|
1
|
Cheng Z, Xiao Q, Xu Y, Tan L, Qu W, Shen W, Luo Y. Effectiveness of patient-centred care in self-management of type 2 diabetes: a systematic review and meta-analysis. BMC Health Serv Res 2025; 25:613. [PMID: 40296007 PMCID: PMC12036161 DOI: 10.1186/s12913-025-12539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 03/07/2025] [Indexed: 04/30/2025] Open
Abstract
OBJECTIVE To assess the effectiveness of community-home patient-centred care (PCC) in the self-management of type 2 diabetes using a systematic evaluation approach. METHODS This systematic review and meta-analysis adhered to the PRISMA 2020 guideline. The PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese Periodicals Full Text Database, CQVIP Chinese Journals Platform and Wanfang databases were searched between database inception and February 2025, with no language limit, using keywords related to type 2 diabetes, PCC and self-management. References of the included studies were reviewed, and citation tracking was used. Eligible studies were English or Chinese peer-reviewed randomised controlled trials (RCTs) involving patients with type 2 diabetes, with PCC applied in the trial group and routine care in the control group, focusing on self-management outcomes. Two reviewers independently screened and extracted data, resolving disagreements through a third reviewer. The Cochrane risk assessment tool was used to assess study quality, with Review Manager 5.3 software used to analyse data using mean difference (MD) and 95%CI via a random-effects model. Heterogeneity was tested, and sensitivity analysis and funnel plots were also used. RESULTS A total of 18 RCTs were included, including 6 Chinese and 12 English studies, with 1,893 patients with type 2 diabetes followed up in this study. Following intervention for at least 6 months, compared with routine treatment, PCC reduced fasting blood glucose (FBG) (MD = - 1.27, 95%CI: [- 2.19, - 0.74], I2 = 34%, fixed-effect model) and 2-hour postprandial blood glucose (2hPG) (MD = - 0.76, 95%CI: [- 1.23,-0.28], I2 = 81%, random-effects model), but there was no improvement in body mass index (BMI) (MD = - 0.59, 95%CI: [- 1.31, - 0.13], I2 = 0%, fixed-effect model) or foot care (MD = - 1.51, 95%CI: [- 2.17, - 5.19], I2 = 94%, random-effects model). After 3 months of intervention, compared with the routine treatment, PCC decreased glycosylated haemoglobin A1c (HbA1c) levels (MD = - 0.60, 95%CI: [- 0.88, - 0.32], I2 = 81%, random-effects model), but the BMI did not decrease significantly (MD = - 0.26, 95%CI: [- 1.46, - 0.93], I2 = 0%, fixed-effect model). CONCLUSION Compared with routine nursing, community-home PCC nursing can reduce the levels of FBG, 2-hour plasma glucose (2hPG) and glycated haemoglobin A1c (HbA1c) in patients with type 2 diabetes. A unified PCC protocol could help patients with diabetes control the disease.
Collapse
Affiliation(s)
- Zhen Cheng
- Guantian Community Healthcare Center, Shenzhen Baoan Shiyan People's Hospital, No.11, Jixiang Road, Shiyan Street, Baoan District, Shenzhen, 518108, China
| | - Qingyu Xiao
- Department of Blood Transfusion, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, 518108, China
| | - Yanfei Xu
- Guantian Community Healthcare Center, Shenzhen Baoan Shiyan People's Hospital, No.11, Jixiang Road, Shiyan Street, Baoan District, Shenzhen, 518108, China
| | - Lianyi Tan
- Department of Neurosurgery, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, 518108, China
| | - Weixiang Qu
- Department of Gastroenterology, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, 518108, China
| | - Wenying Shen
- Department of Ultrasonography, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, 518108, China
| | - Yu Luo
- Yingrenshi Community Healthcare Center, Shenzhen Baoan Shiyan People's Hospital, No.11, Jixiang Road, Shiyan Street, Baoan District, Shenzhen, 518108, China.
| |
Collapse
|
|
2
|
Amiri S, Mahmood N, Javaid SF, Khan MAB. The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Healthcare (Basel) 2024; 12:2263. [PMID: 39595461 PMCID: PMC11594078 DOI: 10.3390/healthcare12222263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/29/2024] [Accepted: 11/08/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations. METHODS Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges' g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined. RESULTS Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g -0.21, 95% confidence interval -0.26, -0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g -0.24, 95% confidence interval -0.32, -0.15; p < 0.001; I2 = 59.25), and stress (-0.34, -0.11; p < 0.001; I2 = 61.40). CONCLUSIONS Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.
Collapse
Affiliation(s)
- Sohrab Amiri
- Spiritual Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran 17166, Iran;
| | - Nailah Mahmood
- Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK;
| | - Syed Fahad Javaid
- Health and Wellness Research Group, Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Moien AB Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| |
Collapse
|
|
3
|
Akif A, Qusar MMAS, Islam MR. The Impact of Chronic Diseases on Mental Health: An Overview and Recommendations for Care Programs. Curr Psychiatry Rep 2024; 26:394-404. [PMID: 38767815 DOI: 10.1007/s11920-024-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE OF REVIEW The current achievement of medical advancement is noteworthy; however, the occurrence of chronic diseases is increasing day by day, with a significant percentage of affected people are suffering from a mental health crisis. This article aims to present a thorough yet brief review of methods that can be employed to build the emotional wellness of chronic patients. RECENT FINDINGS The mental health care strategies include resilience-building, coping skills training, professional counseling, and lifestyle adaptations. Additionally, the article highlights the efficacy of several modern interventions, such as mindfulness-based therapies, cognitive behavioral therapy, eye movement desensitization, and recovery from stress therapy. The global burden of chronic illness emphasizes the pressing need to mitigate mental health problems among chronic patients. By providing actionable insights, our study clears the path for targeted interventions and holistic approaches for chronic disease patients. Moreover, the article suggests to policymakers and clinicians the need for collaboration and multifaceted interventions.
