title: Effects of a structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese Type 2 diabetic patients: a 1-year prospective randomized study. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Randomized Trial of a Literacy-Sensitive, Culturally Tailored Diabetes Self-Management Intervention for Low-Income Latinos One-to-one teaching with pictures--flashcard health education for British Asians with diabetes. The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes. Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Assessment of Barriers to Improve Diabetes Management in Older Adults A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Comprehensive Diabetes Management Program for Poorly Controlled Hispanic Type 2 Patients at a Community Health Center Pharmacist-Led Shared Medical Appointments for Multiple Cardiovascular Risk Reduction in Patients With Type 2 Diabetes Pharmacist-Led Group Medical Appointment Model in Type 2 Diabetes Integrative Health Coaching for Patients With Type 2 Diabetes 3-Year Follow-up of Clinical and Behavioral Improvements Following a Multifaceted Diabetes Care Intervention Diabetes self-management among low-income spanish-speaking patients: A pilot study Outcomes from a Multiple Risk Factor Diabetes Self-Management Trial for Latinas: ¡Viva Bien! A Randomized Trial of a Church-Based Diabetes Self-management Program for African Americans With Type 2 Diabetes Texas-Mexico Border Intervention by Promotores for Patients With Type 2 Diabetes Community-Based Peer-Led Diabetes Self-management A Community-Based, Culturally Tailored Behavioral Intervention for Korean Americans With Type 2 Diabetes Culturally Competent Diabetes Education Promotora Diabetes Intervention for Mexican Americans Biophysiologic outcomes of the Enhancing Adherence in Type 2 Diabetes (ENHANCE) 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. Online Diabetes Self-Management Program Effect of structured group education on glycemic control and hypoglycemia in insulin-treated patients. Translating the Chronic Care Model Into the Community: Results From a Randomized Controlled Trial of a Multifaceted Diabetes Care Intervention Randomised controlled trial of an automated, interactive telephone intervention (TLC Diabetes) to improve type 2 diabetes management: baseline findings and six-month outcomes A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Effect of a pharmaceutical care program on vascular risk factors in type 2 diabetes: the Fremantle Diabetes Study. Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Results of a Successful Telephonic Intervention to Improve Diabetes Control in Urban Adults Effects of the Diabetes Manual 1:1 structured education in primary care. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Prospective Randomized Controlled Trial to Evaluate Effectiveness of Registered Dietitian–Led Diabetes Management on Glycemic and Diet Control in a Primary Care Setting in Taiwan Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial. Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: a randomized controlled trial Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial. Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study. A controlled trial of the effectiveness of a diabetes education programme in a multi-ethnic community in Glasgow [ISRCT28317455] Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Impact of automated calls with nurse follow-up on diabetes treatment outcomes in a Department of Veterans Affairs Health Care System: a randomized controlled trial. A patient-centric, provider-assisted diabetes telehealth self-management intervention for urban minorities. Peer-Led Diabetes Education Programs in High-Risk Mexican Americans Improve Glycemic Control Compared With Standard Approaches Applying the Stages of Change model to Type 2 diabetes care in Trinidad: A randomised trial Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes. Biologic and quality-of-life outcomes from the Mediterranean Lifestyle Program: a randomized clinical trial. Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. Treatment of high-risk patients with diabetes: motivation and teaching intervention: a randomized, prospective 8-year follow-up study. Proactive case management of high-risk patients with type 2 diabetes mellitus by a clinical pharmacist: a randomized controlled trial. Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial Managing the Space between Visits: A Randomized Trial of Disease Management for Diabetes in a Community Health Center Evaluation of the UCL Diabetes Self-management Programme (UCL-DSMP): A Randomized Controlled Trial Are benefits from diabetes self-management education sustained? Nurse case management improves blood pressure, emotional distress and diabetes complication screening. Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes A Randomized Controlled Trial of Weight Reduction and Exercise for Diabetes Management in Older African-American Subjects Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care. Evaluation of a behavior support intervention for patients with poorly controlled diabetes. Experience-based group education in Type 2 diabetes: a randomised controlled trial. Medical Clinics Versus Usual Care for Patients With Both Diabetes and Hypertension Promoting Health in Type 2 Diabetes: Nurse-Physician Collaboration in Primary Care Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes Multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: the Microalbuminuria Education and Medication Optimisation (MEMO) study. Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial. Controlled Trial of Nursing Interventions to Improve Health Outcomes of Older African American Women With Type 2 Diabetes Behavioural interventions for type 2 diabetes: an evidence-based analysis. Effect of diabetes education on glucose control. A preliminary report on an assessment of a community-based intervention for diabetes control in adults with type 2 diabetes. Effect of the diabetes outpatient intensive management programme on glycaemic control for type 2 diabetic patients. Use of Medicare’s Diabetes Self-Management Training Benefit Pharmacist-Led Group Medical Appointments for the Management of Type 2 Diabetes with Comorbid Depression in Older Adults Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Evaluation of the "Know Your Health" program for type 2 diabetes mellitus and hypertension in a large employer group. Effectiveness of a community pharmacist intervention in diabetes care: a randomized controlled trial. Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized study Evaluating the Efficacy of an Empowerment-Based Self-Management Consultant Intervention: Results of a Two-Year Randomized Controlled Trial. Leveling the field: addressing health disparities through diabetes disease management. An integrated intervention program to control diabetes in overweight Chinese women and men with type 2 diabetes. A telephone-delivered intervention to improve glycemic control in type 2 diabetic patients. Pharmacist Assisted Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study. Teaching patients to monitor their risk factors retards the progression of vascular complications in high‐risk patients with Type 2 diabetes mellitus—a randomized prospective study Symptom-focused management for African American women with Type 2 diabetes: a pilot study. A Nurse-Coaching Intervention for Women With Type 2 Diabetes Long-term effects of a structured intensive diabetes education programme (SIDEP) in patients with Type 2 diabetes mellitus--a 4-year follow-up study. Randomized controlled trial of clinical pharmacy management of patients with type 2 diabetes in an outpatient diabetes clinic in Jordan. Integrating medical management with diabetes self-management training: a randomized control trial of the Diabetes Outpatient Intensive Treatment program. Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Effectiveness of lifestyle counseling by certified expert nurse of Japan for non-insulin-treated diabetic outpatients: a 1-year randomized controlled trial. Pounds off with empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Pro-active call center treatment support (PACCTS) to improve glucose control in type 2 diabetes: a randomized controlled trial. Rapid improvement of glycemic control in type 2 diabetes using weekly intensive multifactorial interventions: structured glucose monitoring, patient education, and adjustment of therapy-a randomized controlled trial. Impact of Reinforcement of Diabetes Self-Care on Poorly Controlled Diabetes The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Supporting Diabetes Self-Care in Underserved Populations
abstract: AIMS To assess the effect of regular diabetic health education on cardiovascular risk factors in Chinese Type 2 diabetic patients . METHODS This was a 1-year prospect i ve r and omized study . One hundred and eighty Type 2 diabetic subjects were recruited from three regional diabetic centres in Hong Kong . Ninety received additional structured reinforcement of diabetic health education by a trained nurse after the doctors ' consultations every 3 months ( intervention group ) . The others received the same medical care except no nursing reinforcement ( control group ) . Outcome measures included fasting plasma glucose , HbA(1c ) , body mass index , waist circumference , blood pressure and lipid profiles , which were assessed before the study and after 1 year . RESULTS Two of the controls defaulted follow-up . The intervention group and controls had similar age and sex distribution . At the end of study , the intervention group had reducted their waist circumference , diastolic blood pressure , HbA(1c ) , total cholesterol and low-density lipoprotein cholesterol levels . The controls had reduced their total cholesterol and low-density lipoprotein cholesterol levels . Other cardiovascular risk factors were not significantly changed in the controls . Addition of drugs and /or dosage increment of anti-diabetic drugs , lipid-lowering agents and anti-hypertensive agents were similar between the two groups . CONCLUSIONS Regular structured reinforcement with diabetic health education is useful . It helps to control more successfully some of the cardiovascular risk factors in Chinese Type 2 diabetic patients BACKGROUND African Americans suffer disproportionately from diabetes complications , but little research has focused on how to