“JUMPing into Diabetes Control”: A Group-Setting Self-Empowerment Lifestyle Intervention among Diabetes Patients

Healthcare - Tập 8 Số 2 - Trang 90
Sheena Henry1, Lu Shi2, Virginia Alexander3, Richard O’Neal4, Stephen J. Carey5, Hugh Spitler2, Deborah A. Leonard3, Gail Chastain3, Lauren Hassan6, Meenu Jindal3
1Department of Medicine, University of Missouri, 1 Hospital Dr, Columbia, MO 65212, USA
2Department of Public Health Sciences, Clemson University, 507 Edwards Hall, Clemson, SC 29634, USA
3Internal Medicine Clinic, Prisma Health, 876 West Faris Rd, Greenville, SC 29605-5601, USA
4Department of Medicine, University of Kentucky, 800 Rose Street MN 150, Lexington, KY 40506, USA
5Atrium Healthcare, 1000 Blythe Blvd. Charlotte, NC 28203, USA
6Mayo Clinic, 4500 San Pablo RD S Jacksonville, FL 32224, USA

Tóm tắt

We examined the impact of a group-based self-empowerment intervention among diabetes patients, which uses multidisciplinary education, collaborative learning, peer support, and development of diabetes-specific social capital to improve glycemic control and weight management. Thirty-five patients who had primary care established at the Prisma Health Upstate, Internal Medicine Resident clinic and held the diagnosis of diabetes for longer than one year were recruited for our single-arm pilot intervention. Each group intervention session involved one to two internal medicine resident physician facilitators, a clinical diabetic educator, and 5–10 patients. Each session had a framework facilitated by the resident, with most of the discussion being patient-led, aiming to provide a collaborative learning environment and create a support group atmosphere to encourage self-empowerment. Patients’ hemoglobin A1c level and body mass index (BMI) before the intervention and 3 to 6 months after completion were collected from the laboratory results obtained in the participants’ routine clinic visits. All graduates from this three-week intervention were invited to attend monthly maintenance sessions, and we tracked the HgbA1c measures of 29 JUMP graduates one year after the intervention, even though 13 of the 29 chose not to participate in the monthly maintenance sessions. The pre-intervention HgbA1c level averaged 8.84%, whereas the post-intervention HgbA1c level averaged 7.81%. A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007). For BMI, there was an average decline of 0.78 from the pre-intervention mean value of 40.56 to the post-intervention mean value of 39.78 (p = 0.03). Among the 29 participants who agreed to participate in our follow-up measure of their HgbA1c status one year after the intervention, a paired t test showed that there was no significant difference between the post-JUMP measure and the follow-up measure (p = 0.808). There was no statistically significant difference between the HgbA1c level of those participating in the maintenance program and that of those not participating (post-intervention t test of between-group difference: p = 0.271; follow-up t test of between-group difference: p = 0.457). Our single-arm, pilot study of the three-week group intervention of self-empowerment shows promising results in glycemic control and weight loss. The short duration and small number of sessions expected could make it more feasible for implementation and dissemination as compared with popular intervention protocols that require much longer periods of attendance, if the effectiveness of this patient group-based self-empowerment approach can be further established by randomized controlled studies in the future.

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Tài liệu tham khảo

Centers for Disease Control and Prevention (2016, October 24). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Available online: https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.

International Diabetes Federation (2016, November 02). IDF Diabetes, 7th ed. Available online: http://www.diabetesatlas.org.

Zhang, 2009, Changes in racial/ethnic disparities in the prevalence of Type 2 diabetes by obesity level among US adults, Ethn. Health, 14, 439, 10.1080/13557850802699155

Agency for Healthcare Research and Quality (2016, October 24). Diabetes Disparities among Racial and Ethnic Minorities: Fact Sheet, Available online: http://archive.ahrq.gov/research/findings/factsheets/diabetes/diabdisp/diabdisp.html.

Link, 2009, Disparities in the Prevalence of Diabetes: Is it Race/Ethnicity or Socioeconomic Status? Results from the Boston Area Community Health (BACH) Survey, Ethn. Dis., 19, 288

Signorello, 2007, Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status, Am. J. Public Health, 97, 2260, 10.2105/AJPH.2006.094482

Formosa, 2016, Improving Diabetes Knowledge and Self-Care Practices, J. Am. Podiatr. Med Assoc., 106, 352, 10.7547/15-071

Powell, 2015, New approaches to providing individualized diabetes care in the 21st century, Curr. Diabetes Rev., 11, 222, 10.2174/1573399811666150421110316

Edelman, 2014, Shared Medical Appointments for Patients with Diabetes Mellitus: A Systematic Review, J. Gen. Intern. Med., 30, 99, 10.1007/s11606-014-2978-7

Noordman, 2012, Shared medical appointments for children and adolescents with type I diabetes: Perspectives and experiences of patients, parents, and health care providers, Adolesc. Health Med. Ther., 3, 75

Floyd, 2016, Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control, Pediatr. Diabetes, 18, 204, 10.1111/pedi.12373