Collapse
Affiliation(s)
- Adnan Akif
- University of Houston College of Pharmacy, 4349 Martin Luther King Boulevard, Houston, TX, 77204-5000, USA
| | - M M A Shalahuddin Qusar
- Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Shahabagh, 1000, Dhaka, Bangladesh
| | - Md Rabiul Islam
- School of Pharmacy, BRAC University, Kha 224 Bir Uttam Rafiqul Islam Avenue, Merul Badda, Dhaka, 1212, Bangladesh.
| |
Collapse
|
|
4
|
Suminski RR, Leonard T, Obrusnikova I, Kelly K. The Impact of Health Coaching on Weight and Physical Activity in Obese Adults: A Randomized Control Trial. Am J Lifestyle Med 2024; 18:233-242. [PMID: 38559788 PMCID: PMC10979733 DOI: 10.1177/15598276221114047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Health Coaching (HC) is an evidence-based, patient-centered approach to assisting individuals in achieving their health-related goals. Studies have generally shown positive effects of HC on weight loss in obese adults. However, limitations do exist, that if addressed would further clarify HC's viability as a clinical, obesity treatment approach. To examine the effects of HC on weight loss, moderate-to-vigorous physical activity (MVPA), and psychosocial constructs in obese adults. A randomized control trial with 44 [Mean body mass index (BMI) 36.5] middle-aged, White adults. Participants were randomly assigned to HC (n = 22) or control (n = 22) groups. A certified health coach provided bi-weekly, in-person and telehealth HC for 12 weeks. Percent excess weight loss was 15.7% in HC vs. 2.5% in controls (p< .001). The change in MVPA was significantly greater in HC (+50.3 min/wk) vs controls (+7.1 min/wk). Psychosocial constructs also changed more favorably in HC than controls. Health coaching is an effective approach for weight loss in obese adults. The results of this study support the consideration of HC as a treatment option for obese adults looking to lose weight.
Collapse
Affiliation(s)
- Richard R. Suminski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Tara Leonard
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Iva Obrusnikova
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Kristin Kelly
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| |
Collapse
|
|
5
|
Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 117:107975. [PMID: 37738790 PMCID: PMC10964774 DOI: 10.1016/j.pec.2023.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Health and Wellness Coaching (HWC) may be beneficial in chronic condition care. We sought to appraise its effectiveness on quality of life (QoL), self-efficacy (SE), depression, and anxiety. METHODS We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL for randomized trials published January 2005 - March 2023 that compared HWC to standard clinical care or another intervention without coaching. We examined QoL, SE, depression, or anxiety outcomes. Meta-analysis utilizing the random-effects model was used to estimate the pooled standardized mean difference (SMD). RESULTS Thirty included studies demonstrated that HWC improved QoL within 3 months (SMD 0.62 95 % CI 0.22-1.02, p = 0.002), SE within 1.5 months (SMD 0.38, 95 % CI 0.03-0.73, p = 0.03), and depression at 3, 6, and 12 months (SMD 0.67, 95 % CI 0.13-1.20, p = 0.01), (SMD 0.72, 95 % CI 0.19-1.24, p = 0.006), and (SMD 0.41, 95 % CI 0.09-0.73, p = 0.01) Certainty in the evidence for most outcomes was either very low or low primarily due to the high risk of bias, heterogeneity, and imprecision. CONCLUSION HWC improves QoL, SE, and depression across chronic illness populations. Future research needs to standardize intervention reporting and outcome collection. PRACTICE IMPLICATIONS Future HWC studies should standardize intervention components, reporting, and outcome measures, apply relevant chronic illness theories, and aim to follow participants for greater than one year.
Collapse
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Neri A Álvarez-Villalobos
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico; School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Suzette Barakat
- Community Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Humberto de Leon-Gutierrez
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Fernando G Ruiz-Hernandez
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | | | - Héctor Vaquera-Alfaro
- School of Medicine and University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | - Sangwoo Ahn
- University of Tennessee Knoxville, Knoxville, TN, USA.
| | | | - Michael R Gionfriddo
- Department of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA.
| | - Juan M Millan-Alanis
- Plataforma INVEST-KER Unit Mayo Clinic (KER Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, Mexico.
| | | | | | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Zhen Wang
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
|
6
|
Wang X, Liu XQ. Potential and limitations of ChatGPT and generative artificial intelligence in medical safety education. World J Clin Cases 2023; 11:7935-7939. [DOI: 10.12998/wjcc.v11.i32.7935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
The primary objectives of medical safety education are to provide the public with essential knowledge about medications and to foster a scientific approach to drug usage. The era of using artificial intelligence to revolutionize medical safety education has already dawned, and ChatGPT and other generative artificial intelligence models have immense potential in this domain. Notably, they offer a wealth of knowledge, anonymity, continuous availability, and personalized services. However, the practical implementation of generative artificial intelligence models such as ChatGPT in medical safety education still faces several challenges, including concerns about the accuracy of information, legal responsibilities, and ethical obligations. Moving forward, it is crucial to intelligently upgrade ChatGPT by leveraging the strengths of existing medical practices. This task involves further integrating the model with real-life scenarios and proactively addressing ethical and security issues with the ultimate goal of providing the public with comprehensive, convenient, efficient, and personalized medical services.
Collapse
Affiliation(s)
- Xin Wang
- School of Education, Tianjin University, Tianjin 300350, China
| | - Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
| |
Collapse
|
|
7
|
Sequeira M, Pereira C, Alvarez MJ. Promoting physical activity within breast cancer survivors using behavior change techniques: N-of-1 randomized controlled trials. Health Promot Int 2023; 38:daad075. [PMID: 37466433 DOI: 10.1093/heapro/daad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Survivors of breast cancer are an important target for health promotion interventions, and physical activity (PA) is recommended with benefits being well established. More and more behavior theory guided interventions are planned and tailored to the individuals, targeting specifics needs and personal characteristics. We aimed to test the effectiveness of two behavior change techniques [coping planning (CP) and self-monitoring (SM)] for promoting PA in survivors of breast cancer, using a single-case design. In a powerful multiple sample N-of-1 RCT, 10 women post-breast cancer (M = 52.8 years) were randomly assigned to four experimental conditions (CP and/or SM, control) for 60 days and their daily step count was observed. The overall effects were analyzed using multilevel time-series with random intercepts. Time-series regression models and supplementary pairwise analyses were conducted for individuals. Multilevel analyses showed significant effects of CP and SM. Single-case analyses showed that six participants walked significantly more on the intervention days, that combined interventions were effective for five participants, but two participants had better results with the other two conditions. Combined self-regulatory techniques were more effective in promoting PA however, individual variability should be considered in future studies with survivors of breast cancer. Retrospectively registered: https://osf.io/eakjy/?view_only=81bf3dc084a0410a8ea28265e0f3c360, 31-01-2023.(raise query).
