title: Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study) Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. Outcomes from a Diabetes Self-management Intervention for Native Hawaiians and Pacific People: Partners in Care Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Comparison of family partnership intervention care vs. conventional care in adult patients with poorly controlled type 2 diabetes in a community hospital: a randomized controlled trial. Reducing stress and supporting positive relations in families of young children with type 1 diabetes: A randomized controlled study for evaluating the effects of the DELFIN parenting program Impact of family support improvement behaviors on anti diabetic medication adherence and cognition in type 2 diabetic patients Family intervention to control type 2 diabetes: a controlled clinical trial. Psychological family intervention for poorly controlled type 2 diabetes. Promoting couples collaboration in type 2 diabetes: the diabetes support project pilot data. Viva bien!: Overcoming recruitment challenges in a multiple-risk-factor diabetes trial. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes. Enhancing Diabetes Self-care Among Rural African Americans With Diabetes A brief psychological intervention to improve adherence in type 2 diabetes.
abstract: OBJECTIVE To test whether a theory-based , literacy , and culturally tailored self-management intervention , Latinos en Control  , improves glycemic control among low-income Latinos with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 252 patients recruited from community health centers were r and omized to the  Latinos en Control intervention or to usual care . The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge , attitudes , and self-management behaviors . The primary outcome was HbA1c . Secondary outcomes included diet , physical activity , blood glucose self-monitoring , diabetes knowledge and self-efficacy , and other physiological factors ( e.g. , lipids , blood pressure , and weight ) . Measures were collected at baseline and at 4- and 12-month follow-up . Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach . RESULTS A significant difference in HbA1c change between the groups was observed at 4 months ( intervention −0.88 [ −1.15 to −0.60 ] versus control −0.35 [ −0.62 to 0.07 ] , P < 0.01 ) , although this difference decreased and lost statistical significance at 12 months ( intervention −0.46 [ −0.77 to −0.13 ] versus control −0.20 [ −0.53 to 0.13 ] , P = 0.293 ) . The intervention result ed in significant change differences in diabetes knowledge at 12 months ( P = 0.001 ) , self-efficacy ( P = 0.001 ) , blood glucose self-monitoring ( P = 0.02 ) , and diet , including dietary quality ( P = 0.01 ) , kilocalories consumed ( P < 0.001 ) , percentage of fat ( P = 0.003 ) , and percentage of saturated fat ( P = 0.04 ) . These changes were in turn significantly associated with HbA1c change at 12 months . CONCLUSIONS Literacy-sensitive , culturally tailored interventions can improve diabetes control among low-income Latinos ; however , strategies to sustain improvements are needed PURPOSE We compared a 3-month diabetes self-management education ( DSME ) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin ( HbA1c ) . Secondary outcomes were risk factors for cardiovascular disease ( CVD ) , diabetes distress , and social support . METHODS We r and omized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support . Assessment s were conducted at baseline , 3 , 9 , and 15 months . RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group . The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months . At 15 months , the peer-support group had significantly lower low-density lipoprotein cholesterol levels ( −15 mg/dL , P = .03 ) , systolic blood pressure ( −10 mm Hg , P = .01 ) , diastolic blood pressure ( −8.3 mm Hg , P = .001 ) , and body mass index ( −0.8 kg/m2 , P = .032 ) than the DSME-alone group . CONCLUSIONS In this population of African American adults , an initial DSME program , whether or not followed by 12 months of peer support , had no effect on glycemic control . Participants in the peer-support arm of the trial did , however , experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined Objective To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams . Design Pragmatic cluster r and omised controlled trial . Setting 26 UK secondary and tertiary care paediatric diabetes services . Participants 79 healthcare practitioners ( 13 teams ) trained in the intervention ( 359 young people with type 1 diabetes aged 4 - 15 years and their main carers ) and 13 teams allocated to the control group ( 334 children and their main carers ) . Intervention Talking Diabetes programme , which promotes shared agenda setting and guiding communication style , through flexible menu of consultation strategies to support patient led behaviour change . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) level one year after training . Secondary outcomes were clinical measures ( hypoglycaemic episodes , body mass index , insulin regimen ) , general and diabetes specific quality of life , self reported and proxy reported self care and enablement , perceptions of the diabetes team , self reported and carer reported importance of , and confidence in , undertaking diabetes self management measured over one year . Analysis was by intention to treat . An integrated process evaluation included audio recording a sample of 86 routine consultations to assess skills shortly after training ( intervention group ) and at one year follow-up ( intervention and control group ) . Two key domains of skill assessment were use of the guiding communication style and shared agenda setting . Results 660/693 patients ( 95.2 % ) provided blood sample s at follow-up . Training diabetes care teams had no effect on HbA1c levels ( intervention effect 0.01 , 95 % confidence interval −0.02 to 0.04 , P=0.5 ) , even after adjusting for age and sex of the participants . At follow-up , trained staff ( n=29 ) were more capable than controls ( n=29 ) in guiding ( difference in means 1.14 , P<0.001 ) and agenda setting ( difference in proportions 0.45 , 95 % confidence interval 0.22 to 0.62 ) . Although skills waned over time for the trained practitioners , the reduction was not significant for either guiding ( difference in means −0.33 , P=0.128 ) or use of agenda setting ( difference in proportions −0.20 , −0.42 to 0.05 ) . 390 patients ( 56 % ) and 441 carers ( 64 % ) completed follow-up question naires . Some aspects of diabetes specific quality of life improved in controls : reduced problems with treatment barriers ( mean difference −4.6 , 95 % confidence interval −8.5 to −0.6 , P=0.03 ) and with treatment adherence ( −3.1 , −6.3 to −0.01 , P=0.05 ) . Short term ability to cope with diabetes increased in patients in intervention clinics ( 10.4 , 0.5 to 20.4 , P=0.04 ) . Carers in the intervention arm reported greater excitement about clinic visits ( 1.9 , 1.05 to 3.43 , P=0.03 ) and improved continuity of care ( 0.2 , 0.1 to 0.3 , P=0.01 ) . Conclusions Improving glycaemic control in children attending specialist diabetes clinics may not be possible through brief , team-wide training in consultation skills . Trial registration Current Controlled Trials IS RCT N61568050 OBJECTIVE The objective of this observational open label trial was to characterize changes in diabetes self-management and psychological distress associated with a mobile health ( mHealth ) interactive voice response ( IVR ) self-management support program . METHODS For 3 - 6 months , 301 patients with diabetes received weekly IVR calls assessing health status and self-care  and providing tailored pre-recorded self-management support messages . Patients could participate together with an informal caregiver who received suggestions on self-management support , and patients ' clinicians were notified automatically when patients reported significant problems . RESULTS Patients completed 84 % of weekly calls , providing 5682 patient-weeks of data . Thirty-nine percent participated with an informal caregiver . Outcome analyses adjusted for study design factors and sociodemographics indicated significant pre-post improvement in medication adherence , physical functioning , depressive symptoms , and diabetes-related distress ( all p values < 0.001 ) . Analyses of self-management problems indicated that as the intervention proceeded , there were significant improvements in patients ' IVR-reported frequency of weekly medication adherence , SMBG performance , checking feet , and frequency of abnormal self-monitored blood glucose readings ( all p values < 0.001 ) . CONCLUSIONS We conclude that the combined program of automated telemonitoring , clinician notification , and informal caregiver involvement was associated with consistent improvements in medication adherence , diabetes self-management behaviors , physical functioning , and psychological distress . A r and omized controlled trial is needed to verify these encouraging findings Background Culturally adapted interventions are needed to reduce diabetes-related morbidity and mortality among Native Hawaiian and Pacific People . Purpose The purpose of this study is to pilot test the effectiveness of a culturally adapted diabetes self-management intervention . Methods Participants were r and omly assigned in an unbalanced design to the Partners in Care intervention ( n = 48 ) or wait list control group ( n = 34 ) . Assessment s of hemoglobin A1c , underst and ing of diabetes self-management , performance of self-care activities , and diabetes-related distress were measured at baseline and 3 months ( post intervention ) . Analysis of covariance was used to test between-group differences . The community steering committee and focus group data informed the cultural adaptation of the intervention . Results There were significant baseline adjusted differences at 3 months between the Partners in Care and wait list control group in intent-to-treat ( p < 0.001 ) and complete case analyses ( p < 0.0001 ) for A1c , underst