this cross-sectional study show constructs from two theories of behavior (autonomous self-regulation from selfdetermination theory, and self-efficacy from social learning theory) predict life satisfaction and adherence among 638 patients. Crosstheoretic research such as this will help identify the important components of DSME that improve health for patients with diabetes.

    Article  PubMed  CAS  Google Scholar 

  39. Deci EL, Ryan RM: Intrinsic Motivation and Self-determination in Human Behavior. New York: Plenum; 1985.

    Google Scholar 

  40. Deci EL, Ryan RM: A motivational approach to self: Integration in personality. In Nebraska Symposium on Motivation, vol 38. Perspectives on Motivation. Edited by Dienstbier R. Lincoln, NE: University of Nebraska Press; 1991:237–288.

    Google Scholar 

  41. Hampson SE, Glasgow RE, Strycker LA: Beliefs versus feelings: a comparison of personal models and depression for predicting multiple outcomes in diabetes. Br J Health Psychol 2000, 5:27–40. Demonstrates the predictive validity of personal models for diabetes self-regulation. The findings are consistent with social learning theory and self-determination theory. Patient-centered DSME naturally elicits and acknowledges these models and this process may enhance patient self-regulation.

    Article  Google Scholar 

  42. Leventhal H, Leventhal EA, Contrada RJ: Self-regulation, health and behavior: a perceptual-cognitive approach. Psychol Health 1998, 13:717–733.

    Google Scholar 

  43. Holmes-Rovner M, Llewellyn-Thomas H, Entwhistle V, et al.: Patient choice modules for summaries of clinical effectiveness: a proposal. BMJ 2001, 1:269–272.

    Article  Google Scholar 

  44. Anderson RM, Funnell MM, Fitzgerald JT, Marrero DG: The diabetes empowerment scale. Diabetes Care 2000, 23:739–743.

    Article  PubMed  CAS  Google Scholar 

  45. Sheldon K, Williams G, Joiner T: Motivating Physical and Mental Health: Applying Self-determination Theory in the Clinic. New Haven, CT: Yale University Press; 2001.

    Google Scholar 

  46. Lorenz R, Gregory R, Davis DL: Utility of a brief self-efficacy scale in clinical training program evaluation. Eval Health Professions 2000, 23:182–193.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine and Department of Clinical and Social Sciences in Psychology, University of Rochester School of Medicine and Dentistry, 2400 S. Clinton Avenue, Building G - 2nd Floor, 14618, Rochester, NY, USA

    Geoffrey C. Williams MD, PhD & Allan Zeldman MA

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  1. Geoffrey C. Williams MD, PhD
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  2. Allan Zeldman MA
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Williams, G.C., Zeldman, A. Patient-centered diabetes self-management education. Curr Diab Rep 2, 145–152 (2002). https://doi.org/10.1007/s11892-002-0074-6

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  • DOI: https://doi.org/10.1007/s11892-002-0074-6

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