Assessment of the complexity of drug therapy and psychosocial and behavioral aspects in people living with type 2 diabetes mellitus.

Background Type 2 diabetes mellitus is a public health problem worldwide. The complexity of drug therapy and behavioral aspects are important factors in its management. Objective To characterize the complexity of drug therapy, attitudes, empowerment and self-care in people with type 2 diabetes mellitus. Methods Observational descriptive study involving people with type 2 diabetes mellitus recruited in eight public primary care settings in Brazil, 2018. We used validated instruments to determine the complexity of drug therapy employing the Medication Regimen Complexity Index, and to describe the behavioral aspects, encompassing Diabetes Attitudes Questionnaires, Diabetes Empowerment Scale-Short Form and Diabetes Mellitus Care Self-Management. Results The 119 participants showed median age of 64 years (Quartile 1 57.0; Quartile 3 71.0) with predominance of women (68.1%). We found high percentages of participants with low scores on attitudes (87.9%) and self-care (84.8%) questionnaires, but with high scores on empowerment questionnaire (81.8%) in groups with high complexity of drug therapy. Conclusion High complexity of drug therapy concentrated low scores for attitudes and self-care, even though presenting elevated empowerment scores. Further studies are needed to investigate the effect of these aspects on the behavior of people with type 2 diabetes mellitus on drug therapies of high complexity.

Evaluating the effectiveness of an empowerment program for self-care in type 2 diabetes: a cluster randomized trial.

BACKGROUND: The prevalence of type 2 diabetes mellitus is increasing substantially worldwide, leading to serious economic effects, complications and deaths. This study evaluated the effectiveness of an empowerment program providing support for psychosocial, behavioral, and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition. METHODS: In this cluster randomized trial, participants aged 30-80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015. Five units were randomly assigned to receive the empowerment program based on a behavior change protocol, and five continued to receive only conventional treatment. The primary outcome was the biochemical and anthropometric parameters, and the secondary outcomes were self-care, attitude, knowledge and empowerment related to diabetes. The effect of the experiment was defined as the percentage variation between the values at the initial and final periods. To evaluate this effect and to compare it in the two groups, tests were used for paired and independent samples, respectively. RESULTS: There were 238 participants: 127 and 111 in the intervention and control group, respectively. For glycated hemoglobin, the mean effect in the control and intervention groups was 3.93 and -5.13, respectively (p < 0.001). Levels of glycated hemoglobin and other metabolic indicators, as well as the most part of the secondary outcomes showed a significant difference in the experimental group compared to the control group. CONCLUSIONS: The empowerment program improved metabolic control of type 2 diabetes in Brazilian users. TRIAL REGISTRATION: NCT02132338 - April 22, 2014.