title: Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Integrating Type 2 Diabetes Mellitus and Depression Treatment Among African Americans Integrative Health Coaching for Patients With Type 2 Diabetes Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes The Effect of Diabetes Self-Management Education With Frequent Follow-Up on the Health Outcomes of African American Men The impact of nurse short message services and telephone follow-ups on diabetic adherence: which one is more effective? An explanatory randomised controlled trial of a nurse-led, consultation-based intervention to support patients with adherence to taking glucose lowering medication for type 2 diabetes Self-management support in "real-world" settings: an empowerment-based intervention. Peer support for patients with type 2 diabetes: cluster randomised controlled trial Results of a Successful Telephonic Intervention to Improve Diabetes Control in Urban Adults Improving Diabetes Care and Health Measures Among Hispanics Using Community Health Workers The diabetes mellitus medication choice decision aid: a randomized trial. Reinforcement of adherence to prescription recommendations in Asian Indian diabetes patients using short message service (SMS)--a pilot study. Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: results of a controlled trial. A diabetes education multimedia program in the waiting room setting Family intervention to control type 2 diabetes: a controlled clinical trial. The Pharmaceutical care of patients with type 2 diabetes mellitus Improving Adherence and Reducing Medication Discrepancies in Patients with Diabetes Electronic monitoring and counseling to improve medication adherence. Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management Can Prescription Refill Feedback to Physicians Improve Patient Adherence? Pharmaceutical care model for patients with type 2 diabetes: integration of the community pharmacist into the diabetes team – a pilot study Caring for Poorly Controlled Diabetes Mellitus: A Randomized Pharmacist Intervention Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes A culturally targeted self-management program for African Americans with type 2 diabetes mellitus. Evaluating the impact of mobile telephone technology on type 2 diabetic patients' self-management: the NICHE pilot study. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Reach and effectiveness of DVD and in-person diabetes self-management education SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored MAP study: RCT of a medication adherence program for patients with type 2 diabetes. Framework for design and evaluation of complex interventions to improve health WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Adherence to diabetes control recommendations: impact of nurse telephone calls. Integrated Management of Type 2 Diabetes Mellitus and Depression Treatment to Improve Medication Adherence: A Randomized Controlled Trial
abstract: Abbreviations ACCORD Action to Control Cardiovascular Risk in Diabetes ADVANCE Action in Diabetes and Vascular Disease : Preterax and Diamicron Modified-Release Controlled Evaluation AGI α-Glucosidase inhibitor  CAD Coronary artery disease CKD Chronic kidney disease CVD Cardiovascular disease DPP-4 Dipeptidyl peptidase IV GIP Glucose-dependent insulinotropic peptide GLP-1 Glucagon-like peptide 1 NPH Neutral protamine Hagedorn TZD Thiazolidinedione UKPDS UK Prospect i ve Diabetes Study VADT Veterans Affairs Diabetes Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care .  Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the  Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Purpose The purpose of this study was to evaluate the effectiveness of integrative health ( IH ) coaching on psychosocial factors , behavior change , and glycemic control in patients with type 2 diabetes . Methods Fifty-six patients with type 2 diabetes were r and omized to either 6 months of IH coaching or usual care ( control group ) . Coaching was conducted by telephone for fourteen 30-minute sessions . Patients were guided in creating an individualized vision of health , and goals were self-chosen to align with personal values . The coaching agenda , discussion topics , and goals were those of the patient , not the provider . Preintervention and postintervention assessment s measured medication adherence , exercise frequency , patient engagement , psychosocial variables , and A1C . Results Perceived barriers to medication adherence decreased , while patient activation , perceived social support , and benefit finding all increased in the IH coaching group compared with those in the control group . Improvements in the coaching group alone were also observed for self-reported adherence , exercise frequency , stress , and perceived health status . Coaching participants with elevated baseline A1C ( ≥7 % ) significantly reduced their A1C . Conclusions A coaching intervention focused on patients ’ values and sense of purpose may provide added benefit to traditional diabetes education programs . Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy , accountability , and clinical outcomes Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans . Social Cognitive Theory provided the framework for the study . Methods Twenty-two participants were recruited and r and omly assigned to either Group or Individual diabetes self-management ( DSME ) . Group DSME included story-telling , h and s-on activities , and problem-solving exercises . Individual DSME sessions focused on goal - setting and problem-solving strategies . Sessions were offered in an accessible community center over a 10-week period . Results Outcomes included glycosylated hemoglobin ( A1C ) , self-care actions , self-efficacy level , goal attainment , and satisfaction with DSME . Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities , A1C level , and goal attainment . Although differences were not statistically significant , trends indicate improved scores on dietary actions , foot care , goal attainment , and empowerment for those experiencing Group DSME . Conclusions The culturally tailored approach was well received by all participants . Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control . Additional testing among more participants over a longer time period is recommended PURPOSE This study was conducted to determine whether objective clinical , patient performance , quality -of-life , and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program . METHODS Prior to the diabetes self-management education program , 30 African American men with type 2 diabetes were r and omly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period . Information obtained at follow-up contact included HbA1c level , perception of general health , and present diabetes knowledge . In addition , daily foot care , dietary , exercise , and medication compliance measures were assessed postprogram . RESULTS There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical , patient performance , quality -of-life , and subjective outcomes . CONCLUSIONS This cross-sectional study showed that telephone follow-up at 3 month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up AIM To compare the effectiveness of two methods of follow-up : short message service and telephone follow-up on type 2 diabetes adherence for three months . BACKGROUND Using telemedicine approaches may preserve appropriate blood glucose levels and may improve adherence to diabetes control recommendations in diabetic patients . DESIGN A quasi-experimental , two-group , pretest and post-test design was used in this study to evaluate the effectiveness of nurse 's follow-up via cellular phones and telephones . METHODS The sample consisted of 77 patients with type 2 diabetes that r and omly were assigned to two groups : telephone follow-up ( n = 39 ) and short message service ( n = 38 ) . Telephone interventions were applied by a research er for three months ; twice a week for the first month and every week for the second and third month . For three successive months , the short message service group that received messages about adherence to therapeutic regimen was examined . The data gathering instrument included data sheets - to record glycosylated haemoglobin - and the question naire related to adherence therapeutic regimen . Data gathering was carried out at the beginning of the study and after three and six months . The data were analysed using descriptive and inferential statistic methods with SPSS version 11.5 . RESULTS Results showed that both interventions had significant mean changes in glycosylated haemoglobin . For the telephone group ( p < 0.001 ) , a mean change of -0.93 and for the short message service group ( p < 0.001 ) , a mean change of -1.01 . There was no significant difference in diet adherence ( p = 0.000 ) , physical exercise ( p = 0.000 ) and medication taking ( p = 0.000 ) adherence in either groups . CONCLUSION Intervention using short message services of cellular phones and nurse-led-telephone follow-up improved HbA1c levels and adherence to diabetes therapeutic regimen for three months in type 2 diabetic patients . RELEVANCE TO CLINICAL PRACTICE Both of follow-up intervention uses in this study can decrease HbA1c levels and escalate adherence to diabetes control recommendations in people with type 2 diabetes for three months Background Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality . We evaluated the efficacy of a consultation-based intervention to support objective ly-assessed adherence to oral glucose lowering medication ( OGLM ) compared to usual care among people with type 2 diabetes . Methods This was a parallel group r and omised trial in adult patients with type 2 diabetes and HbA1c≥7.5 % ( 58 mmol/mol ) , prescribed at least one OGLM . Participants were allocated to a clinic nurse delivered , innovative consultation-based intervention to strengthen patient motivation to take OGLM regularly and support medicine taking through action-plans , or to usual care . The primary outcome was the percentage of days on which the prescribed dose of medication was taken , measured objective ly over 12 weeks with an electronic medication-monitoring device ( TrackCap , Aardex , Switzerl and ) . The primary analysis was intention-to-treat . Results 211 patients were r and omised between July 1 , 2006 and November 30 , 2008 in 13 British general practice s ( primary care clinics ) . Primary outcome data were available for 194 participants ( 91.9 % ) . Mean ( sd ) percentage of adherent days was 77.4 % ( 26.3 ) in the intervention group and 69.0 % ( 30.8 ) in st and ard care ( mean difference between groups 8.4 % , 95 % confidence interval 0.2 % to 16.7 % , p = 0.044 ) . There was no significant adverse impact on functional status or treatment satisfaction . Conclusions This well-specified , theory based intervention delivered in a single session of 30 min in primary care increased objective ly measured medication adherence , with no adverse effect on treatment satisfaction . These findings justify a definitive trial of this approach to improving medication adherence over a longer period of time , with clinical and cost-effectiveness outcomes to inform clinical practice .Trial registration Current Controlled Trials IS RCT OBJECTIVE This study examined the impact of a 6-month , empowerment-based diabetes self-management support ( DSMS ) intervention on clinical outcomes , self-care behaviors , and quality of life ( QOL ) compared to a 6-month control period . METHODS This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes . Baseline , 6-month , and 12-month assessment s measured A1C , weight , body mass index ( BMI ) , blood pressure , lipids , self-care behaviors , and QOL . During the control period , participants received weekly educational newsletters . During the intervention period , participants attended weekly DSMS groups as frequently as they needed . Sessions were guided by participants ' self-management questions and concerns , and also emphasized experiential learning , coping , problem-solving , and goal - setting . RESULTS The control period found significant improvements for diastolic BP ( p<0.05 ) , serum cholesterol ( p<0.001 ) , following a healthy diet ( p<0.01 ) , and monitoring blood glucose ( p<0.01 ) . The intervention period found significant additional improvements for A1C ( p<0.001 ) , weight ( p<0.05 ) , BMI ( p<0.05 ) , and LDL ( p<0.001 ) . Compared to the control period , participation in the intervention led to a significant reduction in A1C ( p<0.01 ) . CONCLUSION Findings suggest that an empowerment-based , DSMS intervention is promising for improving and /or maintaining diabetes-related health , particularly A1C . PRACTICAL IMPLICATION S Incorporating empowerment principles in DSMS interventions may be useful for supporting patients ' self-management efforts in " real-world " setting Objective To test the effectiveness of  peer support  for patients with type 2 diabetes . Design Cluster r and omised controlled . Setting 20 general practice s in the east of the Republic of Irel and . Participants 395 patients ( 192 in intervention group , 203 in control group ) and 29 peer supporters with type 2 diabetes . Intervention All practice s introduced a st and ardised diabetes care system . The peer support intervention ran over a two year period and contained four elements : the recruitment and training of peer supporters , nine group meetings led by peer supporters in participant ’s own general practice , and a retention plan for the peer supporters . Main outcome measures HbA1c ; cholesterol concentration ; systolic blood pressure ; and wellbeing score . Results There was no difference between intervention and control patients at baseline . All practice s and 85 % ( 