A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial. An educational programme for peer review groups to improve treatment of chronic heart failure and diabetes mellitus type 2 in general practice. Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: a randomized controlled trial. The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial A multifaceted school-based intervention to reduce risk for type 2 diabetes in at-risk youth. Effect of a multifaceted intervention on use of evidence-based therapies in patients with acute coronary syndromes in Brazil: the BRIDGE-ACS randomized trial. Reducing patient delay with symptoms of acute coronary syndrome: a research protocol for a systematic review of previous interventions to investigate which behaviour change techniques are associated with effective interventions Implementation of a telephone-based secondary preventive intervention after acute coronary syndrome (ACS): participation rate, reasons for non-participation and 1-year survival A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. Underuse of evidence-based treatment modalities in diabetic patients with non-ST elevation acute coronary syndrome. A prospective nation wide study on acute coronary syndrome (FINACS). A randomized controlled trial on the effect of behavioral strategies for adherence to oral antidiabetic drugs: study protocol Effectiveness of Systematic Health Education Model for Type 2 Diabetes Patients A culturally competent intervention of education and care for black women with type 2 diabetes. The expanded Global Registry of Acute Coronary Events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. Efficacy of self-monitoring blood glucose as a key component of a chronic care model versus usual care in type 2 diabetes patients treated with oral agents: results of a randomized trial
Translating evidence into clinical practice in the management of acute coronary syndromes ( ACS ) is challenging . Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes . We design ed a pragmatic , 2-arm , cluster-r and omized trial involving 34 clusters ( Brazilian public hospitals ) . Clusters were r and omized to receive a multifaceted quality improvement intervention ( experimental group ) or routine practice ( control group ) . The 6-month educational intervention included reminders , care algorithms , a case manager , and distribution of educational material s to health care providers . The primary end point was a composite of evidence -based post-ACS therapies within 24 hours of admission , with the secondary measure of major cardiovascular clinical events ( death , nonfatal myocardial infa rct ion , nonfatal cardiac arrest , and nonfatal stroke ) . Prescription of evidence -based therapies at hospital discharge were also evaluated as part of the secondary outcomes . All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling ( generalized estimating equations ) . If proven effective , this multifaceted intervention would have wide use as a means of promoting optimal use of evidence -based interventions for the management of ACS RATIONALE , AIMS AND OBJECTIVES Peer review groups are considered helpful for quality improvement in primary care . An interactive educational programme for small peer groups was developed , focusing on the implementation of newly developed treatment guidelines . The aim is to evaluate the effect of the programme on adherence to treatment guidelines in general practice . METHODS A cluster r and omized trial using a balanced incomplete block design was used ; one arm received a programme on treatment of chronic heart failure ( CHF ) , the other on hypertension treatment in diabetes mellitus type 2 ( T2DM ) . A r and om sample of 10 CHF and 10 T2DM patients per GP was drawn , for whom data were extracted from electronic patient records 1 years before and 6 months after the intervention . The outcomes were prescribing of ACE inhibitors , and antihypertensive treatment in T2DM . The effect was analysed separately for both programmes using multilevel regression models . RESULTS All 27 peer review groups in one region in the Netherl and s were r and omized , of which 16 participated . No significant effects were observed in the CHF group or in the T2DM group . The opportunity for change was limited , as only 53 % of the CHF patients and 60 % of the T2DM patients had a contact with their GP between the intervention and follow-up measurement . CONCLUSION The peer review programme was not successful for changing the treatment of chronic patients , although the programme focused on dealing with barriers perceived by the participants . Not all problems perceived can be solved in a peer group discussion OBJECTIVE To test the effectiveness of an individualized educational intervention on knowledge , attitudes and beliefs about acute coronary syndrome ( ACS ) . METHODS This multi-site , r and omized controlled trial was conducted on 1947 patients with a diagnosis of ACS . Both groups received usual in-hospital education . Participants r and omized to the intervention group received a 40-min one to