Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample
Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample
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DOI：
10.1007/s11606-011-1689-6
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发表时间：
2011-09-01
影响因子：
5.7
通讯作者：
Brancati, Frederick L.
中科院分区：
文献类型：
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作者：
Hill-Briggs, Felicia;Lazo, Mariana;Brancati, Frederick L.
背景：较低的社会经济地位与糖尿病的过度疾病负担有关。糖尿病自我管理支持干预措施是需要的，是有效地参与低收入患者，解决竞争的生活优先事项和自我保健的障碍，并促进behaviorchanges.OBJECTIVE：试点测试的可行性，可接受性，以及对疾病控制的影响，以问题为基础的糖尿病自我管理培训适应低识字率和可及性。设计：两组随机对照试验在汇总分析中检测到随访时A1 C的0.50%变化，双侧α为0.05。五十六例患有2型糖尿病的城市非裔美国患者，血糖、血压、或胆固醇控制招募从糖尿病登记处在一所大学附属的管理保健organization.INTERVENTIONS：一组，以问题为基础的糖尿病自我管理培训，旨在交付在一个密集的和浓缩的程序格式。试验期间进行了三个强化和三个浓缩程序组。（A1 C，收缩压[SBP]，舒张压[DBP]，LDL和HDL胆固醇）和行为（知识、解决问题、自我管理行为）数据在基线、干预后和干预后3个月进行测量结果：两个项目的采用率都很高（> 85%的出勤率，95%的保留率）。干预后3个月，A1 C变化的组间差异为-0.72%（p = 0.02），有利于强化计划。A1 C降低部分由随访时的问题解决技能介导（=-0.13，p = 0.04）。强化计划患者在知识（p < 0.001），解决问题（p = 0.01）和自我管理行为（p = 0.04）方面表现出组内改善。在基线时血压或血脂低于最佳水平的患者亚组中，强化方案使SBP、DBP和LDL胆固醇有临床显著的个体改善。患者满意度和可用性评级都很高，为两个programs.CONCLUSIONS：识字适应，密集，解决问题为基础的糖尿病自我管理培训是有效的关键临床和行为结果在低收入患者样本。
BACKGROUND: Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change.OBJECTIVE: To pilot test feasibility, acceptability, and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility.DESIGN: Two-arm randomized controlled trial powered to detect a 0.50% change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis.PARTICIPANTS: Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar, blood pressure, or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization.INTERVENTIONS: A group, problem-based diabetes self-management training designed for delivery in an intensive and a condensed program format. Three intensive and three condensed program groups were conducted during the trial.MAIN MEASURES: Clinical (A1C, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL and HDL cholesterol) and behavioral (knowledge, problem solving, self-management behavior) data were measured at baseline, post-intervention, and 3 months post-intervention (corresponding with 6-9 months following baseline).RESULTS: Adoption of both programs was high (> 85% attendance rates, 95% retention). At 3 months post-intervention, the between-group difference in A1C change was -0.72% (p = 0.02), in favor of the intensive program. A1C reduction was partially mediated by problem-solving skill at follow-up ( = -0.13, p = 0.04). Intensive program patients demonstrated within-group improvements in knowledge (p < 0.001), problem-solving (p = 0.01), and self-management behaviors (p = 0.04). Among the subsets of patients with suboptimal blood pressure or lipids at baseline, the intensive program yielded clinically significant individual improvements in SBP, DBP, and LDL cholesterol. Patient satisfaction and usability ratings were high for both programs.CONCLUSIONS: A literacy-adapted, intensive, problem-solving-based diabetes self-management training was effective for key clinical and behavioral outcomes in a lower income patient sample.