Rijswijk, 2010, Shared and individual medical appointments for children and adolescents with type 1 diabetes; differences in topics discussed?, Patient Educ. Couns., 79, 351, 10.1016/j.pec.2010.04.016

Davis, 2015, Shared Medical Appointments for Adolescents with Type 1 Diabetes Mellitus: Important Learning Communities, J. Pediatr. Nurs., 30, 632, 10.1016/j.pedn.2015.04.004

Christie, 2013, The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: A clinical review, Diabetes, Obes. Metab., 16, 381, 10.1111/dom.12195

Chen, 2012, Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: A randomized controlled trial, Int. J. Nurs. Stud., 49, 637, 10.1016/j.ijnurstu.2011.11.011

Heisler, 2010, Diabetes control with reciprocal peer support versus nurse care management: A randomized trial, Ann. Intern. Med., 153, 507, 10.7326/0003-4819-153-8-201010190-00007

Johansson, 2015, Effectiveness of a Peer Support Programme versus Usual Care in Disease Management of Diabetes Mellitus Type 2 regarding Improvement of Metabolic Control: A Cluster-Randomised Controlled Trial, J. Diabetes Res., 2016, 1, 10.1155/2016/3248547

Zhang, 2016, How to achieve better effect of peer support among adults with type 2 diabetes: A meta-analysis of randomized clinical trials, Patient Educ. Couns., 99, 186, 10.1016/j.pec.2015.09.006

Zhao, H., Liu, Q., Qi, X., Wu, N., Tang, W., and Xiong, H. (2015). Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: A meta-analysis of randomized controlled trials. BMC Public Health, 15.

Dale, 2012, What is the effect of peer support on diabetes outcomes in adults? A systematic review, Diabet. Med., 29, 1361, 10.1111/j.1464-5491.2012.03749.x

Zoffmann, 2012, Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control?, Diabet. Med., 29, 251, 10.1111/j.1464-5491.2011.03521.x

Lorig, 2009, Community-Based Peer-Led Diabetes Self-management, Diabetes Educ., 35, 641, 10.1177/0145721709335006

Funnell, 2009, Peer-based behavioural strategies to improve chronic disease self-management and clinical outcomes: Evidence, logistics, evaluation considerations and needs for future research, Fam. Pr., 27, i17, 10.1093/fampra/cmp027

Joensen, 2016, Patient perspectives on peer support for adults with type 1 diabetes: A need for diabetes-specific social capital, Patient Prefer. Adherence, 10, 1443, 10.2147/PPA.S111696

Pajovic, 2014, Different susceptibility of prefrontal cortex and hippocampus to oxidative stress following chronic social isolation stress, Mol. Cell. Biochem., 393, 43, 10.1007/s11010-014-2045-z

Baynes, 1991, Role of oxidative stress in development of complications in diabetes, Diabetes, 40, 405, 10.2337/diab.40.4.405

Novick, 2004, CenteringPregnancy and the Current State of Prenatal Care, J. Midwifery Women’s Health, 49, 405, 10.1111/j.1542-2011.2004.tb04434.x

Parikh, 2016, Glycemic control, compliance, and satisfaction for diabetic gravidas in Centering® group care, J. Matern. Neonatal Med., 30, 1

Schellinger, 2016, Improved Outcomes for Hispanic Women with Gestational Diabetes Using the Centering Pregnancy© Group Prenatal Care Model, Matern. Child Health J., 21, 297, 10.1007/s10995-016-2114-x

World Health Organization (2016). Global Report on Diabetes, World Health Organization. Available online: https://apps.who.int/iris/handle/10665/204871.

Genuth, 2003, Implications of the United Kingdom prospective diabetes study, Diabetes Care, 26, 28, 10.2337/diacare.26.2007.S28

Umpierre, 2011, Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: A systematic review and meta-analysis, JAMA, 305, 1790, 10.1001/jama.2011.576

Ackermann, 2008, Translating the Diabetes Prevention Program into the Community, Am. J. Prev. Med., 35, 357, 10.1016/j.amepre.2008.06.035

Anderson, 2000, The Diabetes Empowerment Scale: A measure of psychosocial self-efficacy, Diabetes Care, 23, 739, 10.2337/diacare.23.6.739

Kroenke, 2001, The PHQ-9: Validity of a brief depression severity measure, J. Gen. Intern. Med., 16, 606, 10.1046/j.1525-1497.2001.016009606.x

Camara, 2015, Prevalence of anxiety and depression among diabetic African patients in Guinea: Association with HbA1c levels, Diabetes Metab., 41, 62, 10.1016/j.diabet.2014.04.007

Stange, 2010, Defining and Measuring the Patient-Centered Medical Home, J. Gen. Intern. Med., 25, 601, 10.1007/s11606-010-1291-3

Kirsh, 2007, Shared medical appointments based on the chronic care model: A quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk, Qual. Saf. Health Care, 16, 349, 10.1136/qshc.2006.019158

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Healthcare

Tập 8 Số 2

90

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