337 ) of patients were followed up . At two year follow-up , there were no significant differences in HbA1c ( mean difference −0.08 % , 95 % confidence interval −0.35 % to 0.18 % ) , systolic blood pressure ( −3.9 mm Hg , −8.9 to 1.1 mm Hg ) , total cholesterol concentration ( −0.03 mmol/L , −0.28 to 0.22 mmol/L ) , or wellbeing scores ( −0.7 , −2.3 to 0.8 ) . While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up , particularly for systolic blood pressure ( 52 % ( 87/166 ) > 130 mm Hg in intervention v 61 % ( 103/169 ) > 130 mm Hg in control ) , these changes were not significant . The process evaluation indicated that the intervention was generally delivered as intended , though 18 % ( 35 ) of patients in the intervention group never attended any group meetings . Conclusions A group based peer support intervention is feasible in general practice setting s , but the intervention was not effective when targeted at all patients with type 2 diabetes . While there was a trend towards improvements of clinical outcomes , the results do not support the widespread adoption of peer support . Trial registration Current Controlled Trials IS RCT N42541690 OBJECTIVE To compare the effectiveness of a telephonic and a print intervention over 1 year to improve  diabetes control in low-income urban adults . RESEARCH DESIGN AND METHODS A r and omized trial in Spanish and English comparing a telephonic intervention implemented by health educators with a print intervention .  Participants ( N = 526 ) had an A1C ≥7.5 % and were prescribed one or more oral agents . All were members of a union/employer jointly sponsored health benefit plan . Health coverage included medications . Primary outcomes were A1C and pharmacy cl aims data ; secondary outcomes included self-report of two medication adherence measures and other self-care behaviors . RESULTS Participants were 62 % black and 23 % Hispanic ; 77 % were foreign born , and 42 % had annual family incomes < $ 30 thous and . Baseline median A1C was 8.6 % ( interquartile range 8.0–10.0 ) . Insulin was also prescribed for 24 % of participants . The telephone group had mean ± SE decline in A1C of 0.23 ± 0.11 % over 1 year compared with a rise of 0.13 ± 0.13 % for the print group ( P = 0.04 ) . After adjusting for baseline A1C , sex , age , and insulin use , the difference in A1C was 0.40 % ( 95 % CI 0.10–0.70 , P = 0.009 ) . Change in medication adherence measured by cl aims data , but not by self-report measures , was significantly associated with change in A1C ( P = 0.01 ) . Improvement in medication adherence was associated ( P = 0.005 ) with the telephonic intervention , but only among those not taking insulin . No diabetes self-care activities were significantly correlated with the change in A1C . CONCLUSIONS A 1-year tailored telephonic intervention implemented by health educators was successful in significantly , albeit modestly , improving diabetes control compared with a print intervention in a low-income , insured , minority population The increasing prevalence of diabetes and obesity , growing health disparities , and shortage of bilingual and culturally trained health care professionals underscore the role of trained community health workers ( CHWs ) to provide economically sustainable and culturally relevant services . This prospect i ve r and omized design evaluated the relative effectiveness of a CHW intervention among Hispanic persons with newly diagnosed type 2 diabetes , as compared with usual clinic practice in three inner-city health centers . In sum , 189 Hispanic patients newly diagnosed with type 2 diabetes were r and omly assigned to one of three 6-month diabetes management approaches — CHW , case management , and st and ard provider care— and assessed for diabetes-related health measures and clinical indicators at baseline and postintervention . Participants in the CHW group achieved greater improvements than did the controls in program measures : health status , emergency department utilization , dietary habits , physical activity , and medication adherence . They also had 2.9 times greater odds of decreasing body mass index BACKGROUND Patient involvement in the choice of antihyperglycemic agents could improve adherence and optimize glycemic control in patients with type 2 diabetes mellitus . METHODS We conducted a pilot , cluster r and omized trial of Diabetes Medication Choice , a decision aid that describes 5 antihyperglycemic drugs , their treatment burden ( adverse effects , administration , and self-monitoring dem and s ) , and impact on hemoglobin A(1c ) ( HbA(1c ) ) levels . Twenty-one clinicians were r and omized to use the decision aid during the clinical encounter and 19 to dispense usual care and an educational pamphlet . We used surveys and video analysis to assess postvisit decisional outcomes , and medical and pharmacy records to assess 6-month medication adherence and HbA(1c ) levels . RESULTS Compared with usual care patients ( n = 37 ) , patients receiving the decision aid ( n = 48 ) found the tool more helpful ( clustered-adjusted mean difference [ AMD ] in a 7-point scale , 0.38 ; 95 % confidence interval [ CI ] , 0.04 - 0.72 ) ; had improved knowledge ( AMD , 1.10 of 10 questions ; 95 % CI , 0.11 - 2.09 ) ; and had more involvement in making decisions about diabetes medications ( AMD , 21.8 of 100 ; 95 % CI , 13.0 - 30.5 ) . At 6-month follow-up , both groups had nearly perfect medication use ( median , 100 % of days covered ) , with better adherence ( AMD , 9 % more days covered ; 95 % CI , 4%-14 % ) and persistence ( AMD , 12 more days covered ; 95 % CI , 3 - 21 days ) in the usual care group , and no significant impact on HbA(1c ) levels ( AMD , 0.01 ; 95 % CI , -0.49 to 0.50 ) . CONCLUSION An innovative decision aid effectively involved patients with type 2 diabetes mellitus in decisions about their medications but did not improve adherence or HbA(1c ) levels . Trial Registration clinical trials.gov Identifier : NCT00388050 OBJECTIVES To investigate the acceptability and feasibility of using short message services ( SMS ) via cell phones to ensure adherence to management prescriptions by diabetic patients . METHODS Type 2 diabetic patients with 5 or more years of diabetes and having HbA1c between 7.0 % to 10 % were r and omized to the control arm ( n = 105 ) to receive st and ard care and to the intervention arm ( SMS , n = 110 ) . Messages in English on principles of diabetes management were sent once in 3 days , the contents and frequencies varied as per the patients ' preferences . The study duration was 1 year . All participants were advised to report for quarterly clinic visits . A comparative assessment of the clinical , biochemical and anthropometric outcomes was made among the groups at the annual visit . RESULTS Annual review was possible in 71 % of intervention group and 63 % of control group . SMS was acceptable to the patients and the median number requested was 2 per week . HbA1c and plasma lipids improved significantly in the SMS group . CONCLUSIONS The pilot study showed that frequent communication via SMS was acceptable to diabetic patients and it helped to improve the health outcomes OBJECTIVE The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes . RESEARCH DESIGN AND METHODS We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta , Canada . The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers .  Clinical and patient-reported outcomes were assessed after 6 months . Patient-reported outcomes included changes in health-related quality of life ( Health Utilities Index Mark 3 [ HUI3 ] ) , satisfaction with care , lifestyle ( Diabetes Lifestyle Form ) , and adherence to self-care activities . Analysis of covariance was used to assess differences over time between the control and intervention regions . RESULTS A total of 200 intervention and 172 control subjects were included in this analysis . After adjusting for important clinical and demographic differences , a statistically significant and clinical ly important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region ( 0.06 [ 95 % CI 0.02 - 0.10 ] ) compared with the control region ( 0.01 [ -0.04 to 0.04 ] ) ( P = 0.03 for the difference between groups ) . Satisfaction with general medical care ( P < 0.001 between groups ) and diabetes care ( P < 0.001 between groups ) increased among patients in the intervention region compared with the control region . Self-efficacy , attitudes , and beliefs about diabetes control all increased in the intervention region when compared with the control region , but adherence to self-care activities did not . CONCLUSIONS A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life , satisfaction with care , and other humanistic outcomes Introduction This study evaluated the impact of a waiting room-administered , low-literacy , computer multimedia diabetes education program on patient self-management and provider intensification of therapy . Methods In this r and omized , controlled trial , 129 participants either viewed a computer multimedia education program ( intervention group ) or read an educational brochure ( control group ) while in the waiting room . Participants were uninsured , primarily ethnic minority adults with type 2 diabetes receiving care from a county clinic in Chicago , Illinois . Wilcoxon test , t-test , and linear mixed model analyses evaluated changes in diabetes knowledge , self-efficacy , behaviors , medications prescribed , hemoglobin A1c ( HbA1c ) , and blood pressure levels over 3 months . Results During the study period , there was an increase in the number of oral diabetes medications prescribed over three months to multimedia users compared with those in the control group ( P=0.017 ) . HbA1c declined by 1.5 in the multimedia group versus 0.8 in the control group ( P=0.06 ) . There were no differences between groups in changes in blood pressure levels , self-efficacy , and most diabetes-related behaviors . Self-reported exercise increased in the control group compared with the multimedia group ( 0.9 days/week vs. 0.1 days/week , P=0.016 ) . Conclusion Multimedia users received a greater intensification of diabetes therapy , but demonstrated no difference in self-management in comparison with those receiving educational brochures . The availability of a computer multimedia program in the waiting room appears to be a novel and acceptable approach in providing diabetes education for underserved population PURPOSE Chilean patients with type 2 diabetes mellitus ( T2DM ) have a low rate of blood sugar control . We studied the effectiveness of a culturally sensitive family oriented intervention design ed to improve metabolic control in primary care patients with uncontrolled T2DM . METHODS Patients with T2DM from three primary care clinics in Santiago , Chile were r and omly selected for inclusion if they had a recent HbA1c ≥7 % , were between 18 and 70 years old and lived with a family member . Patients from one clinic received the family oriented intervention ;  patients from the other two ( control ) clinics received st and ard care . The intervention involved family members in care and included family counselling during clinic visits , family meetings and home visits . The primary outcome was HbA1c , measured at 6 and 12 months . RESULTS A total of 243 patients were enrolled and 209 ( 86 % ) completed the study . The intervention was fully administered to only 34 % of patients in the intervention clinic . The reduction in the HbA1c from baseline to 12 months was not significantly different between clinics . During the second 6-month period , when the intervention was more intensive , the patients in the intervention clinic significantly improved their HbA1c ( P < 0.001 ) compared to the control patients . CONCLUSIONS A family intervention for the control of T2DM was associated with a significant reduction in HbA1c when the intervention was provided . Incomplete implementation , low statistical power and potential confounding variables between groups could be some of the main factors that explain the lack of difference between clinics in the 12-month period Objective To evaluate the efficiency of pharmaceutical care on the control of clinical parameters , such as fasting glycaemia and glycosylated haemoglobin in patients with Type 2 Diabetes mellitus . Setting This study was conducted at the Training and Community Health Centre of the College of Medicine of Ribeirao Preto , University of Sao Paulo , Brazil . Methods A prospect i ve and experimental study was conducted with 71 participants divided in two groups : ( i ) pharmaceutical care group ( n=40 ) , and ( ii ) the control group ( n=31 ) . The distribution of patients within these groups was made casually , and the patients were monitored for 12 months . Main outcome measure : Values for fasting glycaemia and glycosylated haemoglobin were collected . Results Mean values of fasting glycaemia in the pharmaceutical care group were significantly reduced whilst a small reduction was detected in the control group at the same time . A significant reduction in the levels of glycosylated haemoglobin was detected in patients in the pharmaceutical care group , and an average increase was observed in the control group . Furthermore , the follow-up of the intervention group by a pharmacist contributed to the resolution of 62.7 % of 142 drug therapy problems identified . Conclusion In Brazil , the information provided by a pharmacist to patients with Type 2 Diabetes mellitus increases compliance to treatment , solving or reducing the Drug Therapy Problem and , consequently , improving glycaemic control OBJECTIVE : To improve medication adherence by reducing self-reported adherence barriers , and to identify medication discrepancies by comparing physician-prescribed and patient-reported