improve diabetic control in this population . There are also few or no data on a combined primary care and community-based intervention approach . METHODS We r and omly assigned 186 urban African Americans with type 2 diabetes ( 76 % female , mean A SD age 59 A 9 years ) to 1 of 4 parallel arms : ( 1 ) usual care only ; ( 2 ) usual care + nurse case manager ( NCM ) ; ( 3 ) usual care + community health worker ( CHW ) ; ( 4 ) usual care + nurse case manager/community health worker team . Using the framework of the Precede-Proceed behavioral model , interventions included patient counseling regarding self-care practice s and physician reminders . RESULTS The 2-year follow-up visit was completed by 149 individuals ( 84 % ) . Compared to the Usual care group , the NCM group and the CHW group had modest declines in HbA(1c ) over 2 years ( 0.3 and 0.3 % , respectively ) , and the combined NCM/CHW group had a greater decline in HbA(1c ) ( 0.8 % . P = 0.137 ) . After adjustment for baseline differences and /or follow-up time , the combined NCM/CHW group showed improvements in triglycerides ( -35.5 mg/dl ; P = 0.041 ) and diastolic blood pressure , compared to the usual care group ( -5.6 mmHg ; P = 0.042 ) . CONCLUSIONS Combined NCM/CHW interventions may improve diabetic control in urban African Americans with type 2 diabetes . Although results were clinical ly important , they did not reach statistical significance . This approach deserves further attention as a means to reduce the excess risk of diabetic complications in African Americans 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 BACKGROUND Type 2 diabetes is up to four times more common in British Asians , but they know little about its management and complications . AIM To design and evaluate a structured pictorial teaching programme for Pakistani Moslem patients in Manchester with type 2 diabetes . METHOD A r and omized controlled trial of pictorial flashcard one-to-one education in 201 patients attending a hospital outpatient clinic or diabetic clinics in ten general practice s in Manchester . Patients ' knowledge , self-caring skills and attitudes to diabetes were measured on four topics before the structured teaching , and compared with results six months later . RESULTS All parameters of knowledge were increased in the study group ; for example , percentage scores for correctly identifying different food values increased from 57 % to 71 % ( Analysis of Variance ( ANOVA ) adjusted difference + 11.8 % ) and knowledge of one diabetic complication from 18 % to 78 % . Self-caring behaviour improved , with 92 % of patients doing regular glucose tests at six months compared with 63 % at the start . Attitudinal views were more resistant to change , with patients still finding it hard to choose suitable foods at social occasions . Haemoglobin A1c control improved by 0.34 % over six months ( ANOVA adjusted difference , 95 % CI -0.8 % to + 0.1 % ) . CONCLUSION It is concluded that this health education programme can empower Asian diabetics to take control of their diets , learn to monitor and interpret glucose results , and underst and the implication s of poor glycaemic control for diabetic complications BACKGROUND Cardiovascular disease ( CVD ) and diabetes account for one-third of the mortality difference between African American and white patients . We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes . METHODS We r and omized 359 African Americans with type 2 diabetes to receive usual care or a nurse telephone intervention .  The 12-month intervention provided monthly self-management support and quarterly medication management facilitation . Co primary outcomes were changes in systolic blood pressure ( SBP ) , hemoglobin A1c ( HbA1c ) , and low-density lipoprotein cholesterol ( LDL-C ) over 12 months . We estimated between-intervention group differences over time using linear mixed-effects models . The secondary outcome was self-reported medication adherence . RESULTS The sample was 72 % female ; 49 % had low health literacy , and 37 % had annual income < $ 10,000 . Model-based estimates for mean baseline SBP , HbA1c , and LDL-C were 136.8 mm Hg ( 95 % CI 135.0 - 138.6 ) , 8.0 % ( 95 % CI 7.8 - 8.2 ) , and 99.1 mg/dL ( 95 % CI 94.7 - 103.5 ) , respectively . Intervention patients received 9.9 ( SD 3.0 ) intervention calls on average . Primary providers replied to 76 % of nurse medication management facilitation contacts , 18 % of these result ed in medication changes . There were no between-group differences over time for SBP ( P = .11 ) , HbA1c ( P = .66 ) , or LDL-C ( P = .79 ) . Intervention patients were more likely than those receiving usual care to report improved medication adherence ( odds ratio 4.4 , 95 % CI 1.8 - 10.6 , P = .0008 ) , but adherent patients did not exhibit relative improvement in primary outcomes . CONCLUSIONS This intervention improved self-reported medication adherence but not CVD risk factor control among African Americans with diabetes . Further research is needed to determine how to maximally impact CVD risk factors in African American patients BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss OBJECTIVE To evaluate whether assessment of barriers to self-care