one individualized education session , delivered using motivational interviewing techniques . The intervention was reinforced 1 month and 6 months later . Knowledge , attitudes and beliefs were measured using the ACS Response Index . A total of 1136 patients ( control , n=551 ; intervention , n=585 ) completed the question naire at baseline , 3 and 12 months . Data were analyzed using repeated measures analysis of variance . Ethical approval was obtained . RESULTS There was a significant effect of the intervention on mean knowledge ( p<0.001 ) , attitude ( p=0.003 ) and belief ( p<0.001 ) scores at 3 and 12 months . CONCLUSION Ensuring patients retain information post education has always been difficult to attain . This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge , attitudes and beliefs about ACS among a high risk population . PRACTICE IMPLICATION S This relatively short , simple and effective educational intervention could be delivered by nurses in multiple setting Background Patients with type 2 diabetes mellitus ( T2DM ) have an increased risk to develop severe diabetes related complications , especially cardiovascular disease ( CVD ) . The risk to develop CVD can be estimated by means of risk formulas . However , patients have difficulties to underst and the outcomes of these formulas . As a result , they may not recognize the importance of changing lifestyle and taking medication in time . Therefore , it is important to develop risk communication methods , that will improve the patients ' underst and ing of risks associated with having diabetes , which enables them to make informed choices about their diabetes care . The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception , attitude and intention to change lifestyle behaviour in patients with T2DM . The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory . Methods A r and omised controlled trial will be performed in the Diabetes Care System West-Friesl and ( DCS ) , a managed care system . Newly referred T2DM patients of the DCS , younger than 75 years will be eligible for the study . The intervention group will be exposed to risk communication on CVD , on top of st and ard managed care of the DCS . This intervention consists of a simple explanation on the causes and consequences of CVD , and possibilities for prevention . The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram . The control group will receive st and ard managed care . The primary outcome is appropriateness of risk perception . Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception . Differences between baseline and follow-up ( 2 and 12 weeks ) between groups will be analysed according to the intention-to-treat principle . The study was powered on 120 patients in each group . Discussion This innovative risk communication method based on two behavioural theories might improve patient 's appropriateness of risk perception and attitude concerning lifestyle change . With a better underst and ing of their CVD risk , patients will be able to make informed choices concerning diabetes care . Trail registration The trial is registered as NTR1556 in the Dutch Trial Register OBJECTIVE To evaluate the impact of a multifaceted , school-based intervention on inner city youth at high risk for type 2 diabetes mellitus ( T2DM ) and to determine whether the addition of coping skills training ( CST ) and health coaching improves outcomes . METHOD 198 students in New Haven , CT at risk for T2DM ( BMI > 85th percentile and family history of diabetes ) were r and omized by school to an educational intervention with or without the addition of CST and health coaching .  Students were enrolled from 2004 to 2007 and followed for 12 months . RESULTS Students in both groups showed some improvement in anthropometric measures , lipids , and depressive symptoms over 12 months . BMI was not improved by the intervention . Students who received CST showed greater improvement on some indicators of metabolic risk than students who received education only . CONCLUSION A multifaceted , school-based intervention may hold promise for reducing metabolic risk in urban , minority youth CONTEXT Studies have found that patients with acute coronary syndromes ( ACS ) often do not receive evidence -based therapies in community practice . This is particularly true in low- and middle-income countries . OBJECTIVE To evaluate whether a multifaceted quality improvement ( QI ) intervention can improve the use of evidence -based therapies and reduce the incidence of major cardiovascular events among patients with ACS in a middle-income country . DESIGN , SETTING , AND PARTICIPANTS The BRIDGE-ACS ( Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes ) trial , a cluster-r and omized ( concealed allocation ) trial conducted among 34 clusters ( public hospitals ) in Brazil and enrolling a total of 1150 patients with ACS from March 15 , 2011 , through November 2 , 2011 , with follow-up through January 27 , 2012 .  