Collapse
Affiliation(s)
- Margarida Sequeira
- CICPSI, Department of Psychology, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
- CIIAS, Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setubal, Portugal
| | - Cícero Pereira
- ICS, Department of Psychology, Instituto de Ciências Sociais da Universidade de Lisboa, Lisbon, Portugal
| | - Maria-João Alvarez
- CICPSI, Department of Psychology, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
|
8
|
Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2023; 17:794-825. [PMID: 34957864 PMCID: PMC10210100 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
Collapse
Affiliation(s)
- Stine Hangaard
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Sisse H. Laursen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University
College of Northern Denmark, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
- Department of Endocrinology, Aalborg
University Hospital, Aalborg, Denmark
- Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
|
9
|
Almulhim AN, Hartley H, Norman P, Caton SJ, Doğru OC, Goyder E. Behavioural Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis. BMC Public Health 2023; 23:95. [PMID: 36639632 PMCID: PMC9837922 DOI: 10.1186/s12889-022-14874-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Given the high rates globally of Type 2 Diabetes Mellitus (T2DM), there is a clear need to target health behaviours through person-centred interventions. Health coaching is one strategy that has been widely recognised as a tool to foster positive behaviour change. However, it has been used inconsistently and has produced mixed results. This systematic review sought to explore the use of behaviour change techniques (BCTs) in health coaching interventions and identify which BCTs are linked with increased effectiveness in relation to HbA1C reductions. METHODS In line with the PICO framework, the review focused on people with T2DM, who received health coaching and were compared with a usual care or active control group on HbA1c levels. Studies were systematically identified through different databases including Medline, Web of science, and PsycINFO searches for relevant randomised controlled trials (RCTs) in papers published between January 1950 and April 2022. The Cochrane collaboration tool was used to evaluate the quality of the studies. Included papers were screened on the reported use of BCTs based on the BCT taxonomy. The effect sizes obtained in included interventions were assessed by using Cohen's d and meta-analysis was used to estimate sample-weighted average effect sizes (Hedges' g). RESULTS Twenty RCTs with a total sample size of 3222 were identified. Random effects meta-analysis estimated a small-sized statistically significant effect of health coaching interventions on HbA1c reduction (g+ = 0.29, 95% CI: 0.18 to 0.40). A clinically significant HbA1c decrease of ≥5 mmol/mol was seen in eight studies. Twenty-three unique BCTs were identified in the reported interventions, with a mean of 4.5 (SD = 2.4) BCTs used in each study. Of these, Goal setting (behaviour) and Problem solving were the most frequently identified BCTs. The number of BCTs used was not related to intervention effectiveness. In addition, there was little evidence to link the use of specific BCTs to larger reductions in HbA1c across the studies included in the review; instead, the use of Credible source and Social reward in interventions were associated with smaller reductions in HbA1c. CONCLUSION A relatively small number of BCTs have been used in RCTs of health coaching interventions for T2DM. Inadequate, imprecise descriptions of interventions and the lack of theory were the main limitations of the studies included in this review. Moreover, other possible BCTs directly related to the theoretical underpinnings of health coaching were absent. It is recommended that key BCTs are identified at an early stage of intervention development, although further research is needed to examine the most effective BCTs to use in health coaching interventions. TRIAL REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228567 .
Collapse
Affiliation(s)
- Abdullah N Almulhim
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, 13316, Saudi Arabia.
| | - Hannah Hartley
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK
| | - Paul Norman
- Department of Psychology, The University of Sheffield, Cathedral Court, The University of Sheffield, Vicar Ln, Sheffield, S1 2LT, UK
| | - Samantha J Caton
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| | - Onur Cem Doğru
- Department of Psychology, Afyon Kocatepe University, Gazlıgöl St, 03200, Afyonkarahisar, Turkey
| | - Elizabeth Goyder
- School of Health and Related Research, The University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| |
Collapse
|
|
10
|
Kusuma CF, Aristawidya L, Susanti CP, Kautsar AP. A review of the effectiveness of telemedicine in glycemic control in diabetes mellitus patients. Medicine (Baltimore) 2022; 101:e32028. [PMID: 36482628 PMCID: PMC9726301 DOI: 10.1097/md.0000000000032028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This review aimed to evaluate the effectiveness of telemedicine as an intervention for patients with diabetes mellitus, considering blood glucose levels as the primary outcome. A comprehensive literature search was performed using the PubMed, Embase, Web of Science, and EBSCO databases. This narrative review covered randomized controlled trials published in English. The process of selecting studies adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. Nine studies were selected, and their data were analyzed and summarized. Five of the nine reviewed studies found that telemedicine counseling was effective in decreasing glycated hemoglobin A (HbA1c) levels in the blood. Due to methodological limitations, one study could not report HbA1c results, and two studies reported that telemedicine counseling did not lead to any significant changes in HbA1c levels. One study found that while HbA1c levels did not show a marked decrease, patients' treatment adherence and quality of life improved when telemedicine was combined with health counseling. Moreover, six studies found that telemedicine counseling was more effective than traditional counseling regarding secondary outcomes. The overall findings of this review suggest that telemedicine counseling is more effective than conventional counseling in achieving decreased blood glucose levels in patients with diabetes mellitus while increasing their treatment adherence and improving their quality of life.
Collapse
Affiliation(s)
- Clara Fernanda Kusuma
- Undergraduate of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Levina Aristawidya
- Undergraduate of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Chairani Putri Susanti
- Undergraduate of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Angga Prawira Kautsar
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Department of Pharmaceutics and Technology of Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen (RUG)/University Medical Center Groningen (UMCG), Groningen, The Netherlands
- * Correspondence: Angga Prawira Kautsar, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java 45363, Indonesia (e-mail: )
| |
Collapse
|
|
11
|
Asmat K, Dhamani K, Gul R, Froelicher ES. The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis. Front Public Health 2022; 10:994766. [PMID: 36388341 PMCID: PMC9650641 DOI: 10.3389/fpubh.2022.994766] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/03/2022] [Indexed: 01/26/2023] Open
Abstract
Background Patient-centered care in diabetes self-management might be a significant factor in improving health outcomes of adults with type 2 diabetes, yet the supporting evidence is inadequate. This review aimed at assessing the effectiveness of patient-centered self-management care interventions on glycemic control (HbA1c) and self-care behaviors compared with usual care. Methods CINAHL, PubMed, Cochrane Library, Google Scholar, and the HEC Digital Library were searched for studies in English language that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or older with type 2 diabetes from 2005 to 2020. Interventional studies with at least 3 months of follow-up and reporting on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors including diet control, physical activity, foot care, and medication adherence were included. Results Of 168 identified records, 24 were found eligible comprising 20 RCTs and four QESs with total 4,083 participants. The meta-analysis involved 19 RCTs that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c, -0.56 (95% CI -0.79, -0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components, -0.66 (95% CI -0.97, -0.34); spanned over shorter (<03 months) duration, -0.85 (95% CI -1.28, -0.43); administered by nurses, -0.80 (95% CI -1.44, -0.16); and delivered in community settings -0.70 (95% CI -1.14, -0.26). Conclusion This systematic review provided evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing toward success.