and strategies to cope with these barriers in older adults with diabetes is superior to usual care with attention control . The American Diabetes Association guidelines recommend the assessment of age-specific barriers . However , the effect of such strategy on outcomes is unknown . RESEARCH DESIGN AND METHODS We r and omized 100 subjects aged ≥69 years with poorly controlled diabetes ( A1C > 8 % ) in two groups . A geriatric diabetes team assessed barriers and developed strategies to help patients cope with barriers for an intervention group . The control group received equal amounts of attention time . The active intervention was performed for the first 6 months , followed by a “ no-contact ” period . Outcome measures included A1C , Tinetti test , 6-min walk test ( 6MWT ) , self-care frequency , and diabetes-related distress . RESULTS We assessed 100 patients ( age 75 ± 5 years , duration 21 ± 13 years , 68 % type 2 diabetes , 89 % on insulin ) over 12 months . After the active period , A1C decreased by −0.45 % in the intervention group vs. −0.31 % in the control group . At 12 months , A1C decreased further in the intervention group by −0.21 % vs. 0 % in control group ( linear mixed-model , P < 0.03 ) . The intervention group showed additional benefits in scores on measures of self-care ( Self-Care Inventory-R ) , gait and balance ( Tinetti ) , and endurance ( 6MWT ) compared with the control group . Diabetes-related distress improved in both groups . CONCLUSIONS Only attention between clinic visits lowers diabetes-related distress in older adults . However , communication with an educator cognizant of patients ’ barriers improves glycemic control and self-care frequency , maintains functionality , and lowers distress in this population OBJECTIVE To study time course changes in knowledge , problem solving ability , and quality of life in patients with type 2 diabetes managed by group compared with individual care and education . RESEARCH DESIGN AND METHODS We conducted a 5-year r and omized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit . There were 120 patients with non-insulin-treated type 2 diabetes enrolled and r and omly allocated to group or individual care . Eight did not start and 28 did not complete the study . The main outcome measures were knowledge of diabetes , problem solving ability , quality of life , HbA1c , BMI , and HDL cholesterol . RESULTS Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects ( P<0.001 for both ) . Quality of life improved from year 2 with group care but worsened with individual care ( P<0.001 ) . HbA1c level progressively increased over 5 years among control subjects ( + 1.7 % , 95 % CI 1.1 - 2.2 ) but not group care patients ( + 0.1 % , -0.5 to 0.4 ) , in whom BMI decreased ( -1.4 , -2.0 to -0.7 ) and HDL cholesterol increased ( + 0.14 mmol/l , 0.07 - 0.22 ) . CONCLUSIONS Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and setting s tailored to their needs . Traditional one-to-one care , although delivered according to optimized criteria , is associated with progressive deterioration of knowledge , problem solving ability , and quality of life . Better cognitive and psychosocial results are associated with more favorable clinical outcomes Technology and improved care coordination models can help diabetes educators and providers meet national care st and ards and provide culturally sensitive diabetes education that may improve diabetes outcomes . The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program ( Comprehensive Diabetes Management Program , CDMP ) for poorly controlled Hispanic type 2 diabetes ( T2DM ) patients in an urban community health center setting . Patients were r and omized to the intervention condition ( IC ; n = 21 ) or an attention control condition ( AC ; n = 18 ) . IC and AC conditions were compared on rates of adherence to national clinical practice guidelines ( blood glucose , blood pressure , foot exam , eye exam ) , and levels of diabetes distress , depression , and treatment satisfaction . IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC ( −1.6 % ± 1.4 % versus −0.6 % ± 1.1 % ; P = .01 ) . The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c ( IC = 45 % ; AC = 28 % ) , systolic blood pressure ( IC = 55 % ; AC = 28 % ) , eye screening ( IC = 91 % ; AC = 78 % ) , and foot screening , ( IC = 86 % ; AC = 72 % ) . Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC ( P = .05 and P = .06 , respectively ) , with no differences for depression . The CDMP intervention was more effective than an attention control condition in helping patients meet evidence -based guidelines for diabetes care Purpose To assess whether VA MEDIC-E ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH ] Extended for 6 months ) , a pharmacist-led shared medical appointments program , could improve attainment of target goals for hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to st and ard primary care after 6 months of intervention . Methods A r and omized , controlled trial of VA MEDIC-E ( n = 50 ) versus st and ard primary care ( n = 49 ) in veterans with type 2 diabetes , hemoglobin A1c ( A1C ) > 7 % , blood pressure ( BP ) > 130/80 mmHg , and low density lipoprotein cholesterol ( LDL-C ) > 100mg/dl ( 2.59 mmol/l ) in the previous 6 months was conducted . The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions . Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist . Evaluation measures included lab values of A1C , LDL cholesterol , BP , and goal attainment of these values , and diabetes self-care behavior question naires at 6 months . Results The r and omization groups were similar at baseline in all cardiovascular risk factors except for LDL , which was significantly lower in the MEDIC-E arm . At 6 months , significant improvements from baseline were found in the intervention arm for exercise , foot care , and goal attainment of A1C , LDL-C , and BP but not in the control arm . Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk Purpose The purpose of this study was to assess whether the VA-MEDIC ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction ) , a pharmacist-led group medical visit program , could improve achievement of target goals in hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to usual care . Methods This was a r and omized controlled trial of VA-MEDIC intervention in addition to usual care versus usual care alone in diabetic patients to reduce cardiac risk factors . VA-MEDIC consisted of a 40- to 60-minute educational component by nurse , nutritionist , physical therapist , or pharmacist followed by pharmacist-led behavioral and pharmacological interventions over 4 weekly sessions . Measures The attainment of target goals in hemoglobin A1C ( A1C ) , blood pressure , fasting lipids , and tobacco use recommended by the American Diabetes Association . Results Of 118 participants , 109 completed the study . VA-MEDIC ( n = 58 ) participants were younger and had greater tobacco use at baseline than usual care but were similar in other cardiovascular risk factors . After 4 months , a greater proportion of VA-MEDIC participants versus controls achieved an A1C of less than 7 % and a systolic blood pressure less than 130 mm Hg . No significant change was found in lipid control or tobacco use between the 2 study arms . Conclusion Pharmacist-led group medical visits are feasible and efficacious for improving cardiac risk factors 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 study was to determine if improvements observed in clinical , behavioral , and psychosocial outcomes measured at 12 months following a multifaceted diabetes care intervention were sustained at 3-year follow-up . Methods This study was a multilevel , nonblinded , cluster design , r and omized controlled trial that took place in an under-served suburb of Pittsburgh , Pennsylvania , between 1999 and 2005 . Eleven primary care practice s , and their patients , were r and omly assigned to 3 groups :  chronic care model ( CCM ) intervention ( n = 30 ) , provider education only ( PROV ) ( n = 38 ) , and usual care ( UC ) ( n = 51 ) . Subjects were followed for 3 years . Results Improvements observed at 12-month follow-up in glycemic ( —0.5 % ) and blood pressure control ( —4.8 mm Hg ) , and the proportion of participants who self-monitor their blood glucose ( 86.7%-100 % ) , were sustained at 3-year follow-up in the CCM group . Additional improvements occurred in non-HDLc levels in all study groups and quality of well-being scores in the CCM intervention group . All associations remained after controlling for medication treatment intensification . Conclusions We have demonstrated that improvements in outcomes can be sustained over time following a multifaceted diabetes care intervention . Future research in this area is necessary to underst and if improvements in outcomes can be sustained following diabetes self-management education ( DSME ) and what type of patient fares the best from multifaceted diabetes care interventions Background : The prevalence of type 2 diabetes and diabetesrelated morbidity and mortality is higher among low-income Hispanics when compared to that of Whites . However , little is known about how to effectively promote self-management in this population . Purpose : The objectives were first to determine the feasibility of conducting a r and omized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects . Methods : Participants for this pilot study were recruited from a community health center , an elder program , and a community-wide data base developed by the community health center , in collaboration with other agencies serving the community , by surveying households in the entire community . Participants were r and omly assigned to an intervention  ( n = 15 ) or a control ( n = 10 ) condition . Assessment s were conducted at baseline and at 3 months and 6 months postr and omization . The intervention consisted of 10 group sessions that targeted diabetes knowledge , attitudes , and self-management skills through culturally specific and literacysensitive strategies . The intervention used a cognitivebehavioral theoretical framework . Results : Recruitment rates at the community health center , elder program , and community registry were 48 % , 69 % , and 8 % , respectively . Completion rates for baseline , 3-month , and 6-month assessment s were 100 % , 92 % , and 92 % , respectively . Each intervention