Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics Randomized Clinical Trial
Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics Randomized Clinical Trial
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DOI：
10.1001/archinternmed.2011.70
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发表时间：
2011-03-14
影响因子：
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通讯作者：
Haidet, Paul
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文献类型：
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作者：
Naik, Aanand D.;Palmer, Nynikka;Haidet, Paul
背景：糖尿病（DM）小组门诊能有效控制高血压，但支持血糖控制的数据尚不明确。本研究评估了2 DM组的临床干预措施对糖化血红蛋白（HbA（1C））水平在primary care.Methods：87名参与者被招募从DM登记处的一个单一的区域退伍军人事务部医疗中心参加一个开放的，随机的比较有效性研究的比较有效性。两个初级保健为基础的DM组干预3个月的持续时间进行了比较。Empowering Patients in Care（EPIC）是一个以临床医生为主导、以患者为中心的团体诊所，包括4个关于制定自我管理行动计划（饮食、运动、家庭监测、药物等）和沟通行动计划进展情况的会议。比较干预包括与DM教育者和营养师的小组教育会议，然后与一个人的初级保健提供者进行额外的访问。比较干预后和1年随访时的血红蛋白A（1c）水平。结果：EPIC干预组的参与者在积极干预后即刻的HbA（1c）水平有显著更大的改善（占总血红蛋白的8.86%-8.04% vs 8.74%-8.70%;组间差异均值[SD]为0.67% [1.3%]; P = 0.03），并且这些差异在1年随访时持续存在（0.59% [1.4%]，P = 0.05）。使用所有研究时间点的重复测量分析发现，HbA（1c）水平的时间-治疗相互作用效应显著，有利于EPIC干预（F（2，85）= 3.55; P = .03）。时间-治疗相互作用的影响似乎部分由DM自我效能介导（F（1，85）= 10.39; P = .002）。结论：以初级保健为基础的DM小组诊所，包括结构化的目标设定方法，以自我管理，可以显着改善干预后的HbA（1c）水平，并保持改善1年。试验注册：临床trials.gov标识符：NCT 00481286
Background: Diabetes mellitus (DM) group clinics can effectively control hypertension, but data to support glycemic control are equivocal. This study evaluated the comparative effectiveness of 2 DM group clinic interventions on glycosylated hemoglobin (HbA(1c)) levels in primary care.Methods: Eighty-seven participants were recruited from a DM registry of a single regional Veterans Affairs medical center to participate in an open, randomized comparative effectiveness study. Two primary care-based DM group interventions of 3 months' duration were compared. Empowering Patients in Care (EPIC) was a clinician- led, patient-centered group clinic consisting of 4 sessions on setting self-management action plans (diet, exercise, home monitoring, medications, etc) and communicating about progress with action plans. The comparison intervention consisted of group education sessions with a DM educator and dietician followed by an additional visit with one's primary care provider. Hemoglobin A(1c) levels were compared after intervention and at the 1-year follow-up.Results: Participants in the EPIC intervention had significantly greater improvements in HbA(1c) levels immediately following the active intervention (8.86%-8.04% vs 8.74%-8.70% of total hemoglobin; mean [SD] between-group difference 0.67% [1.3%]; P = .03), and these differences persisted at the 1 year follow-up (0.59% [1.4%], P = .05). A repeated-measures analysis using all study time points found a significant time-by-treatment interaction effect on HbA(1c) levels favoring the EPIC intervention (F(2,85)= 3.55; P = .03). The effect of the time-by-treatment interaction seems to be partially mediated by DM self-efficacy (F(1,85)= 10.39; P = .002).Conclusion: Primary care-based DM group clinics that include structured goal-setting approaches to self-management can significantly improve HbA(1c) levels after intervention and maintain improvements for 1 year.Trial Registration: clinical trials.gov Identifier: NCT00481286