Collapse
Affiliation(s)
- Kainat Asmat
- Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan,*Correspondence: Kainat Asmat
| | - Khairunnisa Dhamani
- Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Raisa Gul
- Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing and Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
|
12
|
Hamidi S, Gholamnezhad Z, Kasraie N, Sahebkar A. The Effects of Self-Efficacy and Physical Activity Improving Methods on the Quality of Life in Patients with Diabetes: A Systematic Review. J Diabetes Res 2022; 2022:2884933. [PMID: 35936392 PMCID: PMC9348907 DOI: 10.1155/2022/2884933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/15/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review is to study the impact of self-efficacy-improving strategies on physical activity-related glycemic control of diabetes. METHOD This systematic review was conducted based on the PRISMA statement. ("Diabetes" OR "glycemic control") AND ("exercise" OR "physical activity") AND "self-efficacy" were searched as keywords in databases including PubMed, Google Scholar, Science Direct, Embase, Cochrane, Web of Science, and Scopus between 2000 and 2019 for relesvant articles. RESULTS Two reviewers independently screened articles (n = 400), and those meeting eligibility criteria (n = 47) were selected for data extraction using a predesigned Excel form and critical appraisal using the "Tool for Quantitative Studies." Different strategies and health promotion programs such as individual or group face-to-face education and multimedia (video conference, video, phone calls, short message service, and Internet-based education) were used in diabetes self-management education programs. The results of different interventions including motivational interviewing (7 studies), exercise (5 studies), multidimensional self-management programs (25 studies), and electronic education (11 studies) had been evaluated. Interventions with more social support, longer duration, combined educative theory-based, and individual education had better outcomes both in postintervention and in follow-up evaluation. CONCLUSION A combination of traditional and virtual long-lasting self-care promoting (motivating) programs is needed to improve patients' self-efficacy for healthy habits like active lifestyle.
Collapse
Affiliation(s)
- Sajjad Hamidi
- Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Gholamnezhad
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Kasraie
- Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, Texas, USA
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
|
13
|
Oyedeji AD, Ullah I, Weich S, Bentall R, Booth A. Effectiveness of non-specialist delivered psychological interventions on glycemic control and mental health problems in individuals with type 2 diabetes: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:9. [PMID: 35120528 PMCID: PMC8817494 DOI: 10.1186/s13033-022-00521-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Typically, specialist mental health professionals deliver psychological interventions for individuals with poorly controlled type 2 diabetes mellitus (T2DM) and related mental health problems. However, such interventions are not generalizable to low- and middle-income countries, due to the dearth of trained mental health professionals. Individuals with little or no experience in the field of mental health (referred to as non-specialists) may have an important role to play in bridging this treatment gap. Aim To synthesise evidence for the effectiveness of non-specialist delivered psychological interventions on glycaemic control and mental health problems in people with T2DM. Methods Eight databases and reference lists of previous reviews were systematically searched for randomized controlled trials (RCTs). Outcome measures were glycated hemoglobin (HbA1c), diabetes distress and depression. The Cochrane Collaboration Risk of Bias Tool was used for risk of bias assessment. Data from the included studies were synthesized using narrative synthesis and random effects meta-analysis. Results 16 RCTs were eligible for inclusion in the systematic review. The 11 studies that were pooled in the meta-analysis demonstrated a reduction in HbA1c in favor of non-specialist delivered psychological interventions when compared with control groups (pooled mean difference = − 0.13; 95% CI − 0.22 to − 0.04, p = 0.005) with high heterogeneity across studies (I2 = 71%, p = 0.0002). The beneficial effects of the interventions on diabetes distress and depression were not consistent across the different trials. Conclusion Non-specialist delivered psychological interventions may be effective in improving HbA1c. These interventions have some promising benefits on diabetes distress and depression, although the findings are inconclusive. More studies of non-specialist delivered psychological interventions are needed in low- and middle-income countries to provide more evidence of the potential effectiveness of these interventions for individuals living with T2DM.
Collapse
Affiliation(s)
- Ayodeji D Oyedeji
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
| | - Ibrahim Ullah
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Richard Bentall
- Department of Psychology, University of Sheffield, Sheffield, S1 4DA, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| |
Collapse
|
|
14
|
Natalicchio A, Sculco C, Belletti G, Fontanelli M, Galeone C, Bossi AC. Patient-Support Program in Diabetes Care During the Covid-19 Pandemic: An Italian Multicentric Experience. Patient Prefer Adherence 2022; 16:113-122. [PMID: 35068927 PMCID: PMC8769051 DOI: 10.2147/ppa.s343949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Telephone coaching and health apps are effective means to support subjects with diabetes. Patient support programs (PSP) on type 2 diabetes are scanty, and none has been conducted in Italy. In a pilot phase, conducted during the COVID-19 pandemic, we aimed to examine the feasibility and acceptance of such program. METHODS The "BE THere for diabetes CARE" (BETHCARE) project is a real-world PSP conducted through telephone and digital coaching system to provide educational and emotional support to Italian adults with diabetes receiving long-acting basal insulin degludec. This pilot phase was conducted in 11 centres that enrolled a total of 63 patients (89% with type-2 diabetes). Counselors contacted patients to define a set of emotional, physical and nutritional targets, and monitoring calls were performed on a monthly basis. Data were collected on socio-demographic and anthropometric characteristics, selected clinical information, quality of life, achievement of targets and patient satisfaction. RESULTS Fifty-eight subjects (92%) chose to participate by telephone and 5 (8%) by mobile app. Most participants (ie, ≥80%) evaluated counselors' calls "useful/very useful", duration of calls "adequate/adequately long", were satisfied with the educational pathway and declared to be more confident in diabetes management after the program. About half of participants were confident to maintain their targets after the PSP. Achievement of nutritional targets improved during counseling, from a mean score of 1.56 at week 1 to 1.88 at week 16 (p-value = 0.03). No significant variations in the achievement of emotional and physical targets emerged. Mean patients weight decreased from 84.9 kg (week 1) to 84.3 kg (week 4) and then levelled off (84.2 kg, week 16). CONCLUSION This project demonstrated the feasibility and patient appreciation of a PSP in diabetes care, which is particularly important for a chronic disease of the elderly and during a pandemic period when face-to-face counseling is problematic.