participant attended an average of 7.8 out of 10 sessions , and as a group the participants showed high adherence to intervention activities ( 93 % turned in daily logs , and 80 % self-monitored glucose levels at least daily ) . There was an overall Group × Time interaction ( p = .02 ) indicating group differences in glycosylated hemoglobin over time . The estimated glycosylated hemoglobin decrease at 3 months for the intervention group was −0.8 % ( 95 % confidence intervals = −1.1 % , −0.5 % ) compared with the change in the control group ( p = .02 ) . At 6 months , the decrease in the intervention group remained significant , −0.85 % ( 95 % confidence intervals = −1.2 , −0.5 ) , and the decrease was still significantly different from that of the controls ( p = .005 ) . There was a trend toward increased physical activity in the intervention group as compared to that of the control group ( p = .11 ) and some evidence ( nonsignificant ) of an increase in blood glucose self-monitoring in the intervention participants but not the control participants . Adjusting for baseline depressive scores , we oberved a significant difference in depressive symptoms between intervention participants and control participants at the 3-month assessment ( p = .02 ) . Conclusions : Low-income Spanish-speaking Hispanics are receptive to participate in diabetes-related research . This study shows that the pilot-tested diabetes self-management program is promising and warrants the conduct of a r and omized clinical trial Background Culturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes . Purpose The purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program , ¡ Viva Bien ! Methods R and om assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡ Viva Bien !  , which included group meetings for building skills to promote the Mediterranean diet , physical activity , stress management , supportive re sources , and smoking cessation . Results ¡ Viva Bien ! participants compared to usual care significantly improved psychosocial and behavioral outcomes ( fat intake , stress management practice , physical activity , and social – environmental support ) at 6 months , and some improvements were maintained at 12 months . Biological improvements included hemoglobin A1c and heart disease risk factors . Conclusions The ¡ Viva Bien ! multiple lifestyle behavior program was effective in improving psychosocial , behavioral , and biological/ quality of life outcomes related to heart health for Latinas with type 2 diabetes ( Clinical Trials.gov no : NCT00233259 ) Purpose This study developed and tested a culturally appropriate , church-based intervention to improve diabetes self-management . Research Design and Methods This was a r and omized trial conducted at 24 African American churches in central North Carolina . Churches were r and omized to receive the special intervention ( SI ; 13 churches , 117 participants ) or the minimal intervention ( MI ; 11 churches , 84 participants ) . The SI included an 8-month intensive phase , consisting of 1 individual counseling visit , 12 group sessions , monthly phone contacts , and 3 encouragement postcards , followed by a 4-month reinforcement phase including monthly phone contacts . The MI received st and ard educational pamphlets by mail . Outcomes were assessed at 8 and 12 months ; the primary outcome was comparison of 8-month A1C levels . Results At baseline , the mean age was 59 years , A1C 7.8 % , and body mass index 35.0 kg/m2 ; 64 % of participants were female . For the 174 ( 87 % ) participants returning for 8-month measures , mean A1C ( adjusted for baseline and group r and omization ) was 7.4 % for SI and 7.8 % for MI , with a difference of 0.4 % ( 95 % confidence interval [ CI ] , 0.1 - 0.6 , P = .009 ) . In a larger model adjusting for additional variables , the difference was 0.5 % ( 95 % CI , 0.2 - 0.7 , P < .001 ) . At 12 months , the difference between groups was not significant . Diabetes knowledge and diabetes-related quality of life significantly improved in the SI group compared with the MI group . Among SI participants completing an acceptability question naire , intervention components and material s were rated as highly acceptable . Conclusions The church-based intervention was well received by participants and improved short-term metabolic control Purpose The purpose of this study is to evaluate the impact of a promotores-led diabetes self-management program by comparing the outcomes ( knowledge , beliefs , and HbA1c level ) of Mexican American patients with type 2 diabetes who received usual diabetic care in a wait-list control group  to those who received self-management education and follow-up by promotores in consultation with clinic providers and staff . Methods This r and omized control study compared the results of 63 patients who attended a promotores-led culturally sensitive diabetes self-management course at a commu- nity clinic with 68 patients in a wait-list , usual-care control group . Participants were Mexican Americans with type 2 diabetes who were patients at the clinic and at least 18 years of age . At baseline , 3 months , and 6 months , the Diabetes Knowledge Question naire ( DKQ ) , Health Beliefs