medical regimens . DESIGN : Prospect i ve , r and omized , controlled trial . SETTING AND PARTICIPANTS : A single academically affiliated community health center . Eligible patients had type 2 diabetes , had undergone laboratory testing in the year preceding the study , and had visited the clinic in the 6 months preceding the study . INTERVENTION : A pharmacist administered detailed question naires , provided tailored education regarding medication use and help with appointment referrals , and created a summary of adherence barriers and medication discrepancies that was entered into the medical record and electronically forwarded to the primary care provider . MEASUREMENTS : Changes in self-reported adherence rates and barriers were compared 3 months after the initial interview . Intervention patients with medication discrepancies at baseline were assessed for resolution of discrepancies at 3 months . RESULTS : Rates of self-reported medication adherence were very high and did not improve further at 3 months ( 6.9 of 7 d , with all medicines taken as prescribed ; p = 0.3 ) . Medical regimen discrepancies were identified in 44 % of intervention patients , involving 45 doses of medicines . At 3-month follow-up , 60 % of discrepancies were resolved by corrections in the medical record , while only 7 % reflected corrections by patients . CONCLUSIONS : In this community cohort , patients reported few adherence barriers and very high medication adherence rates . Our patient-tailored intervention did not further reduce these barriers or improve self-reported adherence . The high prevalence of medication discrepancies appeared to mostly reflect inaccuracies in the medical record rather than patient errors Electronic caps , pill caps that record the date and time of pill bottle opening provide an objective measure of adherence to prescribed medication . A promising intervention to improve adherence , cue-dose training , involves review ing patients ' pill cap-generated reports concerning their medication-taking and offering individualized recommendations for remembering to take medications at specific times of day . In this preliminary study , 79 patients prescribed the antihyperglycemic medication metformin  had adherence assessed during a 4-week baseline period . Adherence , defined as proportion of prescribed doses taken within a predetermined 4-h window , was measured using electronic MEMS caps . Those who had less than 80 % baseline adherence ( n = 33 ) were r and omly assigned to either receive 4 months of cue-dose training ( n = 16 ) or to a control group ( n = 17 ) . Cue-dose training was associated with significantly better adherence to metformin ( mean improvement of 15 % ) . The effects of cue-dose  training on adherence to other antihyperglycemic medication did not reach statistical significance . Glycosylated hemoglobin ( a measure of blood sugar control ) did not differ between groups . Data from nine patients who review ed pill cap-generated data with their primary care providers suggested that both patients and providers found the discussion moderately helpful and not at all uncomfortable This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours . Based on proactive coping , the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours . In a r and omised controlled trial among recent screen-detected patients , participants who received the intervention  were compared with usual-care controls , examining changes in proximal outcomes ( intentions , self-efficacy and proactive coping ) , self-care behaviour ( diet , physical activity and medication ) and weight over time ( 0 , 3 and 12 months ) . Subsequently , the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses , controlling for baseline self-care behaviour , patient characteristics , and intentions and self-efficacy as measured after the course . The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity , result ing in significant weight loss at 12 months . Furthermore , proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy . Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions Background : Although adherence to long‐term drug therapy is an important issue , the means to facilitate its assessment and improvement in clinical practice remain a challenge . Objective : To evaluate the impact of prescription refill feedback and adherence education provided to primary care physicians . Methods : We provided 83 resident and attending physicians at a university‐based general internal medicine practice with refill adherence reports on each of 340 diabetic patients . An educational session on adherence assessment and improvement techniques was held , and all physicians received a written outline on this topic . Physician attitude toward the intervention and 6‐month change in refill adherence ( doses filled/doses prescribed ) of their patient panels were assessed . A nonr and omized comparison group of patients receiving hypertension medications for whom the physicians did not receive feedback was also evaluated . Results : The overall improvement in mean refill adherence was not significant ( 83.9 % vs 86.0 % , P = 0.18 ) . The educational session was attended by 53 % of the physicians . The patient refill adherence of physicians attending the educational session improved by 5.0 % ( P < 0.0009 ) with no significant change among patients of physicians not attending the session . There was no adherence change among patients for whom physicians did not receive refill feedback data , regardless of educational session attendance . Conclusions : Patients of physicians that received refill feedback and attended an educational session improved their refill adherence . After replication of these results in a r and omized trial , broad implementation of this approach could have substantial impact from a public health perspective , given the ubiquity of prescription cl aims data Abstract Objective : To evaluate the feasibility and impact of a structured approach for community pharmacist input as a member of the multidisciplinary team caring for patients with type-2 diabetes and health professional providing advice on medication . Methods : Prospect i ve pretest-posttest single group study . Sixty-two patients on oral hypoglycaemic therapy , identified as regular customers of four Scottish ( UK ) community pharmacies , were recruited . Each patient underwent an initial assessment : review of medical general practice notes/community pharmacy PMR ( Patient medication record ) system and structured interview . St and ardised documentation was completed , a pharmaceutical care plan ( PCP ) prepared , peer- review ed and then discussed face-to-face with patients ' GPs ( general practitioners ) . A second ( final ) assessment was conducted 24 to 28 weeks from the initial interview . Main outcome measures : Pharmaceutical care issues ( PCIs ) throughout study period ; change in parameters from initial to final assessment : patient knowledge of oral hypoglycaemic and anti-hypertensive therapy ; HbA1c ; blood pressure ; total cholesterol ; medication compliance . Results : A total of 178 PCIs were identified ( mean [ range ] 2.9 [ 1–5 ] per patient ) and categorised : drug therapy problems ( n=76 ) ; monitoring ( n=21 ) ; and patient knowledge ( n=81 ) . Drug therapy problems discussed with the GPs were agreed for 74 ( 97 % ) and resolved for 55 ( 72 % ) at final assessment . Biological outcome measures were assessed for 59 patients ( 3 drop-outs ) . A reduction ( P < 0.05 ) in HbA1c , blood pressure and total cholesterol was observed over the study period . Patients knowledge was poor for oral hypoglycaemic therapy but improved ( initial-51 % , final-72 % , P < 0.05 ) . Conclusion : This study demonstrated a feasible pharmaceutical care model for diabetes patients in an European country . The results have shown the pharmacist to be effective and well accepted by GPs and patients BACKGROUND : There is limited information from r and omized controlled studies about the influence of pharmacist interventions on diabetes control . OBJECTIVE : To evaluate the effect of a pharmacist intervention on improving diabetes control ; secondary endpoints were medication appropriateness and self-reported adherence . METHODS : A r and omized , controlled , multi-clinic trial was conducted in the University of Washington Medicine Neighborhood Clinics . Seventy-seven subjects , ⩾18 years old with a hemoglobin ( Hb ) A1c ⩾9 % at baseline and taking at least one oral diabetes medication , were r and omized to receive a pharmacist intervention ( n = 43 ) or usual care ( n = 34 ) for 6 months followed by a 6-month usual-care observation period for both groups . Subjects met with a clinical pharmacist to establish and initiate a diabetes care plan followed by weekly visits or telephone calls to facilitate diabetes management and adherence . HbA1c , medication appropriateness , and self-reported adherence were assessed at baseline , 6 months , and 12 months . RESULTS : The mean HbA1c did not differ between groups over the 12-month period ( p = 0.61 ) . A reduction in HbA1c was noted for both groups over time compared with baseline ( p = 0.001 ) ; however , control subjects relied more heavily on provider visits . Medication appropriateness was not improved for diabetes medications ( p = 0.65 ) . Self-reported adherence was not significantly improved by the intervention . CONCLUSIONS : This pharmacist intervention did not significantly improve diabetes control , but did allow for similar HbA1c control with fewer physician visits . Medication appropriateness and self-reported adherence compared with usual care in individuals with poorly controlled diabetes were not changed Brief , cost-effective interventions to promote diabetes self-management are needed . This study evaluated the effects of a brief , regular , proactive , telephone “ coaching ” intervention delivered by paraprofessionals on diabetes adherence , glycemic control , diabetes-related medical symptoms , and depressive symptoms . Therapeutic mechanisms underlying the intervention ’s effect on the primary outcomes were also examined . Adults diagnosed with type 2 diabetes ( N = 62 ) were r and omly assigned to receive the “ coaching ” intervention and treatment as usual , or only treatment as usual . The intervention increased frequency of exercise and feet inspection , improved diet , reduced diabetes medical symptoms , and lowered depressive symptoms . Self-efficacy , reinforcement , and awareness of self-care goals mediated the treatment effect on depression , exercise , and feet inspection , respectively . A brief telephone intervention delivered by paraprofessionals had positive effects on type 2 diabetes patients Inadequate knowledge of the influence of lifestyle on clinical outcomes contributes to the difficulties many African Americans experience with type 2 diabetes mellitus ( T2DM ) . This pilot study examined a 12-week church-based culturally targeted diabetes self-management education ( DSME ) intervention for middle-aged and older African Americans with T2DM . Quantitative data were collected at baseline and at 12 weeks and included question naires and anthropometric measures . There were significant increases in medication adherence ( p = .006 ) , healthy eating ( p = .009 ) , and foot care adherence ( p = .003 ) . The intervention had a clinical ly significant effect on systolic blood pressure , blood lipids , physical activity , and waist circumference . Church-based culturally targeted DSME interventions may result in improved outcomes for African-American adults with T2DM . The authors discuss the value of community-based interventions that target behavioural changes in population s of chronically ill patients , particularly those who historically have been disenfranchised and /or underserved RATIONALE , AIMS AND OBJECTIVES Utilizing information technology , such as Internet and cellphones , holds great promise in enhancing diabetic care . Yet few studies have examined the impact of cellphone technology on type 2 diabetics ' self-care . The primary aim of the study is to examine the feasibility of utilizing this technology to assist with diabetes self-care in a clinic population as well as its impact on clinical outcomes . METHODS Thirty patients with a diagnosis of type 2 diabetes at two Community Health Centers were r and omized to intervention or control . Intervention patients participated in a brief intervention and received tailored daily messages via cellphone prompting them to enhance their diabetic self-care behaviour .  Patients at the control site continued with their st and ard diabetes self-management .  RESULTS A mean improvement in HbA1c levels was apparent ( -0.1 , SD = 0.3 % ; P = 0.1534 ) in the intervention group , compared with a mean deterioration in the control ( 0.3 , SD = 1.0 % ; P = 0.3813 ) , yet without statistical significance . Self-efficacy scores improved significantly in the intervention group ( -0.5 , SD = 0.6 ; P = 0.0080 ) compared with no improvement in the control ( 0.0 , SD = 1.0 ; P = 0.9060 ) . Participants encountered numerous technological barriers when attempting to adhere to the intervention protocol . CONCLUSION The results indicate the intervention had a positive impact on some clinical outcome and self-efficacy . Although the technology appears feasible in a clinical setting technology must be made more user-friendly before a larger phase II trial is conducted WHAT IS KNOWN AND OBJECTIVE There is little evidence from well- design ed r and omized controlled trials of the impact of community pharmacist intervention on the clinical management of patients with type 2 diabetes . It is also not known how sustainable any observed effects on glycaemic control are , over time . This study was