and ing ( p < 0.0001 ) , and performing diabetes self-management ( p < 0.0001 ) . Conclusions A culturally adapted diabetes self-management intervention of short duration was an effective approach to improving glycemic control among Native Hawaiian and Pacific Isl and ers 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 Background Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control . We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes . Methods and Findings We performed a r and omized , parallel , investigator-blind controlled trial with central ized r and omization in family practice s in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin ( HbA1c ) > 58 mmol/mol . The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group . The control group received usual care , with at least annual review and more frequent review s for  people with poor glycemic or blood pressure control .  HbA1c assessed at 9 mo was the primary outcome . Intention-to-treat analyses were performed . 160 people were r and omized to the intervention group and 161 to the usual care group between June 6 , 2011 , and July 19 , 2013 .  HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group . The mean ( SD ) HbA1c at follow-up was 63.0 ( 15.5 ) mmol/mol in the intervention group and 67.8 ( 14.7 ) mmol/mol in the usual care group . For primary analysis , adjusted mean HbA1c was 5.60 mmol/mol / 0.51 % lower ( 95 % CI 2.38 to 8.81 mmol/mol/ 95 % CI 0.22 % to 0.81 % , p = 0·0007 ) . For secondary analyses , adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower ( 95 % CI 0.56–5.56 mmHg , p = 0.017 ) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower ( 95 % CI 0.62–3.72 , p = 0.006 ) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata . No significant differences were identified between groups in weight , treatment pattern , adherence to medication , or quality of life in secondary analyses . There were few adverse events and these were equally distributed between the intervention and control groups . In secondary analysis , there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group ( rate ratio 7.50 ( 95 % CI 4.45–12.65 , p < 0.0001 ) but no other significant differences between groups in use of health services were identified between groups . Key limitations include potential lack of representativeness of trial participants , inability to blind participants and health professionals , and uncertainty about the mechanism , the duration of the effect , and the optimal length of the intervention . Conclusions Supported telemonitoring result ed in clinical ly important improvements in control of glycaemia in patients with type 2 diabetes in family practice . Current Controlled Trials , registration number IS RCT N71674628 . Trial Registration Current Controlled Trials IS RCT N BACKGROUND Although African American adults bear a disproportionate burden from diabetes mellitus ( DM ) , few r and omized controlled trials have tested culturally appropriate interventions to improve DM care . METHODS We r and omly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group . The intensive intervention group consisted of all components of the minimal intervention plus individualized , culturally tailored care provided by a nurse case manager ( NCM ) and a community health worker ( CHW ) , using evidence -based clinical algorithms with feedback to primary care providers ( eg , physicians , nurse practitioners , or physician assistants ) . The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings . Data on diabetic control were collected at baseline and at 24 months by blind observers ; data emergency department ( ER ) visits and hospitalizations were assessed using administrative data . RESULTS At baseline , participants had a mean age of 58 years , 73 % were women , and 50 % were living in poverty . At 24 months , compared with the minimal intervention group , those in the intensive intervention group were 23 % less likely to have ER visits ( rate difference [ RD ] , -14.5 ; adjusted rate ratio [ RR ] , 0.77 ; 95 % confidence interval [ CI ] , 0.59 - 1.00 ) . In on-treatment analyses , the rate reduction was strongest for patients who received the most NCM and CHW visits ( RD , -31.0 ; adjusted RR , 0.66 ; 95 % CI , 0.43 - 1.00 ; rate reduction downward arrow 34 % ) . CONCLUSION These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00022750 BACKGROUND Although there is a significant correlation between the degree of family support and clinical outcome , little research has focused on the effectiveness of family partnership intervention care ( FPIC ) for patients with poorly controlled type 2 diabetes . OBJECTIVES This study aim ed to compare FPIC with conventional care ( CC ) across a number of outcome measures in patients with poorly controlled type 2 diabetes . DESIGN The study was performed using a r and omized controlled trial design . PARTICIPANTS Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7 % in the previous 12 months , were r and omly assigned to the FPIC group ( n=28 ) and to the  CC group ( n=28 ) . METHODS Baseline and 6-month follow-up scores were compared using the following outcome measures : ( 1 ) hemoglobin A1C , ( 2 ) BMI , ( 3 ) lipid profile , ( 4 ) family supportive behaviours , ( 5 ) , knowledge of and attitudes toward diabetes , and ( 6 ) diabetes self-care behaviours . Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups . RESULTS There were no significant differences in the reduction of hemoglobin A1C levels ( p=0.46 ) , lipid profile values ( p>0.05 ) , and improvement of diabetes self-care behaviours ( p=0.61 ) between the groups at 6 months post-intervention . However , there were significant differences in the scores of family supportive behaviours ( p=0.031 ) and patients ' knowledge of and attitudes toward diabetes between the groups ( p<0.05 ) . CONCLUSION These findings support the use of FPIC to enhance family supportive behaviours , and to improve patients ' knowledge of and attitudes toward diabetes . Thus , the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes Background To assess initial efficacy and feasibility of a structured behavioural group training ( DELFIN ) for parents of children with diabetes type 1 , in order to reduce parenting stress and to improve parenting skills . Methods A r and omized controlled study was conducted between July 2008 and September 2010 , at a children ’s hospital in Hannover with parents of children with type 1 diabetes ( 2–10 yrs ) ( intervention group n = 37 ; control group n = 28 ) . Parenting skills , parents ’ psychological burden , children ’s behavioural difficulties and quality of metabolic control were assessed before , 3 months after and 12 months after participating in the training program . Results In the intervention group parenting behaviour in conflict situations improved significantly after 3 months ( Z = −3.28 ; p ≤ 0.001 ) . It remained stable over 12 months ( Z = −2.94 ; p ≤ 0.01 ) . Depression and anxiety scores of parents decreased ( Z = −1.93 ; p ≤ .05 ; Z = −2.02 ; p ≤ .05 ) . Even though the outcome in the intervention group was more positive , the differences between both study arms failed to reach statistical significance . Unexpectedly parenting behaviour in the control group improved also ( Z = −2.45 ; p ≤ .05 ) . Anxiety as well as stress scores decreased in this group ( Z = −2.02 ; p ≤ .05 and Z = −2.11 ; p ≤ .05 ) . In both groups the initial metabolic control was good and without significant differences ( A1c 7.2±0.8 % vs. 7.1±0.4 % ; p > 0.5 ) . It remained stable in the DELFIN group ( A1c 7.1±0.8 % ; p > 0.5 ) , but it increased slightly in controls ( A1c 7.3±0.5 % ; Z = −2.79 ; p = .005 ) . Conclusions This study has brought first evidence for the efficacy and feasibility of the program . A multicentre study with a larger sample is necessary to confirm these first results Background Glycaemic control is the main goal of treatment for type 2 diabetic patients . Hyperglycaemia may result in cognitive decline . More family support may increase medication adherence and decrease glycaemic level . The purpose of this study was to determine the impact of family support improvement behavior on anti diabetic medication adherence and cognition in type 2 diabetic patients . Method The r and omized control trial study was conducted on 91 patients from an outpatient diabetes clinic . They were r and omly divided to intervention ( n = 45 ) and control  ( n = 46 ) group . Data on the patients ’ demographic information and their family gathered using a question naire , For two groups Morisky Medication Adherence Scale ( MMAS ) , drug administration part of  Diabetes Social Support Question naire – family version ( DSSQ ) , Number Connection Test ( NCT ) were applied and hemoglobin A1C was measured two times in the onset of study and three months later for control group and before and after intervention for intervention group . The key family members of the intervention group were taught according to their educational needs in small groups . Result In intervention group mean of NCT score was significantly decreased after intervention ( P = 0.006 ) however in the control group there was no significant difference after three months . In intervention group a significant correlation was noted between DSSQ scores and MMAS scores after intervention(r = 0.67 , P < 0.001 ) but , there was no significant correlation in the control group . Conclusion Family support instruction based on the educational needs of family members , may improve medication adherence through direct effect and cognitive status with indirect effect 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 effectiveness of a psychological , family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes . METHODS This study was a r and omized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes . Recruitment and follow-up occurred at specialist diabetes clinics . Patients were r and omly allocated to an  intervention group ( n=60 ) or a control group ( n=61 ) . Poor control was defined as at least 2 of the patient 's last 3 glycated hemoglobin (  A1C  )  readings at > 8.0 % . The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient 's home , with a third session involving a 15-minute follow-up telephone call . RESULTS At 6-month follow-up , the intervention group reported significantly lower mean A1C levels than the control group ( 8.4 % [ SD=0.99 % ] vs 8.8 % [ SD=1.36 % ] ; P=.04 ) . The intervention was most effective in those with the poorest control at baseline ( A1C>9.5 % ) ( intervention 8.7 % [ SD=1.16 % , n=15 ] vs control 9.9 % [ SD=1.31 % , n=15 ] ; P=.01 ) . The intervention group also reported statistically significant improvements in beliefs about diabetes , psychological well-being , diet , exercise , and family support . CONCLUSIONS After participating in a family-based intervention targeting negative and /or inaccurate illness perceptions , patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes . Our results suggest that adding a psychological , family-based component to usual diabetes care may help improve diabetes management A pilot study was conducted to assess the feasibility and potential efficacy of a couples focused diabetes intervention in which a collaborative problem-solving approach to diabetes self-care was promoted . Couples ( N = 44 ) , in which one partner had Type 2 diabetes and was in poor blood glucose control were r and omly assigned to one of three groups : a couples intervention , an individual intervention , or individual diabetes education . The intervention included goal - setting , dietary behavior change , and a focus on emotions . For those in the couples arm , this was done within the framework of promoting collaborative communication between the partners . All intervention contacts were over the telephone to increase reach . Results showed that both the individual and couples interventions yielded meaningful clinical improvements in medical outcomes . Diabetes education also result ed in improved blood glucose control . Despite the small number , mixed-model regression analyses found statistically significant treatment effects for total cholesterol . This pilot demonstrates the feasibility and potential efficacy of a telephone intervention for Type 2 diabetes patients and their partners . Information from implementing this pilot led to refinement and further development of the intervention , which is being assessed in a larger , more comprehensive trial OBJECTIVES To describe recruitment of Latinas in a r and omized clinical trial conducted within 2 health care organizations . METHODS The study relied on project-initiated telephone calls as part of a multifaceted recruitment approach . Chi-square and t tests were conducted to compare participants and non participants on a number of variables . RESULTS From 4045 telephone contacts , 280 Latinas agreed to participate . Most were ineligible due to non-Latino ethnicity ( 89 % ) . Of eligible c and i date s , 61 % took part . Few significant differences were found on participant vs nonparticipant characteristics . CONCLUSIONS Using appropriate recruitment procedures , a representative sample of Latinas can be obtained Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended long-term lifestyle changes and reduce heart disease risk . To test the longer-term ( 24-month ) effects of a previously successful , culturally adapted , multiple-health-behavior-change program , ¡ Viva Bien ! , 280 Latinas were r and omly assigned to usual care or ¡ Viva Bien!.  Treatment included group meetings to promote a culturally adapted Mediterranean diet , physical activity , supportive re sources , problem solving , stress-management practice s , and smoking cessation . ¡ Viva Bien ! participants achieved and maintained some lifestyle improvements from baseline through 24 months , including significant improvements for psychosocial outcomes , fat intake , social – environmental support , body mass index , and hemoglobin A1c . Effects tended to diminish over time . The ¡ Viva Bien ! multiple-behavior program was effective in improving and maintaining some psychosocial , behavioral , and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes , a high-risk , underserved population ( Clinical Trials.gov number , NCT00233259 ) This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans , a fast growing minority population experiencing a diabetes epidemic . Patients with diabetes need assistance interpreting and managing symptoms , which are often annoying and potentially life-threatening . A repeated measures r and omized controlled trial was conducted with 72 Mexican Americans aged 25 - 75 years with type 2 diabetes . Experimental condition participants received eight weekly , in-home , one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness , glucose self-testing and appropriate treatments , followed by eight biweekly support telephone sessions . Wait-listed control condition participants served as comparisons at three time points . Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial , behavioral and clinical outcomes .  