Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH Changing illness perceptions in patients with poorly controlled type 2 diabetes, a randomised controlled trial of a family-based intervention: protocol and pilot study Supported self-management for adults with type 2 diabetes and a learning disability (OK-Diabetes): study protocol for a randomised controlled feasibility trial The 6‐month effectiveness of Internet‐based guided self‐help for depression in adults with Type 1 and 2 diabetes mellitus How does change occur following a theoretically based self-management intervention for type 2 diabetes Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial. Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country Self-Efficacy, Depression, and Self-Care Activities in Adult Jordanians with Type 2 Diabetes: The Role of Illness Perception A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH Effectiveness of peer-led self-management coaching for patients recently diagnosed with Type 2 diabetes mellitus in primary care: a randomized controlled trial. Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. A study protocol for a pilot randomised trial of a structured education programme for the self-management of Type 2 diabetes for adults with intellectual disabilities The relative effectiveness of self-management programs for type 2 diabetes. Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care
BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources Background Diabetes specific emotional problems interfere with the dem and ing daily management of living with type 2 diabetes mellitus ( T2DM ) . Possibly , offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients ' belief they are able to manage their illness . It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy . Methods and design Six hundred patients with T2DM ( 45 ≤ 75 years ) who receive care in a structured diabetes care system , HbA1c ≥ 7.0 % , and not using insulin  will be recruited and r and omized into 3 groups ; Self-monitoring of Blood Glucose ( SMBG ) , Self-monitoring of Urine Glucose ( SMUG ) and usual care ( n = 200 per group ) . Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year . All 3 groups will receive st and ardized diabetes care . The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results . Main outcome measures are changes in diabetes specific emotional distress and self-efficacy . Secondary outcome measures include difference in HbA1c , patient satisfaction , occurrence of hypoglycaemia , physical activity , costs of direct and indirect healthcare and changes in illness beliefs . Discussion The IN CONTROL-trial is design ed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy . Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions , guiding the patient to reduce emotional responses to experienced threats , and influences the patients ability to perform and maintain self-management skills . Trial registration Current Controlled Trials IS RCT Background Self-management support for people with type 2 diabetes is essential in diabetes care . Thus , mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management . Objectives The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application ( FTA ) diabetes diary with or without health counseling improved glycated hemoglobin ( HbA1c ) levels , self-management , behavioral change , and health-related quality of life , and to describe the sociodemographic , clinical , and lifestyle characteristics of the participants after 4 months . Methods A 3-armed r and omized controlled trial was conducted in Norway during 2011 - 2013 . In the 2 intervention groups , participants were given a mobile phone for 1 year , which provided access to the FTA diary , a self-help tool that recorded 5 elements : blood glucose , food habits , physical activity , personal goal setting , and a look-up system for diabetes information . One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline . Both intervention groups and the  control group were provided usual care according to the national guidelines . Adults with type 2 diabetes and HbA1c ≥7.1 % were included ( N=151 ) . There were 3 assessment points : baseline , 4 months , and 1 year . We report the short-term findings after 4 months . HbA1c was the primary outcome and the secondary outcomes were self-management ( Health Education Impact Question naire , heiQ ) , behavioral change ( diet and physical activity ) , and health-related quality of life ( SF-36 question naire ) . The data were analyzed using univariate methods ( ANOVA ) , multivariate linear , and logistic regression . Results Data were analyzed from 124 individuals ( attrition rate was 18 % ) . The groups were well balanced at baseline . There were no differences in HbA1c between groups after 4 months , but there was a decline in all groups . There were changes in self-management measured using the health service navigation item in the heiQ , with improvements in the FTA group compared to the control group ( P=.01 ) and in the FTA with health counseling group compared with both other groups ( P=.04 ) . This may indicate an improvement in the ability of patients to communicate health needs to their health care providers . Furthermore , the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group ( P=.02 ) . There were no significant changes in any of the domains of the SF-36 . Conclusions The primary outcome , HbA1c , did not differ between groups after 4 months . Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition Background This paper presents the pilot study and protocol for a r and omised controlled trial to test the effectiveness of a psychological , family-based intervention to improve outcomes in those with poorly controlled type 2 diabetes . The intervention has been design ed to change the illness perceptions of patients with poorly controlled type 2 diabetes , and their family members . It is a complex psychological intervention , developed from the Self-Regulatory Model of Illness Behaviour . The important influence the family context can have in psychological interventions and diabetes management is also recognised , by the inclusion of patients ' family members . Methods / design We aim to recruit 122 patients with persistently poorly controlled diabetes . Patients are deemed to have persistent poor control when at least two out of their last three HbA1c readings are 8.0 % or over . Patients nominate a family member to participate with them , and this patient/family member dyad is r and omly allocated to either the intervention or control group . Participants in the control group receive their usual care . Participants in the intervention group participate , with their family members , in three intervention sessions . Sessions one and two are delivered in the participant 's home by a health psychologist . Session one takes place approximately one week after session two , with the third session , a follow-up telephone call , one week later . The intervention is based upon clarifying the illness perceptions of both the patient and the family member , examining how they influence self-management behaviours , improving the degree of similarity of patient and family member perceptions in a positive direction and developing personalized action plans to improve diabetes management . Discussion This study is the first of its kind to incorporate the evidence from illness perceptions research into developing and applying an intervention for people with poorly controlled diabetes and their families . This study also acknowledges the important role of family members in effective diabetes care . Trial registration IS RCT Background Individuals with a learning disability ( LD ) are at higher risk of developing type 2 diabetes , but LD is not straightforward to define or identify , especially at the milder end of the spectrum , which makes case finding difficult . While supported self-management of health problems is now established , current material is largely educational and didactic with little that facilitates behavioural change . The interaction between the person with diabetes and others supporting their care is also largely unknown . For these reasons , there is considerable work needed to prepare for a definitive trial . The aim of this paper is to publish the abridged protocol of this preparatory work . Methods / Design Phase I is a prospect i ve case-finding study ( target n = 120 to 350 ) to identify and characterise potential participants , while developing a st and ardised supported self-management intervention . Phase II is a r and omised feasibility trial ( target n = 80 ) with blinded outcome assessment . Patients identified in Phase I will be interviewed and consented prior to being r and omised to ( 1 ) st and ard treatment , or ( 2 ) supported self-management . Both arms will also be provided with an ‘ easy read ’ accessible information re source on managing type 2 diabetes . The intervention will be st and ardised but delivered flexibly depending on patient need , including components for the participant , a supporter , and shared activities . Outcomes will be ( i ) robust estimates of eligibility , consent and recruitment rates with refined recruitment procedures ; ( ii ) characterisation of the eligible population ; ( iii ) a st and ardised intervention with associated written material s , ( iv ) adherence and negative outcomes measures ; ( v ) preliminary estimates of adherence , acceptability , follow-up and missing data rates , along with refined procedures ; and ( vi ) description of st and ard treatment . Discussion Our study will provide important information on the nature of type 2 diabetes in adults with LD living in the community , on the challenges of identifying those with milder LD , and on the possibilities of evaluating a st and ardised intervention to improve self-management in this population .Trial registration Current Controlled Trials IS RCT N41897033 ( registered 21 January 2013 ) AIM The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes . METHODS Participants ( n = 260 ) with Type 1 or 2 diabetes and elevated depressive symptoms [ Center for Epidemiological Studies Depression Scale ( CES-D ) ≥ 23 ] were r and omly assigned to a guided Internet-based self-help intervention or a control condition ( treatment as usual + online psychoeducation about depression ) . The primary outcome was a change in depressive symptom severity ( CES-D ) from baseline to 6-month follow-up . The secondary outcomes included numbers of people achieving treatment response ( reliable change of depressive