initiated to address both these issues . METHODS A 6-month , r and omized , controlled parallel-group trial in 66 community pharmacies was conducted in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 135 ) or a predefined pharmacist intervention ( n = 153 ) . The intervention mainly focused on correct medication use , medication adherence and healthy lifestyle promotion . Primary outcome was glycaemic control , as measured by fasting plasma glucose and HbA1c . Sustainability of changes in glycaemic control was assessed by additional glucose measurements 18 months after the end of the study . RESULTS AND DISCUSSION The intervention significantly reduced HbA1c ( between-group difference : 0·5 % , P = 0.009 ) . The largest impact on HbA1c was observed when pharmacotherapy changes ( i.e. , type and /or dose of hypoglycaemic agents ) initiated by the physician were sustained with pharmaceutical care : HbA1c was reduced by 1·05 % in the intervention group , whose medication was changed , compared with a reduction of 0·02 % in the therapy-modification only , group . It was also found that the diabetes education program result ed in improved self-management and better knowledge of diabetes . Eighteen months after the end of the formal study period , the mean HbA1c of the intervention group did not differ significantly from the control group ( 7·4 % vs. 7·2 % ) . WHAT IS NEW AND CONCLUSION This study provides new evidence , from a r and omized controlled trial , of the beneficial  effect of community pharmacist intervention in the clinical management of type 2 diabetic patients . However , questions remain about the sustainability of the observed improvements BACKGROUND Increased emphasis is being placed on the critical need to control hypertension ( HTN ) in patients with diabetes . OBJECTIVE The objective of this study was to evaluate the efficacy of a nurse-managed home telehealth intervention to improve outcomes in veterans with comorbid diabetes and HTN . DESIGN A single-center , r and omized , controlled clinical trial design comparing two remote monitoring intensity levels and usual care in patients with type 2 diabetes and HTN being treated in primary care was used . MEASUREMENTS Primary outcomes were hemoglobin A1c and systolic blood pressure ( SBP ) ; secondary outcome was adherence . RESULTS Intervention subjects experienced decreased A1c during the 6-month intervention period compared with the control group , but 6 months after the intervention was withdrawn , the intervention groups were comparable with the control group . For SBP , the high-intensity subjects had a significant decrease in SBP compared with the other groups at 6 months and this pattern was maintained at 12 months . Adherence improved over time for all groups , but there were no differences among the three groups . LIMITATIONS Subjects had relatively good baseline control for A1c and SBP ; minorities and women were underrepresented . CONCLUSIONS Home telehealth provides an innovative and pragmatic approach to enhance earlier detection of key clinical symptoms requiring intervention . Transmission of education and advice to the patient on an ongoing basis with close surveillance by nurses can improve clinical outcomes in patients with comorbid chronic illness Objectives : To evaluate the reach and effectiveness of a  diabetes self-management DVD compared to classroom-based instruction . Methods : A hybrid preference/r and omized design was used with participants assigned to Choice v. R and omized and DVD v. Class conditions . One hundred and eighty-nine adults with type 2 diabetes participated . Key outcomes included self-management behaviours , process measures including DVD implementation and hypothesized mediators and clinical risk factors . Results : In the Choice condition , four times as many participants chose the mailed DVD  as selected Class-based instruction ( 38.8 v. 9.4 % , p<0.001 ) . At the 6-month follow-up , the DVD produced results generally not significantly different than classroom-based instruction , but a combined Class plus DVD condition did not improve outcomes beyond those produced by the classes alone . Discussion : The DVD appears to have merit as an efficient and appealing alternative to brief classroom-based diabetes education , and the hybrid design is recommended to provide estimates of programme reach BACKGROUND Poor adherence to oral antidiabetics has a negative influence on glycaemic control in type 2 diabetes patients .  Real Time Medication Monitoring ( RTMM ) combines real time monitoring of patients ' medication use with SMS reminders sent only if patients forget their medication , aim ing to improve adherence . This study aim ed to investigate the effect of these SMS reminders on adherence to oral antidiabetics in patients using RTMM  and investigate patients ' experiences with RTMM . METHODS Data were collected in a RCT involving 104 type 2 diabetes patients with suboptimal adherence to oral antidiabetics . Fifty-six patients were r and omised to receive SMS reminders if they forgot their medication , 48 patients received no reminders . Primary outcome measure was adherence to oral antidiabetics registered with RTMM , measured as : ( 1 ) days without dosing ; ( 2 ) missed doses ; ( 3 ) doses taken within predefined st and ardized time windows . Patients ' experiences were assessed with written question naires . RESULTS Over the six-month study period , patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders : 50 % vs. 39 % within a 1-h window ( p=0.003 ) up to 81 % vs. 70 % within a 4-h window ( p=0.007 ) . Reminded patients tended to miss doses less frequently than patients not reminded ( 15 % vs. 19 % , p=0.065 ) . Days without dosing were not significantly different between the groups . The majority of patients reported positive experiences with RTMM and SMS reminders . CONCLUSION RTMM with SMS reminders improves adherence of type 2 diabetes patients , especially the precision with which patients follow their prescribed regimen , and is well accepted by patients . TRIAL REGISTRATION Netherl and s Trial Register NTR1882 OBJECTIVE To evaluate the impact of a community pharmacy-based medication adherence detection and intervention protocol on medication adherence for patients with diabetes . DESIGN R and omized controlled trial . SETTING Four community chain pharmacies in the Seattle , WA , area from April 2008 to October 2009 . PATIENTS Patients with diabetes ( n = 265 ) who were taking oral diabetes medications and late for refills by 6 days or more . INTERVENTION Telephone-initiated adherence support by pharmacists following computer-generated missed refill alerts .  