INTERVENTION Multifaceted QI intervention including educational material s for clinicians , reminders , algorithms , and case manager training , vs routine practice ( control ) . MAIN OUTCOME MEASURES Primary end point was the percentage of eligible patients who received all evidence -based therapies ( aspirin , clopidogrel , anticoagulants , and statins )  during the first 24 hours in patients without contraindications . RESULTS Mean age of the patients enrolled was 62 ( SD , 13 ) years ; 68.6 % were men , and 40 % presented with ST-segment elevation myocardial infa rct ion , 35.6 % with non-ST-segment elevation myocardial infa rct ion , and 23.6 % with unstable angina . The r and omized clusters included 79.5 % teaching hospitals , all from major urban areas and 41.2 % with 24-hour percutaneous coronary intervention capabilities . Among eligible patients ( 923/1150 [ 80.3 % ] ) , 67.9 % in the intervention vs 49.5 % in the control group received all eligible acute therapies ( population average odds ratio [ OR(PA ) ] , 2.64 [ 95 % CI , 1.28 - 5.45 ] ) . Similarly , among eligible patients ( 801/1150 [ 69.7 % ] ) , those in the intervention group were more likely to receive all eligible acute and discharge medications ( 50.9 % vs 31.9 % ; OR(PA ) , , 2.49 [ 95 % CI , 1.08 - 5.74 ] ) . Overall composite adherence scores were higher in the intervention clusters ( 89 % vs 81.4 % ; mean difference , 8.6 % [ 95 % CI , 2.2%-15.0 % ] ) . In-hospital cardiovascular event rates were 5.5 % in the intervention group vs 7.0 % in the control group ( OR(PA ) , 0.72 [ 95 % CI , 0.36 - 1.43 ] ) ; 30-day all-cause mortality was 7.0 % vs 8.4 % ( ORPA , 0.79 [ 95 % CI , 0.46 - 1.34 ] ) . CONCLUSION Among patients with ACS treated in Brazil , a multifaceted educational intervention result ed in significant improvement in the use of evidence -based therapies . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00958958 Introduction Delay to presentation with symptoms of acute coronary syndrome ( ACS ) is common meaning many fail to achieve optimal benefit from treatments . Interventions have had variable success in reducing delay . Evidence suggests inclusion of behaviour change techniques ( BCTs ) may improve effectiveness of interventions but this has not yet been systematic ally evaluated . Data from other time-critical conditions may be relevant . Methods and analysis A systematic review will be undertaken to identify which BCTs are associated with effective interventions to reduce patient delay ( or prompt rapid help-seeking ) among people with time-critical conditions ( eg , chest pain , ACS , lumps , stroke , cancer and meningitis ) . A systematic search of a wide range of data bases ( including Cochrane Library , MEDLINE , EMBASE , CINAHL , PsycInfo ) and grey literature will be undertaken to identify all relevant intervention studies ( r and omised controlled trials , controlled clinical trials and cohort studies ) . Two independent review ers will screen abstract s to identify relevant studies , apply inclusion criteria to full papers , assess method ological quality and extract data . Primary outcome measure Change in patient decision time BCTs reported in each of the included studies will be categorised and presented according to the latest reliable taxonomy . Results of included studies will be synthesis ed , exploring relationships between inclusion of each BCT and effectiveness of the overall intervention . Where possible , means and SDs for differences in delay time will be calculated and combined within meta-analyses to derive a st and ardised mean difference and 95 % CI . Analysis of ( 1 ) all time-critical and ( 2 ) ACS-only interventions will be undertaken . Ethics and dissemination No ethical issues are anticipated . Results will be su bmi tted for publication in a relevant peer- review ed journal Background Acute coronary syndrome ( ACS ) is a major cause of death from a non-communicable disease . Secondary prevention is effective for reducing morbidity and mortality , but evidence -based targets are seldom reached and new interventional methods are needed . The present study is a feasibility study of a telephone-based secondary preventive programme in an unselected ACS cohort . Methods The NAILED ( Nurse-based Age-independent Intervention to Limit Evolution of Disease ) ACS trial is a prospect i ve r and omized controlled trial . All eligible patients admitted for ACS were r and omized to usual follow-up by a general practitioner or telephone follow-up by study nurses . The intervention was made by continuous telephone contact , with counseling on healthy living and titration of medicines to reach target values for blood pressure and blood lipids . Exclusion criteria were limited to physical inability to follow the study design or participation in another study . Results A total of 907 patients were assessed for inclusion . Of these , 661 ( 72.9 % ) were included and r and omized , 100 ( 11 % ) declined participation , and 146 ( 16.1 % ) were excluded . The main reasons for exclusion were participation in another trial , dementia , and advanced disease .  “ Excluded ” and “ declining ” patients were significantly older with more co-morbidity , decreased functional status , and had more seldom received education above compulsory school level than “ included ” patients . Non- participants had a higher 1-year mortality than participants . Conclusions Nurse-led telephone-based follow-up after ACS can be applied to a large proportion in an unselected clinical setting . Reasons for non-participation , which were associated with increased mortality , include older age , multiple co-morbidities , decreased functional status and low level of education . Trial registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : IS RCT N96595458 ( archived by WebCite at http://www.webcitation.org/6RlyhYTYK ) . Application date : 10 July 2011 Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus ( T2DM ) . This pilot study examined a 12-week church-based culturally targeted diabetes self-management education ( DSME ) intervention for middle-aged and older African Americans with T2DM . Quantitative data were collected at baseline and at 12 weeks and included question naires and anthropometric measures . There were significant increases in medication adherence ( p = .006 ) , healthy eating ( p = .009 ) , and foot care adherence ( p = .003 ) . The intervention had a clinical ly significant effect on systolic blood pressure , blood lipids , physical activity , and waist circumference . Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM . The authors discuss the value of community-based interventions that target behavioural changes in population s of chronically ill patients , particularly those who historically have been disenfranchised and /or underserved This study was design ed to evaluate how new treatment guidelines of acute coronary syndrome ( ACS ) without ST elevation have been implemented in clinical practice especially in diabetic patients . A prospect i ve follow-up was performed on 501 consecutive patients with suspected ACS without ST elevation admitted to nine hospitals in Finl and between 15 January and 11 March 2001 . The study group included 143 ( 29 % ) diabetic patients . Their risk profile was more severe than in non-diabetic patients ; ST-depression on admission electrocardiography 57 versus 38 % ; P<0.0001 , elevated troponin levels 66 versus 56 % ; P<0.05 . Six months composite incidence of death , new myocardial infa rct ion ( MI ) , refractory angina or readmission for unstable angina was 39 % in diabetic patients and 20 % in non-diabetic patients ( P<0.0001 ) . In spite of this more severe risk profile , glycoprotein ( GP ) IIb/IIIa receptor antagonists and statins were used with similar frequency in non-diabetic and diabetic patients ( 15 vs. 19 and 48 vs. 54 % , respectively ; P = NS for both ) . In diabetic patients mean delay for in hospital coronary angiography was longer ( 6.4 vs. 4.2 days , P<0.05 ) and it was performed less often ( 32 vs. 45 % P<0.05 ) . Our results show that diabetic patients with ACS have higher risk profile and worse outcome than non-diabetic patients . Despite their indisputable benefits in diabetic patients , statins , GP IIb/IIIa receptor antagonists and invasive strategy were underused or often neglected . Further education is needed to change attitudes and to better implement new guidelines into clinical practice Background : Non-adherence to oral antidiabetics drugs ( OADs ) has been a common problem and may contribute to poor glycemic control . Aim : To describe an experimental study protocol that aims at implementing and evaluating the effect of the “ action planning and coping planning ” interventions on medication adherence to OADs  in patients with type 2 diabetes mellitus ( T2DM ) in follow-up at primary care services . Design : A r and omized controlled trial . Methods : Two groups ( intervention and control ) will be followed over a period of 105 days . The intervention group will receive a combination of the “ action planning ” and “ coping planning ” intervention strategies . There will be in-person meetings and phone calls to reinforce the intervention . The control group will receive the usual care from the health unit . Conclusions : It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence Background Health education is considered to be essential in the overall care of patients with type 2 diabetes mellitus ( T2DM ) ;  systematic health education integrates individual education not only during hospitalization but also extended care outside of a hospital . To test effectiveness of the systematic health education model for T2DM , we conducted a r and omized study with a control group among patients with T2DM living in Nanjing , China . Methods 998 eligible patients completed the enrollment and were r and omized to systematic health education model and conventional model groups ( 498 and 500 patients , resp . ) . The systematic health education model was based on the following aspects : image education , visitation of the exhibition hall , dissemination of educational material s , individualized medical nutrition therapy and exercise programs , WeChat group and regular health lectures , evaluation of complications , lifestyle modification , systematic treatment scheme , self-monitoring of glycemic control , monthly evaluation of the therapeutic effect , proposed improvement measures , and individualized follow-up scheme . The main outcome measures were glycated hemoglobin A1c ( HbA1c ) , blood pressure , body mass index ( BMI ) , and lipids during the 2-year follow-up . Results The systematic health education model led to a favorable variation in HbA1c , LDL cholesterol , and systolic blood pressure ( SBP ) ( P < 0.05 ) . After adjusted analysis , the HbA1c decreased by 0.67 % ( P < 0.01 ) in the systematic health education model , SBP decreased by 10.83 mmHg ( P < 0.01 ) , and the level of diastolic blood pressure ( DBP ) , HDL cholesterol , and total cholesterol decreased slightly and was not significant . The BMI did not change significantly during the study in either of the two groups . Conclusions The systematic health education model is a useful method in the treatment of T2DM because it contributes to decrease in HbA1c , LDL cholesterol , and SBP levels , as well as helps in increasing the compliance with the control criteria , except for DBP and BMI This article reports on the development and pilot feasibility testing of a culturally competent intervention of education and care for black women with type 2 diabetes mellitus ( T2DM ) . Using a one group , pretest posttest quasi-experimental design , the intervention was tested with a convenience sample of 25 community black women with T2DM . The conceptual basis , process , and content of the intervention as well as the feasibility and acceptability of study material s and methods are described . Significant improvements from baseline to 3 months were observed in measures of glycemic control , weight , body mass index , and diabetes-related emotional distress . The findings suggest that a culturally sensitive intervention of nurse practitioner diabetes care and education is beneficial for black women with T2DM , result ing in program attendance , kept appointments , improved glycemic control and weight , and decreased diabetes-related emotional distress BACKGROUND The Global Registry of Acute Coronary Events (GRACE)-a prospect i ve , multinational study of patients hospitalized with acute coronary syndromes (ACSs)-was design ed to improve the quality of care for patients with an ACS . Exp and ed GRACE aims to test the feasibility of a simplified data collection tool and provision of quarterly feedback to index individual hospital management practice s to an international reference cohort . METHODS We describe the objectives ; study design ; study and data management ; and the characteristics , management , and hospital outcomes of patients > or = 18 years old enrolled with a presumptive diagnosis of ACS . RESULTS From 2001 to 2007 , 31,982 patients were enrolled at 184 hospitals in 25 countries ; 30 % were diagnosed with ST-segment elevation myocardial infa rct ion , 31 % with non-ST-segment myocardial infa rct ion , 26 % with unstable angina , and 12 % with another cardiac/noncardiac final diagnosis . The median age was 65 ( interquartile range 55 - 75 ) years ; 24 % were > 75 years old , and 33 % were women . In general , increases were observed over time across the spectrum of ACS ( 1 ) in the use in the first 24 hours and at discharge of aspirin , clopidogrel , beta-blockers , and angiotensin-converting enzyme inhibitors/receptor blockers ; ( 2 ) in the use at discharge of statins ; ( 3 ) in the early use of glycoprotein IIb/IIIa inhibitors and low-molecular-weight heparin ; and ( 4 ) in the use of cardiac catheterization and percutaneous coronary intervention . An increase in the use of primary percutaneous coronary intervention and a similar decrease in the use of fibrinolysis in ST-segment elevation myocardial infa rct ion were also seen . CONCLUSIONS Over the course of 7 years , general increases in the use of evidence -based therapies for ACS patients were observed in the exp and ed GRACE Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 BACKGROUND Physical activity ( PA ) is a cornerstone in the management of type 2 diabetes ( T2DM ) . This pilot investigation explores the effects of a st and ard diabetes education program compared with a supplemental PA intervention on diabetes-related health outcomes . METHODS Using a prospect i ve 2-armed design , 96 adults with T2DM were r and omly assigned to either st and ard care ( diabetes education program ; n = 49 ) or st and ard care supplemented with an 8-week , individualized-counseling and community-based PA component ( n = 47 ) . Measurements were taken at baseline , 3 , 6 , and 12 months . Primary outcomes were changes in PA ( self-report ) and HbA1c . Between group changes were compared using analysis of covariance ( ANCOVA ) and changes over time using repeated- measures ANOVA . RESULTS In comparison with st and ard care , the supplemental group demonstrated an increase in PA ( Ps < 0.01 ) and cardiorespiratory fitness ( Ps < 0.05 ) from baseline to all follow-up time-points . HbA1c levels declined ( P < .05 ) from baseline to all time points in the st and ard care group . Reduction in cholesterol-ratio ( P < .01 ) , increase in HDL ( P < .05 ) , and reductions in blood pressure , resting heart rate and BMI ( approaching statistical significance Ps < 0.10 ) were also reported for both groups . CONCLUSIONS PA counseling in addition to st and ard care is effective for promoting PA behavior change and positive health-related outcomes among individuals with T2DM In recent years , patient-centered chronic care models ( CCMs ) have been widely recognized as the most effective approach for the management of chronic diseases including type 2 diabetes ( T2DM ) [ 1 ] ; however , their implementation in the real world is a dem and ing challenge [ 2 , 3 ] . In Italy , the SINERGIA CCM was developed in the diabetes outpatient clinic of Cusano Milanino [ 4 ] . In this model , self-monitoring blood glucose ( SMBG ) represents the key tool for patient engagement ; within the empowerment philosophy , patients undergo an educational process , which incorporates interactive teaching strategies design ed to involve patients in problem-solving and address their clinical , cultural and psychosocial needs [ 5 ] . Patients are actively involved in the discussion of their goals and instructed about the importance of glycemic control , lifestyle modifications , reduction in body weight and regular monitoring of diabetes complications and their risk factors . Organizational aspects , i.e. , training , skills and roles of each member of diabetes team , electronic data collection , and continuity of communication with the patients are also addressed by the model [ 4 ] . Following a preliminary evaluation of the SINERGIA impact in an observational cohort of over 1000 patients with T2DM cared for by the Cusano Milanino center [ 4 ] , the Self-Care Study was design ed as a multicenter , national , r and omized ( 1:1 ) , open-label , parallel group , controlled clinical trial of a duration of 12 months to compare SINERGIA models versus usual care . The primary end point was the change after 12 months from r and omization in HbA1c levels . Secondary end points were changes in body weight , waist circumference , blood pressure , lipid profile , specific quality -of-life scores , incidence of hypoglycemia and adverse events , and contacts between patient and center . After 24 months from r and omization , an additional analysis ( post-trial observational phase of the study ) assessed the long-term impact of SINERGIA versus  usual care . Inclusion criteria were : men or women aged ≥ 45 years with diagnosis of T2DM , at their first access at the diabetes clinic , with any diabetes duration , HbA1c > 7.0 and ≤ 9.0 % , treated or requiring the initiation of therapy with any oral oral hypoglycemic agent ( OHA ) , not using SMBG ( i.e. , frequency ≤ 1 test/week ) and signature of informed consent . Exclusion criteria were : treated or requiring the initiation of therapy with insulin , any condition that could render the subject unlikely or unable to comply with the protocol requirements ( full list of eligibility criteria available in https:// clinical trials.gov/ct2/show/NCT02082028?term= SINERGIA&cond = Diabetes+Mellitus%2C+Type+2&cntr y1=EU%3AIT&rank=1 ) . Patients were r and omized to two study arms :  patients allocated to the  experimental group received the SINERGIA diabetes educational model [ 4 ] and patients allocated to the control group received the st and ard diabetes education provided by the center , and SMBG ( any glucose meter ) was prescribed only if deemed appropriate based on physician ’s judgment . Patients in both groups were seen six times during the study period : 2 weeks before r and omization , at r and omization visit , 3 , 6 and 12 months after r and omization and 24 months after r and omization ( post-trial ) . Considering as clinical ly relevant a minimum betweengroup difference in HbA1c levels of 0.4 % after 12 months and assuming a st and ard deviation of HbA1c of 0.9 % and a Managed by Antonio Secchi
Nurses only and multidisciplinary teams were the most frequent professionals to provide education , and most educational interventions were delivered postdischarge .
Psychoeducational interventions were generally effective at reducing smoking and admissions for patients with ACS .
Culturally appropriate health education , self-management educational interventions , group medical visits and psychoeducational interventions were generally effective for patients with T2DM .
Results indicate that there is a body of current evidence about the efficacy of health education , its content and delivery methods for patients with ACS or T2DM .
OBJECTIVES This umbrella review aim ed to identify the current evidence on health education-related interventions for patients with acute coronary syndrome ( ACS ) or type two diabetes mellitus ( T2DM ) ; identify the educational content , delivery methods , intensity , duration and setting required .
The purpose was to provide recommendations for educational interventions for high-risk patients with both ACS and T2DM .