Collapse
Affiliation(s)
- Annalisa Natalicchio
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Camilla Sculco
- Healthcare Network Partners Italy, Bologna, Italy
- Correspondence: Camilla Sculco Email
| | | | | | | | | |
Collapse
|
|
15
|
Batalha APDB, Ponciano IC, Chaves G, Felício DC, Britto RR, da Silva LP. Behavior change interventions in patients with type 2 diabetes: a systematic review of the effects on self-management and A1c. J Diabetes Metab Disord 2021; 20:1815-1836. [PMID: 34900827 PMCID: PMC8630317 DOI: 10.1007/s40200-021-00846-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to identify the characteristics of interventions employed to promote behavior change in people with type 2 diabetes mellitus (T2DM) and their impact on disease self-management and glycated hemoglobin (A1c). METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to guide the protocol development for this systematic review. Randomized controlled clinical trials which compared behavior change interventions to controls in adults with T2DM and investigated disease self-management and glycated hemoglobin (A1c) measured by validated methods were eligible for this study. The risk of bias and quality of evidence was assessed respectively by Cochrane's tool and grading of recommendations, assessment, development, and evaluation (GRADE). RESULTS A total of 27 studies were included involving 4464 participants. Behavior change was mainly promoted by education sessions on diabetes care delivered face-to-face, monthly, or every other month, lasting more than 60 min, involving blood glucose monitoring, healthy eating, exercise, and medication. Four studies showed significant improvement in both disease self-management and A1c. The risk of bias was classified as high in most studies. A meta-analysis could not be performed for A1c and self-management due to the high differences in intervention parameters (delivery mode, number, duration, and frequency) and self-management assessments. CONCLUSION Low evidence of improvement in disease self-management and A1c considering only validated assessment methods were found for behavior change interventions, mainly promoted by education sessions on diabetes care. The quality of studies and probably the differences in intervention protocols contributed to this finding. PROSPERO NUMBER CRD42020161162.
Collapse
Affiliation(s)
- Ana Paula Delgado Bomtempo Batalha
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
| | - Isabela Coelho Ponciano
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
| | | | - Diogo Carvalho Felício
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
- Faculty of Physical Therapy, UFJF, Juiz de Fora, MG Brazil
| | - Raquel Rodrigues Britto
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
- Graduate Program in Rehabilitation Science, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Lilian Pinto da Silva
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
- Faculty of Physical Therapy, UFJF, Juiz de Fora, MG Brazil
- Cardiovascular Research and Exercise Physiology Unit, University Hospital, UFJF, Juiz de Fora, MG Brazil
- Faculty of Physiotherapy, Federal University of Juiz de Fora, Av. Eugenio do Nascimento S/N Bairro Dom Bosco, Juiz de Fora, MG CEP: 36038-330 Brazil
| |
Collapse
|
|
16
|
Mayberry LS, Nelson LA, Gonzalez JS. Adults with type 2 diabetes benefit from self-management support intervention regardless of depressive symptoms. J Diabetes Complications 2021; 35:108024. [PMID: 34521578 PMCID: PMC8511161 DOI: 10.1016/j.jdiacomp.2021.108024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023]
Abstract
AIMS Elevated depressive symptoms are common among adults with type 2 diabetes (T2D). In a secondary analysis from an RCT of a diabetes self-management support intervention that did not target depressive symptoms, we sought to determine if depressive symptoms were reduced by the intervention (i.e., depressive symptoms an outcome) or, alternatively, if intervention effects on hemoglobin A1c were lesser among persons with clinically elevated depressive symptoms (i.e., depressive symptoms an effect modifier). METHODS We evaluated a text messaging intervention, REACH, in a diverse (half non-white, half underinsured) sample of N = 506 adults with T2D. Participants completed the Patient Health Questionnaire-8 (PHQ) and A1c tests at baseline and 6 months. We conducted a factor analysis to identify somatic- and cognitive-affective symptoms on the PHQ. We tested our hypotheses with regression models, using interaction terms and subgroup analyses. RESULTS REACH improved depressive symptoms among participants with lower baseline A1c (<8.5%; β = -0.133, p = .007; cognitive β = -0.107, p = .038; somatic β = -0.131, p = .014) but not among participants with higher baseline A1c (≥8.5%; β = 0.040, p = .468). Baseline depressive symptoms did not modify the effect on A1c. CONCLUSIONS We found support for the hypothesis that depressive symptoms - both somatic- and cognitive-affective - may be an outcome, rather than an effect modifier, of effective diabetes self-management support interventions.
Collapse
Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Center for Diabetes Translation Research, Nashville, TN, United States of America.
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Center for Diabetes Translation Research, Nashville, TN, United States of America
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States of America; Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America; New York Regional Center for Diabetes Translation Research, Bronx, NY, United States of America
| |
Collapse
|
|
17
|
Nguyen TV, Wantonoro W, Suryaningsih EK. Self-management Behavior Interventions for Type 2 Diabetes Mellitus: A Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Diabetes mellitus is chronic diseases with serious complications and reduces the quality of life of patients. Evidence based strategies to enhance diabetes self-management may prevent complications and enhance the quality of life for patients is needed.
AIM: This study to summarize the types of intervention strategies used to enhance diabetes self-management behaviors in adult individuals type 2 diabetes mellitus (T2DM).
METHOD: This study was used Literature review randomized controlled trials study. PubMed, Scopus, Web of Science, and Cochrane Library data base were used. Jadad scale checklist was used to evaluate quality appraisal included in the study.
RESULTS: Twenty-six randomized controlled trials studies were included in this review. Overall, quality of the studies was high-quality. Varied interventions included studies at different countries were found to enhance diabetes self-management behaviors in T2DM patients. In addition, almost type interventions were reported a significant enhancement diabetes self-management behaviors especially in adults with type 2 diabetes patients.
CONCLUSION: Varied self-management behavior interventions in diabetes mellitus. This review suggested for investigate best intervention to enhance diabetes self-management behaviors in different cultural for best outcomes.