Patients were r and omized at the pharmacy level with pharmacists blinded to r and omization . MAIN OUTCOMES MEASURES Changes in medication adherence ( i.e. , days late at first refill , percent with a refill gap of 6 days or more at first refill , medication possession ratio [ MPR ] at 6 and 12 months ) measured during three time periods . RESULTS Baseline MPR ( previous 12 months ) of oral diabetes medications for study versus control participants was relatively high and similar ( 0.86 and 0.84 , respectively ) . At 12 months , MPR was significantly improved for the study group ( P = 0.004 ) compared with the control group ( difference between groups , P = 0.01 ) . The intervention showed greater effect for patients with baseline MPR less than 80 % ( difference between groups , P = 0.02 ) . The likelihood of MPR above 80 % at the 12-month follow-up for any patient significantly favored the intervention group ( odds ratio 4.77 [ 95 % CI 2.00 - 11.40 ] ) . CONCLUSION A brief missed refill intervention program involving urban community chain pharmacies was effective in achieving improved diabetes medication adherence , particularly among individuals with baseline MPR of 0.80 or less R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community BACKGROUND Less than 63 % of individuals with diabetes meet professional guidelines target of hemoglobin A1c < 7.0 % , and only 7 % meet combined glycemic , lipid , and blood pressure goals . The primary study aim was to assess the impact on A1c of a cell phone-based diabetes management software system used with web-based data analytics and therapy optimization tools . Secondary aims examined health care provider ( HCP ) adherence to prescribing guidelines and assessed HCPs ' adoption of the technology . METHODS Thirty patients with type 2 diabetes were recruited from three community physician practice s for a 3-month study and evenly r and omized . The intervention group received cell phone-based software design ed by endocrinologists and CDEs ( WellDoc Communications , Inc. , Baltimore , MD ) . The software provided real-time feedback on patients ' blood glucose levels , displayed patients ' medication regimens , incorporated hypo- and hyperglycemia treatment algorithms , and requested additional data needed to evaluate diabetes management . Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms . The system sent computer-generated logbooks ( with suggested treatment plans ) to intervention patients ' HCPs . RESULTS The average decrease in A1c for intervention patients was 2.03 % , compared to 0.68 % ( P < 0.02 , one-tailed ) for control patients . Of the intervention patients , 84 % had medications titrated or changed by their HCP compared to controls ( 23 % , P = 0.002 ) . Intervention patients ' HCPs reported the system facilitated treatment decisions , provided organized data , and reduced logbook review time . CONCLUSIONS Adults with type 2 diabetes using WellDoc 's software achieved statistically significant improvements in A1c . HCP and patient satisfaction with the system was clinical ly and statistically significant BACKGROUND Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications . AIM The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin ( HbA1c ) levels and adherence to diabetes control recommendations . METHODS A r and omized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls .  Twenty patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA1c < 7 % ) . The intervention was applied to the intervention group for 12 weeks , and consisted of continued education and reinforcement of diet , exercise , medication adjustment recommendations , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month and then weekly for the second and third month . Participants were requested to write self-management logs including blood glucose levels , diet and an exercise diary . A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail . All medication adjustments were communicated to participants ' doctors . The HbA1c and diabetes adherence were measured before and after the intervention . RESULTS Patients in the intervention group had a mean decrease of 1.2 % in HbA1c levels and those in the control group had a mean increase of 0.6 % in HbA1c levels . The intervention group had greater diet and blood glucose testing adherence than the control group . CONCLUSION These findings indicate that a nurse telephone intervention can improve HbA1c , and diet and blood glucose testing adherence PURPOSE Depression commonly accompanies diabetes , result ing in reduced adherence to medications and increased risk for morbidity and mortality . The objective of this study was to examine whether a simple , brief integrated approach to depression and type 2 diabetes mellitus ( type 2 diabetes ) treatment improved adherence to oral hypoglycemic agents and antidepressant medications , glycemic control , and depression among primary care patients . METHODS We undertook a r and omized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care . Patients were r and omly assigned to an integrated care intervention or usual care . Integrated care managers collaborated with physicians to offer education and guideline -based treatment recommendations and to monitor adherence and clinical status . Adherence was assessed using the Medication Event Monitoring System ( MEMS ) . We used  glycated hemoglobin ( HbA1c ) assays  to measure glycemic control and the 9-item Patient Health Question naire ( PHQ-9 ) to assess depression . RESULTS Intervention and usual care groups did not differ statistically on baseline measures . Patients who received the intervention were more likely to achieve HbA1c levels of less than 7 % ( intervention 60.9 % vs usual care 35.7 % ; P < .001 ) and remission of depression ( PHQ-9 score of less than 5 : intervention 58.7 % vs usual care 30.7 % ; P < .001 ) in comparison with patients in the usual care group at 12 weeks . CONCLUSIONS A r and omized controlled trial of a simple , brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care . An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practice s with competing dem and s for limited re sources
target: The review found that multifaceted interventions , addressing several non-adherence factors , were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies .
  However , interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results , making it difficult to conclude on effective intervention strategies to promote adherence .
  Educational strategies have remained the most popular intervention strategy , followed by behavioural , with affective components becoming more common in recent years .
  There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications .
background: BACKGROUND Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes ( T2D ) .
  A range of interventions have been developed to promote anti-diabetic medication adherence .
  However , there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence .
  In this systematic review we assessed the characteristics of interventions that aim ed to promote adherence to anti-diabetic medications .