Participants were predominantly female , middle-aged , moderately acculturated and in poor glycemic control . Experimental group participants ( n = 39 ) significantly improved glycemic control , blood pressure , symptoms , knowledge , self-efficacy , empowerment and quality of life . Post intervention focus groups reported satisfaction with the symptom focus . Addressing symptoms led to clinical and psychosocial improvements . Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications Purpose The purpose of this study is to test the feasibility of conducting a community-based r and omized controlled trial evaluating a culturally tailored community-based group diabetes self-management education ( DSME ) program among rural African Americans . Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study design ed to test the effectiveness of the “ Taking Care of Sugar ” DSME program for the 2-year follow-up . Participants were selected from rural central Virginia . Primary outcomes variables included average blood sugar levels , cardiovascular risk factors , and general physical and mental health . These outcomes were assessed at baseline , 3 months , 6 months , and 12 months post baseline . Results From baseline to 3-month follow-up assessment , participants exhibited significant improvement on several physiological and behavioral measures . Given the small sample size , hypothesis testing was limited . Results show change from baseline over time , illustrating that the primary outcome of A1C decreased , although not significant . Additionally , participants reported more knowledge about diabetes self-management and personal care skills ( ie , exercise and foot care ) that persisted over time . The feasibility of the culturally tailored DSME was established , and participation with the program was high . Conclusions A community-based group DSME program using storytelling is feasible . This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population . If such a program is carried out , we can improve knowledge , reduce complications , and improve quality of life among rural African Americans OBJECTIVE Diabetes perceptions , acceptance and treatment motivation are changeable factors of adherence . This study aim ed to test the effects of brief psychological interventions based on diabetes threat and mastery perceptions in terms of adherence , acceptance and motivation . Physicians may find such interventions useful during a 15-minute consultation with diabetes patients . RESEARCH DESIGN AND METHODS This r and omized controlled study included 80 patients with type 2 diabetes , recruited from the hospital diabetes department , who were r and omly assigned to four intervention groups based on autobiographical recall . Those in the two intervention groups were asked to recall diabetic events based on mastery and threat perceptions , respectively , whereas those in the two control groups recalled non-diabetic events based on positive and negative emotions , respectively . Following this , all participants completed vali date d self- question naires assessing diabetes perceptions , acceptance , treatment motivation and adherence . RESULTS Patients in the threat group reported less adherence ( P<0.01 ) and less avoidance ( P<0.05 ) , and perceived diabetes as less threatening ( P<0.05 ) than those in the mastery group . Similar results were obtained when the threat group was compared with its matched negative-emotion control group ( P<0.05 , P<0.05 and P=0.087 , respectively ) . Patients in the mastery group reported feeling a stronger sense of mastery ( P<0.05 ) than those in their positive-emotion control group and greater treatment acceptance than those in the threat group ( P<0.01 ) . CONCLUSION Contrary to conventional medical belief , discussing threatening personal events with patients can yield positive results . Health professionals should take threat and mastery perceptions of diabetes into account during regular consultations with a view to improving treatment acceptance and adherence . With this brief intervention of type 2 diabetes patients , it was also more effective to alleviate their emotional difficulties than to enhance their perception of mastery
target: Overall , family support had a positive impact on healthy diet , increased perceived support , higher self-efficacy , improved psychological well-being and better glycemic control .
  This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients .
background: The rate of type-2 diabetes mellitus ( T2D ) is dramatically increasing worldwide .
  Continuing diabetes mellitus ( DM ) care needs effective self-management education and support for both patients and family members .
  This study aim ed to review and describe the impacts of diabetes mellitus self-management education ( DSME ) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence , blood glucose monitoring , diet and exercise changes , health outcomes including psychological well-being and self-efficacy , and physiological markers including body mass index , level of blood pressure , cholesterol level and glycemic control .