Collapse
|
|
18
|
Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, Heller S, Ismail K. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess 2021; 24:1-232. [PMID: 32568666 DOI: 10.3310/hta24280] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. OBJECTIVES The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. DATA SOURCES The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. REVIEW METHODS Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). DESIGN Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. SETTING Settings in primary or secondary care were included. PARTICIPANTS Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. INTERVENTIONS The interventions used were psychological treatments, including and not restricted to cognitive-behavioural therapy, counselling, family therapy and psychotherapy. MAIN OUTCOME MEASURES Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. RESULTS A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of -0.13 (95% confidence interval -0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval -0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of -0.21 (95% confidence interval -0.31 to -0.10), equivalent to reduction in glycated haemoglobin levels of -0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive-behavioural therapy are clinically effective and cognitive-behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive-behavioural therapy and counselling are effective and cognitive-behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. LIMITATIONS Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40-50% of studies. CONCLUSIONS This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. FUTURE WORK Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033619. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
| | - Daniel Pollard
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Architaa Kasera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
|
19
|
Kang E, Park SM, Lee K, Lee EB, Yim JJ, Lee J, Kim S, Rhee YE, Yun YH. Efficacy of Health Coaching and an Electronic Health Management Program: Randomized Controlled Trial. J Gen Intern Med 2021; 36:2692-2699. [PMID: 33674921 PMCID: PMC8390579 DOI: 10.1007/s11606-021-06671-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND For chronic disease management, self-management strategies are essential to achieve sustained improvement. OBJECTIVE Our study evaluated the efficacy of health coaching and a self-management strategy-based electronic program on self-management strategies for patients with osteoporosis, chronic respiratory disease, or arthritis. DESIGN Three-arm randomized controlled trial, pilot study PARTICIPANTS: Fifty-four participants INTERVENTIONS: The first intervention group (n = 53) received a self-management strategy-based electronic program and 12 weeks of health coaching (20 sessions). The second intervention group received the information and communications technology (ICT) program; the control group received usual care and an educational booklet about self-management of chronic diseases. MAIN MEASURES The primary outcome was the difference in the change of the mean of self-management strategy scores. Secondary outcomes included depression (PHQ-9), physical activity (Godin Leisure Exercise Questionnaire), and health habit maintenance (transtheoretical model) after 12 weeks in the program. KEY RESULTS The combination of health coaching and ICT was superior to control group (change 18.5 vs. - 2.6, adjusted difference = 24.5, p < 0.001); however, the ICT alone group was not superior to the control group (change 8.0 vs. - 2.6, adjusted difference = 8.0, p = 0.156). As a result of evaluating the change in the percentage of people with positive stage changes in the transtheoretical model of health habits, regular exercise (p = 0.008), a balanced diet (p = 0.005), helping others (p = 0.001), and living with loved ones (p = 0.038) showed significant differences. There was no significant difference in the changes in percentage of patients with depressive symptoms in comparison with control group; however, there was in comparison with control group among groups (p = 0.033). Compared to the control group, the proportion of patients who achieved an exercise amount of 12.5 MET or higher was significantly higher (p = 0.028) in the health coaching and ICT group. CONCLUSIONS The combination of ICT + health coaching led to improvement in self-management as well as in increasing exercise, and several healthy behaviors. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03294057.
Collapse
Affiliation(s)
- EunKyo Kang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kiheon Lee
- Department of Family Medicine, Bundang Seoul National University Hospital, Seongnam, Republic of Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jihye Lee
- Department of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soojeong Kim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ye Eun Rhee
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
|
20
|
Upsher R, Onabajo D, Stahl D, Ismail K, Winkley K. The Effectiveness of Behavior Change Techniques Underpinning Psychological Interventions to Improve Glycemic Levels for Adults With Type 2 Diabetes: A Meta-Analysis. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:699038. [PMID: 36994330 PMCID: PMC10012110 DOI: 10.3389/fcdhc.2021.699038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022]
Abstract
An existing systematic review and meta-analysis found a significant reduction in glycemic levels for adults with type 2 diabetes who received a psychological intervention over control conditions. To help develop effective interventions in the future, there is a need to understand the active ingredients which underpin these psychological interventions. We conducted a secondary meta-analysis including 67 randomized controlled trials (RCTs) reported in English. We reviewed the psychological intervention descriptions of the included studies of the existing review and extracted the behavior change techniques (BCTs) according to the BCT taxonomy (BCTTv1). We also extracted information on primary behavioral target versus primary outcome, and presence of fidelity assessment. The most frequent BCTs across RCTs were ‘social support (unspecified)’ (n=50), ‘problem solving’ (n=38) and ‘goal setting (behavior’) (n=30). These BCTs were independently associated with a significant reduction in glycemic levels (HbA1c) compared to control conditions, but not significantly different from studies that did not include these BCTs. Meta-regressions revealed no significant associations between HbA1c, and psychological intervention category (counselling versus cognitive behavioral therapy interventions) (p=0.84), frequency of BCTs per psychological intervention (p=0.29), primary behavioral target versus primary outcome (p=0.48), or presence of fidelity assessment (p=0.15). Social support (unspecified), problem solving, and goal setting (behavior) could be useful BCTs to develop psychological interventions for people with type 2 diabetes to improve glycemic levels. However, more research is required to understand which combination of individual BCTs are most effective for this population.Systematic Review RegistrationRegistered with the international prospective register of systematic reviews registration (PROSPERO) CRD42016033619.
Collapse
Affiliation(s)
- Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- *Correspondence: Rebecca Upsher,
| | - Deborah Onabajo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, London, United Kingdom
| |
Collapse
|
|
21
|
Mohan A, Vadhariya A, Majd Z, Esse TW, Serna O, Abughosh SM. Impact of a motivational interviewing intervention targeting statins on adherence to concurrent hypertension or diabetes medications. PATIENT EDUCATION AND COUNSELING 2021; 104:1756-1764. [PMID: 33402279 DOI: 10.1016/j.pec.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study explored if a motivational interviewing intervention customized for statins impacted adherence to concomitantly used antidiabetic/antihypertensive medications. METHODS The intervention was conducted among patients with a history of suboptimal adherence to statins and included 152 patients in intervention and 304 controls. This retrospective study design identified patients with claims for statins and either antidiabetic/antihypertensive medications. The outcome variable was adherence, measured as proportion of days covered ≥ 0.80, to antidiabetic/antihypertensive medications. Multivariable linear and logistic regression evaluated the effect of intervention on adherence to antidiabetic/antihypertensive medications during the 6 months post-intervention. RESULTS The antidiabetic group had 53 intervention patients and 102 controls. The antihypertensive group had 80 intervention patients and 159 controls. There was no significant improvement in adherence for antidiabetic/antihypertensive medications following the intervention. Adherence at baseline was a significant predictor of adherence post-intervention in the antidiabetic (OR = 6.5;P < 0.0001) and antihypertensive (OR = 4.1; P = 0.0001 & β = 0.09; P = 0.008) users. Physician specialty (OR = 3.902; P = 0.01& β = 0.09; P = 0.015) among antidiabetic users and age >70 years (OR = 2.148; P = 0.025) among antihypertensive users were predictors of adherence. CONCLUSION The intervention targeting statin did not significantly improve antihypertensive/antidiabetic adherence. PRACTICE IMPLICATIONS Targeted interventions tailored to patient past adherence and specific medications should be explored.
