An Educational Intervention Using Steno Balance Cards to Improve Glycemic Control in Patients With Poorly Controlled Type 2 Diabetes Mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is largely attributableto lifestyle factors. Although physiological and medical care needs must be met, psychosocial factors should not be neglected. PURPOSE: The aim of this study was to determine whether a 6-month intervention consisting of educational sessions using Steno Balance Cards, which involves guided group dialogue, resulted in better glycemic outcomes than conventional diabeteseducation. METHODS: Patients with T2DM whose glycolated hemoglobin A1c levels were higher than 8% were recruited from September to October 2015. Ninety-two patients were assigned to either the psychosocial balance dialogue (PBD) group (n = 46) or the standard care (SC) group (n = 46). The PBD group received instructions about diabetes using the Steno "Balance Card" method, which involves the use of themed picture cards to elicit group dialogue. The Balance Cards were developed by the Danish Steno Diabetes Center. In the SC group, patients received general diabetes education using a conventional teachingmode. RESULTS: In the PBD group, glycolated hemoglobin A1c decreased 1.3% from 8.1% ± 0.7% to 6.8% ± 0.8%, whereas it decreased 0.6% in the SC group from 8.0% ± 0.6% to 7.4% ± 0.7%, with p < .05. At the end of the 6-month study period, the PBD group and the SC group completed a health-related quality of life questionnaire(12-item Short-Form Health Survey) and a well-being index (WHO-5) questionnaire. In the PBD group, the difference before and after the intervention showed that the well-being (WHO-5) score increased by 45.4 points, whereas the physiological score increased by 28.0, and the mental component score increased by 29.0. In the SC group, the well-being (WHO-5) score increased by 6.4, whereas the physiological score increased by 4.7, and the mental component score increased by 9.6. There were statistically significant differences in questionnairescores between the two groups (p < .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study indicate that the dialogue sessions using Steno Balance Cards are beneficial for patients with T2DM in terms of improved glycemic control and quality of life.

Comparison of Different Models of Structured Self-Monitoring of Blood Glucose in Type 2 Diabetes.

BACKGROUND: The aim of this study is to compare the effectiveness of different models of structured self-monitoring of blood glucose (SMBG) in non-insulin-treated type 2 diabetes. SUBJECTS AND METHODS: This was a prospective, three-arm, randomized, 36-week trial. There were 138 participants with a mean age of 58.7 years and glycated hemoglobin A1c (HbA1c) level of 8.72% who were allocated to the following groups: six-pair glucose test of pre- and postprandial blood glucose (BG) per week (n = 43); three-pair glucose test of pre- and postprandial BG per week (n = 39); and seven-point BG testing before and after each meal and at bedtime over a course of 3 days in 1 month (n = 40). RESULTS: The intention-to-treat analysis revealed that all three groups showed significant reductions in HbA1c levels. Comparisons among the groups revealed that only the seven-point group had a significant greater reduction of HbA1c level compared with the three-pair group (between-group mean difference of -0.86 and -0.80 from baseline to 24 and 36 weeks, respectively). No severe hypoglycemic events were reported. Diabetes distress was slightly higher in the six-pair group. CONCLUSIONS: Our results demonstrated that BG testing at six pairs/week, three pairs/week, and seven points for 3 days/month were all effective in improving glycemic outcome, with greater reduction of HbA1c level in the seven-point for 3 days/month group, without increasing burdensome distress in SMBG.

Adherence to self-care behavior and glycemic effects using structured education.

AIMS/INTRODUCTION: The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university-based hospital primary care clinic. MATERIALS AND METHODS: This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes. RESULTS: A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = -0.59% and Δ = -1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = -0.43% and Δ = -0.49%), based on an intention-to-treat analysis. A per-protocol analysis showed the significant change was maintained at 12 months (Δ = -0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem-solving, reducing risk and health coping. CONCLUSIONS: In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care.