Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level: a randomised controlled trial
Olry de Labry Lima A., Bermúdez Tamayo C., Pastor Moreno G., Bolívar Muñoz J., Ruíz Pérez I., Johri M., Quesada Jiménez F., Cruz Vela P., Ríos Álvarez AM., Prados Quel MA., Moratalla López E., Domínguez Martín S., López de Hierro JA., Ricci Cabello I.
Purpose: To determine whether an intervention based in patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. Methods: 12 month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered in two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level, and glycated haemoglobin (HbA1c) >7% (53.01mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and on the use of a tool for monitoring glycaemic control and provide feedback to patients. The control group continued standard care. The primary outcome was difference in glycated haemoglobin after 12 months. dyslipidemia, blood pressure, body mass index, and abdominal circumference were also assessed as secondary outcomes. Two level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. Results: The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-groupHbA1c difference=0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidemia, blood pressure, body mass index and abdominal circumference. Conclusions: In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.