Collapse
Affiliation(s)
- Anjana Mohan
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| | - Aisha Vadhariya
- Duquesne University School of Pharmacy Graduate School of Pharmaceutical Sciences, 418A Mellon Hall, United States.
| | - Zahra Majd
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| | | | - Omar Serna
- CareAllies, Houston, Texas, United States.
| | - Susan M Abughosh
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| |
Collapse
|
|
22
|
Abraham AM, Sudhir PM, Philip M, Bantwal G. Efficacy of a Brief Self-management Intervention in Type 2 Diabetes Mellitus: A Randomized Controlled Trial from India. Indian J Psychol Med 2020; 42:540-548. [PMID: 33354080 PMCID: PMC7735239 DOI: 10.1177/0253717620932250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diabetes mellitus places a considerable burden on the individual and the family with respect to lifestyle changes. There is a paucity of systematic studies in India examining the efficacy of self-management programs for diabetes. The study examined the impact of a brief self-management intervention (SMI) on primary outcome of HbA1c and secondary outcomes of quality of life (QOL), self-care, perceived barriers to self-care (BSC), perceptions regarding illness and mood in patients with type 2 diabetes mellitus. METHODS AND MATERIALS Eighty patients with type 2 diabetes mellitus were randomly allocated to either a 4-session SMI or treatment as usual (TAU) and were assessed on HbA1c levels, QOL, self-care, BSC, illness perceptions, anxiety, and depression at baseline, postintervention , and at three-month postintervention follow-up. RESULTS Repeated measures analysis of variance indicated significant improvement in the SMI group from baseline to follow-up on HbA1c (P = 0.001), impact of diabetes on QOL (P = 0.006), self-care with respect to diet and exercise (Ps = 0.001), perceived barriers in adherence to diet, exercise, (P = 0.001), medication (P < 0.01), glucose testing (P = 0.04), general BSC (P = 0.001), total barriers (P = 0.001), illness perceptions-timeline or chronicity of illness (P = 0.002), personal control over illness, (P = 0.001), belief in effectiveness of treatment (P = 0.002), understanding of one's illness (P = 0.001), and emotional representations regarding illness (P =0.001), depression, (P = 0.001), and anxiety (P = 0.001). In the SMI group, large effect sizes were obtained at the postintervention assessment and the three-month follow-up on most outcome measures. CONCLUSIONS Brief psychological intervention is efficacious in patients with type 2 diabetes.
Collapse
Affiliation(s)
| | - Paulomi M Sudhir
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mariamma Philip
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ganapathi Bantwal
- Dept. of Endocrinology, St. John's Medical College and Teaching Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
|
23
|
Dwinger S, Rezvani F, Kriston L, Herbarth L, Härter M, Dirmaier J. Effects of telephone-based health coaching on patient-reported outcomes and health behavior change: A randomized controlled trial. PLoS One 2020; 15:e0236861. [PMID: 32960886 PMCID: PMC7508388 DOI: 10.1371/journal.pone.0236861] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/14/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Telephone based health coaching (TBHC) seems to be a promising approach to foster self-management in patients with chronic conditions. The aim of this study was to evaluate the effectiveness of a TBHC on patient-reported outcomes and health behavior for people living with chronic conditions in Germany. METHODS Patients insured at a statutory health insurance were randomized to an intervention group (IG; TBHC) and a control group (CG; usual care), using a stratified random allocation before giving informed consent (Zelen's single-consent design). The TBHC was based on motivational interviewing, goal setting, and shared decision-making and carried out by trained nurses. All outcomes were assessed yearly for three years. We used mixed effects models utilizing all available data in a modified intention-to-treat sample for the main analysis. Participants and study centers were included as random effects. All models were adjusted for age, education and campaign affiliation. RESULTS Of the 10,815 invited patients, 4,283 returned their questionnaires at baseline. The mean age was 67.23 years (SD = 9.3); 55.5% were female. According to the model, TBHC was statistically significant superior to CG regarding 6 of 19 outcomes: physical activity in hours per week (p = .030) and in metabolic rate per week (p = .048), BMI (p = .009) (although mainly at baseline), measuring blood pressure (p< .001), patient activation (p< .001), and health literacy (p< .001). Regarding stages of change (p = .005), the IG group also showed statistically different results than the CG group, however the conclusion remains inconclusive. Within-group contrasts indicating changes from baseline to follow-ups and significant between-group comparisons regarding these changes supported the findings. Standardized effect sizes were small. TBHC did not show any effect on mental QoL, health status, alcohol, smoking, adherence, measuring blood sugar, foot monitoring, anxiety, depression and distress. Campaign-specific subgroup effects were detected for 'foot monitoring by a physician' and 'blood sugar measurement'. CONCLUSION TBHC interventions might have small effects on some patient reported and behavioral outcomes. PRACTICE IMPLICATIONS Future research should focus on analyzing which intervention components are effective and who profits most from TBHC interventions. REGISTRATION German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS): DRKS00000584.
