Randomized Controlled Trial
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World J Diabetes. Jun 15, 2014; 5(3): 407-414
Published online Jun 15, 2014. doi: 10.4239/wjd.v5.i3.407
Impact of chronic disease self-management programs on type 2 diabetes management in primary care
Samuel N Forjuoh, Marcia G Ory, Luohua Jiang, Ann M Vuong, Jane N Bolin
Samuel N Forjuoh, Department of Family and Community Medicine, Baylor Scott and White Health, College of Medicine, Texas A&M Health Science Center, Temple, TX 76504, United States
Samuel N Forjuoh, Marcia G Ory, Department of Health Promotion and Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843, United States
Samuel N Forjuoh, Luohua Jiang, Ann M Vuong, Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843, United States
Jane N Bolin, Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843, United States
Author contributions: Forjuoh SN, Ory MG and Bolin JN conceptualized the study, acquired funding, provided supervision, interpreted the data, drafted the manuscript, and reviewed the final version; Jiang L and Vuong AM analyzed the data and assisted with data interpretation and manuscript preparation.
Supported by The National Institutes of Health’s National Institute on Minority Health and Health Disparities, No. #1P20MD002295
Correspondence to: Samuel N Forjuoh, MD, MPH, DrPH, FGCP, Department of Family and Community Medicine, Baylor Scott and White Health, College of Medicine, Texas A&M Health Science Center, 1402 West Ave H, Temple, TX 76504, United States. sforjuoh@sw.org
Telephone: +1-254-7717695 Fax: +1-254-7718493
Received: December 4, 2013
Revised: April 10, 2014
Accepted: April 16, 2014
Published online: June 15, 2014
Abstract

AIM: To assess the effectiveness of the Chronic Disease Self-Management Program (CDSMP) on glycated hemoglobin A1c (HbA1c) and selected self-reported measures.

METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls who received usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life (HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.

RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6% (P < 0.0001), but the reductions did not differ significantly between the two groups (P = 0.885). Few significant differences were observed in participants’ diabetes self-care activities. No significant differences were observed in the participants’ HRQOL, pain, or fatigue measures.

CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.

Keywords: Type 2 diabetes, Self-management, Chronic Disease Self-Management Program, Glycemic control, Glycated hemoglobin, Chronic disease

Core tip: Diabetes is a serious chronic disease. One of the most studied evidence-based behavioral or self-care programs targeting chronic conditions including diabetes is the Stanford Chronic Disease Self-Management Program (CDSMP). Although the CDSMP has been studied extensively, its impact on glycemic control has not been thoroughly evaluated in a randomized controlled trial to date. To the best of our knowledge, this is the first study to evaluate the effectiveness of the CDSMP in a randomized controlled trial. Our finding that the CDSMP intervention may not lower hemoglobin A1c any better than good routine care in an integrated healthcare system calls for further research.