symptoms ) and remission ( CES-D ≤ 16 ) , as well as the effects on glycaemic control , diabetes-related emotional distress and diabetes acceptance . Repeated measures analysis of variance examined between-group differences using intent-to-treat principles . RESULTS Both conditions showed improvements in depression severity : intervention condition , d = 1.48 [ 95 % confidence interval ( 95 % CI ) : 1.21 to 1.76 ] ; control condition d = 0.55 ( 95 % CI : 0.30 to 0.80 ) . Changes were significantly greater in the intervention condition with a large between-group effect size ( d = 0.83 , 95 % CI : 0.57 to 1.08 ) . Accordingly , effects on response [ relative risk ( RR ) = 2.60 ( 95 % CI : 2.01 to 3.36 ) , P < 0.001 ] and remission [ RR = 3.36 ( 95 % CI : 2.98 to 5.44 ) , P < 0.001 ] were in favour of the intervention group , as were differences in change in diabetes emotional distress ( d = 0.50 , 95 % CI : 0.04 to 0.54 ) , and physical and mental functioning [ Short Form Health Survey ( SF-12 ) Physical d = 0.27 ( 95 % CI : 0.01 to 0.51 ) and SF-12 Mental d = 0.68 ( 95 % CI : 0.11 to 0.40 ) ] . The intervention group was not superior with regard to glycaemic control , diabetes self-management and diabetes acceptance . CONCLUSIONS The trial indicates that Internet-based guided self-help treatments for  depression in people with diabetes can have sustained effects on depressive symptoms , well-being and emotional distress associated with diabetes The purpose of this study was to test the extent that constructs from two theoretical models ( self-regulatory theory and social cognitive theory ) mediated change in outcomes following a self-management intervention .  One hundred and twenty four individuals with type 2 diabetes who had participated in a r and omised controlled trial of a diabetes self-management programme  were analysed for the extent that illness beliefs and self-efficacy mediated change in self-management behaviours and illness specific quality of life . Exercise specific self-efficacy significantly mediated change in exercise  at three months ( B = .03 ; .01 , p < .05 ) while  monitoring specific self-efficacy mediated change in monitoring behaviour at both three ( B = .04 ; .01 , p < .01 ) and nine months follow-up ( B = 5.97 ; 1.01 , p < .01 ) . Belief in control over diabetes mediated change in illness specific quality of life at three months ( B = −.07 ; .28 , p < .05 ) and nine months ( B = .79 ; .28 , p < .01 ) follow-ups , as well as change in exercise behaviour at immediately post-intervention ( B = −.12 ; .17 , p < .05 ) . Behaviour-specific self-efficacy may have a stronger role in mediating self-management behaviours than illness beliefs ; however , belief in control over diabetes may be important to manipulate for change in quality of life . This suggests different theoretical constructs may mediate change dependent on outcome Patients in a low-income community health center with Type 2 diabetes ( N = 81 ) taking a one-day education workshop  as part of their diabetes medical management were r and omly assigned either to education alone or to a combination of education and acceptance and commitment therapy ( ACT ) . Both groups were taught how to manage their diabetes , but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings . Compared with patients who received education alone , after 3 months those in the ACT condition were more likely to use these coping strategies , to report better diabetes self-care , and to have glycated hemoglobin ( HbA-sub(1C ) ) values in the target range . Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA-sub(1C ) AIM Patient education that enhances one 's self-management ability is of utmost importance for improving patient outcomes in chronic diseases . We developed a 12 month self-management education program for type 2 diabetes , based on a previous 6 month program , and examined its efficacy . METHODS A r and omized controlled trial was carried out on out patients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate . They were r and omly divided into an intervention group that followed the program and a control group that followed usual clinical practise . The intervention group received < 30 min of monthly interviews based on the program 's textbook and biweekly telephone calls from a nurse educator throughout the 12 months . RESULTS Of the 50 participants in the intervention group and the 25 participants in the control group , 42 and 23 , respectively , completed the program ( a completion rate of 84.0 % ) . The body weight , HbA1c , self-efficacy , dietary and exercise stages , quality of life , diastolic blood pressure , and total cholesterol level were significant by two-way repeated- measures anova . As for changes over time within the groups , only the intervention group showed significant differences by Friedman 's test . The complication prevention behaviors showed a high implementation rate in the intervention group . The overall evaluation of this program by the participants was very high and , therefore , they highly recognized the need for this type of program . CONCLUSIONS Self-management education works successfully in relation to patients ' behavior modification skills , degree of goal attainment , and self-efficacy , consequently improving their health outcomes Background Type 2 diabetes mellitus ( DM2 ) is a disease with high prevalence and significant impact in terms of mortality and morbidity . The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management . The Spanish Diabetes Self-Management Program ( SDSMP ) has proven to be effective in other setting s. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care setting s within the Basque Health Service – Osakidetza ( Spain ) . Method / Design This is a r and omised clinical trial in which patients diagnosed with DM2 , 18–79 years of age , from four health regions within the Basque Health Service will be r and omised into two groups : an intervention group , who will follow the SDSMP , and a control group , who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region . The intervention consists of 2,5 hour-group sessions once a week for six weeks . The sessions cover target setting and problem solving techniques , promotion of physical exercise , basic knowledge of nutrition , proper use of medication , effective communication with relatives and health professionals , and basic knowledge about DM2 and its complications . This content is complemented by educational material : books , leaflets and CDs . The primary outcome measure will be the change in glycated haemoglobin ( HbA1c ) , and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables , cardiovascular risk , quality of life , self-efficacy , number of consultations and drug prescriptions . The results will be analysed 6 , 12 and 24 months after the intervention . Discussion If the intervention were to be effective , the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases . Trial registration Clinical Trials.gov identifier Diabetes mellitus is reaching epidemic levels worldwide . In a developing country like Jordan , type 2 diabetes mellitus ( T2DM ) has reached a prevalence rate of 17.1 % . This cross-sectional study examined the relationship between  self-care activities  and : illness perception , depression , social support , religiosity and spiritual coping , and self-efficacy among patients with T2DM . A r and om sample of 220 patients with T2DM , who attended Jordan University Hospital in Jordan were enrolled . The data were collected through a structured interview and the medical files . The instruments consisted of a sociodemographic and clinical st and ardised question naires : Brief Illness Perception Question naire ,  Patients ’ Health Question naire-9 ; ENRICH Social Support Instrument ; Religious and Spiritual Coping Subscale ; Diabetes Management Self-Efficacy Scale ; and  Summary of Diabetes Self-Care Activities .  Bivariate analysis investigated the relationship between variables . Structure Equation Modelling ( SEM ) was performed to test the proposed conceptual model . The study found that approximately 70 % of the respondents suffered some form of depressive symptoms . The SEM showed a direct relationship between self-efficacy and self-care activities ( β = 0.40 ; p < 0.001 ) . Depression was indirectly related to self-care activities through self-efficacy ( β = –0.20 ; p = 0.003 ) ; nevertheless , it was directly related to perception of : treatment control , consequences , and emotional representations . Overall , the sequence between illness perception and self-efficacy was mediated by depression . Strategies to promote self-efficacy and illness perception are vital in customising a diabetes health plan to meet Arabic cultural expectations Background Self-management is crucial in the daily management of type 2 diabetes . It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling . Objective The objective of this study was to test whether the use of a mobile phone – based self-management system used for 1 year , with or without telephone health counseling by a diabetes specialist nurse for the first 4 months , could improve glycated hemoglobin A1c ( HbA1c ) level , self-management , and health-related quality of life compared with usual care . Methods We conducted a 3-arm prospect i ve r and omized controlled trial involving 2 intervention groups and 1 control group . Eligible participants were persons with type 2 diabetes with an HbA1c level ≥7.1 % ( ≥54.1 mmol/mol ) and aged ≥18 years . Both intervention groups received the mobile phone – based self-management system Few Touch Application ( FTA ) . The FTA consisted of a blood glucose – measuring system with automatic wireless data transfer , diet manual , physical activity registration , and management of personal goals , all recorded and operated using a diabetes diary app on the mobile phone . In addition , one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after r and omization . All groups received usual care by their general practitioner . The primary outcome was HbA1c level . Secondary outcomes were self-management ( heiQ ) , health-related quality of life ( SF-36 ) , depressive symptoms ( CES-D ) , and lifestyle changes ( dietary habits and physical activity ) . Data were analyzed using univariate methods ( t test , ANOVA ) and multivariate linear and logistic regression . Results A total of 151 participants were r and omized : 51 to the FTA group , 50 to the FTA-health counseling ( FTA-HC )  group , and 50 to the  control group . Follow-up data after 1 year were available for 120 participants ( 79 % ) . HbA1c level decreased in all groups , but did not differ between groups after 1 year . The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age , gender , and education ( P=.04 ) . Other secondary outcomes did not differ between groups after 1 year . In the FTA group , 39 % were substantial users of the app ; 34 % of the FTA-HC group were substantial users . Those aged ≥63 years used the app more than their younger counterparts did ( OR 2.7 ; 95 % CI 1.02 - 7.12 ; P=.045 ) . Conclusions The change in HbA1c level did not differ between groups after the 1-year intervention . Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group . Older participants used the app more than the younger participants did AIMS To study the effectiveness of a peer-led self-management coaching intervention in recently diagnosed patients with Type 2 diabetes . METHODS R and omized controlled trial of recently diagnosed patients with Type 2 diabetes from 54 participating general practice s. The intervention group received three home visits by an experienced peer ( expert patient ) who adhered to the recommended treatment and lifestyle guidelines . Together with their expert patient , participants set feasible goals and these were evaluated in the next visit . Participants in the control group received care as usual . At baseline , 3 months and 6 months post-intervention , participants completed a question naire measuring changes in self-efficacy , coping , physical activity , dietary habits , psychological well-being , depressive symptoms and diabetes related distress . RESULTS In total , 327 patients were eligible for inclusion in the study of which 133 consented to participate . In participating patients , self-efficacy , coping and saturated fat intake improved significantly over time . Analyses of participants with low self-efficacy at baseline ( 25th percentile : 44 ) revealed a significant time × group difference , F = 3.71 ; P = 0.03 . Participants who reported low psychological well-being at baseline increased substantially throughout the study ( F = 23.84 ; P < 0.01 ) but no significant time × group differences were found . CONCLUSIONS A peer-led self-management coaching programme for recently diagnosed patients with Type 2 diabetes  improved self-efficacy of patients experiencing low self-efficacy shortly after diagnosis OBJECTIVE The objective of this observational open label trial was to characterize changes in diabetes self-management and psychological distress associated with a mobile health ( mHealth ) interactive voice response ( IVR ) self-management support program . METHODS For 3 - 6 months , 301 patients with diabetes received weekly IVR calls assessing health status and self-care  and providing tailored pre-recorded self-management support messages . Patients could participate together with an informal caregiver who received suggestions on self-management support , and patients ' clinicians were notified automatically when patients reported significant problems . RESULTS Patients completed 84 % of weekly calls , providing 5682 patient-weeks of data . Thirty-nine percent participated with an informal caregiver . Outcome analyses adjusted for study design factors and sociodemographics indicated significant pre-post improvement in medication adherence , physical functioning , depressive symptoms , and diabetes-related distress ( all p values < 0.001 ) . Analyses of self-management problems indicated that as the intervention proceeded , there were significant improvements in patients ' IVR-reported frequency of weekly medication adherence , SMBG performance , checking feet , and frequency of abnormal self-monitored blood glucose readings ( all p values < 0.001 ) . CONCLUSIONS We conclude that the combined program of automated telemonitoring , clinician notification , and informal caregiver involvement was associated with consistent improvements in medication adherence , diabetes self-management behaviors , physical functioning , and psychological distress . A r and omized controlled trial is needed to verify these encouraging findings Background The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world . One such national education programme in the United Kingdom is the DESMOND Programme , which has been shown to be robust and effective for patients in general . However , these programmes are not generally targeted to people with intellectual disabilities ( ID ) , and robust evidence on their effects for this population is lacking . We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID.This protocol is for a pilot trial to determine whether a large-scale r and omised trial is feasible , to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes , in particular as a means to reduce glycated haemoglobin ( Hb1Ac ) , improve psychological wellbeing and quality of life and promote a healthier lifestyle . This protocol describes the rationale , methods , proposed analysis plan and organisational and administrative details . Methods / Design This trial is a two arm , individually r and omised , pilot trial for adults with ID and type 2 diabetes , and their family and /or paid carers . It compares the DESMOND-ID programme with usual care .  Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom . Family and /or paid carers may also participate in the study . Participants will be r and omly assigned to one of two conditions using a secure computerised system with robust allocation concealment . A range of data will be collected from the adults with ID ( biomedical , psychosocial and self-management strategies ) and from their carers . Focus groups with all the participants will assess the acceptability of the intervention and the trial . Discussion The lack of appropriate structured education programmes and educational material s for this population leads to secondary health conditions and may lead to premature deaths . There are significant benefits to be gained globally , if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments . Trial registration Registered with International St and ard R and omised Controlled Trial ( identifier : IS RCT N93185560 ) on 10 November 2014 OBJECTIVES The objectives of the study were to investigate the effectiveness of 2 types of peer-led self-management programs in bringing about improvements in subjects with type 2 diabetes mellitus and to determine whether there were differences in effectiveness between the 2 programs . METHODS The study used a 3-arm r and omized controlled trial design with clinical measures taken at baseline and at 6 and 12 months post-program . In total , 405 persons completed baseline question naires and were r and omly allocated to a diabetes self-management program ( n=130 ) , to a general self-management program ( n=109 ) or to a control group ( n=122 ) . A 2-way factorial analyses of variance was employed as the primary statistical analysis . RESULTS The findings showed that the self-management programs had affected 5 of the 30 measures : fatigue , cognitive symptom management , self-efficacy with regard to the disease in general , communication with physician , and the score on the Diabetes Empowerment Scale . In addition , 3 variables-social role limitations , total hospital nights and glycated hemoglobin levels-showed marginally significant interaction effects . The second analysis found similar results , with 4 of the 5 measures remaining statistically significant : fatigue , cognitive symptom management , communication with physician and diabetes empowerment , with neither program being more effective than the other . CONCLUSIONS The major findings are that although both programs were effective in bringing about positive changes in the outcome measures , there was little difference in effectiveness between the Diabetes Self-Management Program and the Chronic Disease Self-Management Program . This finding is consistent with the principle that behaviour-change strategies using self-efficacy are key components in health education programs Objective To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years . Design Three year follow-up of a multicentre cluster r and omised controlled trial in primary care , with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 731 of the 824 participants included in the original trial were eligible for follow-up . Biomedical data were collected on 604 ( 82.6 % ) and question naire data on 513 ( 70.1 % ) participants . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) levels . The secondary outcomes were blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , emotional impact of diabetes , and drug use at three years . Results HbA1c levels at three years had decreased in both groups . After adjusting for baseline and cluster the difference was not significant ( difference −0.02 , 95 % confidence interval −0.22 to 0.17 ) . The groups did not differ for the other biomedical and lifestyle outcomes and drug use . The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years ( P<0.01 ) . Depression scores and quality of life did not differ at three years . Conclusion A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs . Trial registration Current Controlled Trials IS RCT N17844016
Research ers noted small improvements in body mass index immediately after the intervention was provided and at six months , along with improved weight post intervention .
Diabetes knowledge and self efficacy improved immediately following receipt of the intervention , and knowledge also at six months .
The intervention did not improve blood pressure .
Evidence is insufficient to show whether type 2 diabetes self management interventions for people with severe mental illness are effective in improving outcomes .
BACKGROUND People with severe mental illness are twice as likely to develop type 2 diabetes as those without severe mental illness .
Treatment guidelines for type 2 diabetes recommend that structured education should be integrated into routine care and should be offered to all .
However , for people with severe mental illness , physical health may be a low priority , and motivation to change may be limited .
These additional challenges mean that the findings reported in previous systematic review s of diabetes self management interventions may not be generalised to those with severe mental illness , and that tailored approaches to effective diabetes education may be required for this population .
OBJECTIVES To assess the effects of diabetes self management interventions specifically tailored for people with type 2 diabetes and severe mental illness .