Collapse
Affiliation(s)
- Sarah Dwinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Herbarth
- Kaufmännische Krankenkasse, Statutory Health Insurance, Hannover, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
|
24
|
Naik AD, Hundt NE, Vaughan EM, Petersen NJ, Zeno D, Kunik ME, Cully JA. Effect of Telephone-Delivered Collaborative Goal Setting and Behavioral Activation vs Enhanced Usual Care for Depression Among Adults With Uncontrolled Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e198634. [PMID: 31390035 PMCID: PMC6686779 DOI: 10.1001/jamanetworkopen.2019.8634] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Depression symptoms are present in one-third of patients with diabetes, contributing to significant adverse consequences. Population screening of high-risk patients coupled with telephone delivery of evidence-based therapies for comorbid diabetes may address barriers to care. OBJECTIVE To evaluate the effectiveness of proactive population screening plus telephone delivery of a collaborative goal-setting intervention among high-risk patients with uncontrolled diabetes and depression. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial, 225 participants (intervention [n = 136] and control [n = 89]) were enrolled from a regional Veterans Healthcare System serving Southeast Texas from November 1, 2012, through June 24, 2016. Data were gathered at baseline and 6 and 12 months after intervention. Patients selected had uncontrolled diabetes (hemoglobin A1c [HbA1c] >7.5%]) and clinically significant depression (Patient Health Questionnaire-9 scores [PHQ-9] ≥10) and were living more than 20 miles from the Veterans Affairs medical center. Data collection was completed on December 6, 2016, and final analyses were completed by January 25, 2018. All analyses were intent to treat. INTERVENTIONS Healthy Outcomes Through Patient Empowerment (HOPE) included 9 telephone sessions with 24 trained health care professionals using collaborative goal-setting and behavioral activation methods. The control group received enhanced usual care (EUC) and notification of high-risk status. MAIN OUTCOMES AND MEASURES Change in depression symptoms using PHQ-9 and glycemic control using HbA1c from baseline to 6 months and to 12 months. Secondary analyses evaluated clinically significant responses for these measures. RESULTS Among 225 participants, 202 (89.8%) were men, the mean (SD) age was 61.9 (8.3) years, 145 (64.4%) were married, and 156 (69.3%) had some education beyond high school. For the overall study, 38 participants (16.9%) were lost to follow-up or withdrew at 6 months and another 21 (9.3%) were lost to follow-up or withdrew at 12 months. Repeated-measures analysis with multiple imputation for missing data assessing the interaction of treatment group (HOPE vs EUC) and time (baseline, 6 months, and 12 months) found no significant improvement in PHQ-9 (β, 1.56; 95% CI, -0.68 to 3.81; P = .17) or HbA1c (β, -0.005; 95% CI, -0.73 to 0.72; P = .82). Analyses using t test for change from baseline to 12 months showed a HOPE vs EUC between-group mean difference for PHQ-9 of 2.14 (95% CI, 0.18 to 4.10; P = .03) and for HbA1c of -0.06% (95% CI, -0.61% to 0.50%; P = .83). A secondary analysis of patients experiencing a clinical response found that 52.1% of HOPE participants had clinically significant responses in PHQ-9 at 12 months vs 32.9% in EUC (difference, 0.19; 95% CI, 0.04-0.33; P = .01). CONCLUSIONS AND RELEVANCE Telephone-delivered, collaborative goal setting produced clinically significant reductions in depression symptoms but not glycemic control among patients who remained engaged at 12 months compared with EUC among a population screened sample of high-risk patients with diabetes and depression. Although the intervention created some lasting effect for depression, additional strategies are needed to maintain engagement of this high-risk population within an interprofessional team approach to primary care. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01572389.
Collapse
Affiliation(s)
- Aanand D. Naik
- Research Service Line, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Alkek Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Natalie E. Hundt
- Research Service Line, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | - Nancy J. Petersen
- Research Service Line, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas
- Alkek Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Darrell Zeno
- Research Service Line, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Mark E. Kunik
- Research Service Line, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
- Alkek Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jeffrey A. Cully
- Research Service Line, Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- VA South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
|
25
|
Effect of mobile learning (application) on self-care behaviors and blood glucose of type 2 diabetic patients. J Diabetes Metab Disord 2019; 18:307-313. [PMID: 31890655 DOI: 10.1007/s40200-019-00414-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 05/07/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
Purpose More than 70% of the health expenditure is related to chronic diseases. Therefore, an efficient managerial program can markedly reduce medical and administrative costs and benefit both patients and service providers. The use of mobile technologies can be very helpful in this regard. This study was conducted to determine the effect of mobile learning (application) on self-care behaviors and blood glucose control of type 2 diabetic patients attending the Diabetes Clinic of Imam Khomeini Hospital Complex. Methods This interventional, quasi-experimental study was conducted on 51 diabetic patients. The patients were randomly assigned to case and control groups, and a specifically designed application was used in the case group for three months. Self-care behavior, FBS, and HbA1C were assessed in both groups before and three months after the intervention, and the results were analyzed after the intervention. The Summary of Diabetes Self-Care Activities (SDSCA) measure and medical records was used for data collection. Descriptive and inferential statics (paired t test, ANCOVA analysis) were used for data analysis. Results The Mean ± SD of the self-care posttest score, FBS, and HbA1C was 76.95 ± 7.94 vs. 43.4 ± 9.74 (P = 0.001), 143.58 ± 23.39 vs. 171.81 ± 36.98 (P = 0.001), and 6.84 ± 0.63 vs. 8.10 ± 0.10 (P = 0,001), in the case and control group respectively, indicating a difference in all cases. Conclusions The results indicated the positive effect of the mobile application on self-care behavior, FBS, and HbA1C.
Collapse
|
|
26
|
Long H, Howells K, Peters S, Blakemore A. Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. Br J Health Psychol 2019; 24:515-546. [PMID: 31033121 PMCID: PMC6767143 DOI: 10.1111/bjhp.12366] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 03/04/2019] [Indexed: 11/29/2022]
Abstract
Purpose To systematically review the evidence for health coaching as an intervention to improve health‐related quality of life (HRQoL) and reduce hospital admissions in people with chronic obstructive pulmonary disease (COPD). Methods We systematically searched MEDLINE, EMBASE, PsycINFO, and CINAHL from database inception to August 2018 to identify all randomized controlled trials (RCTs) of health coaching for people with COPD. Eligible health coaching interventions had to include three components: goal setting, motivational interviewing, and COPD‐related health education. Data were extracted on study characteristics and the effects of the intervention on HRQoL, hospital admissions, physical activity, self‐care behaviour, and mood. Study quality was appraised by two authors using the Cochrane tool for assessing the risk of bias in RCTs. Effect sizes (standardized mean differences [SMD] or odds ratios [OR]) with 95% confidence intervals (CIs) were calculated and pooled using random effects meta‐analyses. Results Of 1578 articles, 10 RCTs were included. Meta‐analysis showed that health coaching has a significant positive effect on HRQoL (SMD = −0.69, 95% CI: −1.28, −0.09, p = .02, from k = 4) and leads to a significant reduction in COPD‐related hospital admissions (OR = 0.46, 95% CI: 0.31, 0.69, p = .0001, from k = 5), but not in all‐cause hospital admissions (OR = 0.70, 95% CI: 0.41–1.12, p = .20, from k = 3). Three of four studies reported significant improvements to self‐care behaviours such as medication adherence and exercise compliance. Conclusions This is the first systematic review to show that health coaching may be a candidate intervention to improve HRQoL and reduce costly hospital admissions in people with COPD.
|