Question naire ( HBQ ) , and HbA1c levels ( drawn by the clinic laboratory ) were collected . Results There was a significant improvement in the intervention group 's DKQ scores over time and in treatment by time . The baseline HbA1c level was 7.49 and did not change over time in either group . The DKQ , HBQ , and HbA1c results were significantly affected by age ; the DKQ and HbA1c were affected by years with diabetes . Conclusions The promotores-led diabetes self-management course improved the knowledge of patients with diabetes . Participant baseline HbA1c level was close to therapeutic level ( much lower than reported in previous studies ) , suggesting participants received good medical care within the community clinic Purpose The purpose of this study is to determine the effectiveness of a community-based diabetes self-management program comparing treatment participants to a r and omized usual-care control group at 6 months . Methods A total of 345 adults with type 2 diabetes but no criteria for high A1C were r and omized to a usual-care control group or 6-week community-based , peer-led diabetes self-management program ( DSMP ) . R and omized participants were compared at 6 months . The DSMP intervention participants were followed for an additional 6 months ( 12 months total ) . A1C and body mass index were measured at baseline , 6 months , and 12 months . All other data were collected by self-administered question naires . Results At 6 months , DSMP participants did not demonstrate improvements in A1C as compared with controls . Baseline A1C was much lower than in similar trials . Participants did have significant improvements in depression , symptoms of hypoglycemia , communication with physicians , healthy eating , and reading food labels ( P < .01 ) . They also had significant improvements in patient activation and self-efficacy . At 12 months , DSMP intervention participants continued to demonstrate improvements in depression , communication with physicians , healthy eating , patient activation , and self-efficacy ( P < .01 ) . There were no significant changes in utilization measures . Conclusions These findings suggest that people with diabetes without elevated A1C can benefit from a community-based , peer-led diabetes program . Given the large number of people with diabetes and lack of low-cost diabetes education , the DSMP deserves consideration for implementation Purpose The purpose of this study is to test the efficacy of a culturally tailored comprehensive type 2 diabetes management intervention for Korean American immigrants ( KAIs ) with type 2 diabetes . Methods A r and omized controlled pilot trial with 2 parallel arms ( intervention vs control ) with a delayed intervention design was used . A total of 79 KAIs , recruited from the Baltimore-Washington area , completed baseline , 18-week , and 30-week follow-ups ( intervention , n = 40 ; control , n = 39 ) . All participants had uncontrolled type 2 diabetes ( hemoglobin A1C ≥7.5 % ) at baseline . The authors ’ comprehensive , self-help intervention program for type 2 diabetes management ( SHIP-DM ) consisted of a 6-week structured psychobehavioral education , home glucose monitoring with teletransmission , and bilingual nurse telephone counseling for 24 weeks . The primary outcome of the study was A1C level , and secondary outcomes included an array of psychobehavioral variables . Results Using analysis of covariance , the findings support that the proposed intervention was effective in significantly lowering A1C and fasting glucose and also in improving psychosocial outcomes in the sample . Specifically , the amount of reduction in A1C among intervention group participants was 1.19 % at 18 weeks and 1.31 % at 30 weeks , with 10 % and 15.5 % of the participants achieving the suggested goal of A1C < 7 % at 18 and 30 weeks of follow-up , respectively . Conclusions The results highlight the clinical efficacy of the SHIP-DM intervention composed of a 6-week education program , self-monitoring , and follow-up counseling , in terms of maintaining the improved intervention effects obtained and in terms of glucose control Purpose The purpose of this study was to test effects of a culturally competent , dietary self-management intervention on physiological outcomes and dietary behaviors for African Americans with type 2 diabetes . Methods A longitudinal experimental study was conducted in rural South Carolina with a sample of 97 adult African Americans with type 2 diabetes who were r and omly assigned to either usual care or the intervention . The intervention consisted of 4 weekly classes in low-fat dietary strategies , 5 monthly peer-professional group discussion s , and weekly telephone follow-up . The culturally competent approach reflected the ethnic beliefs , values , customs , food preferences , language , learning methods , and health care practice s of southern African Americans . Results Body mass index and dietary fat behaviors were significantly lowered in the experimental group . At 6 months , weight decreased 1.8 kg ( 4 lb ) for the experimental group and increased 1.9 kg ( 4.2 lb ) for the control group , a net difference of 3.7 kg ( 8.2 lb ) . The experimental group reduced high-fat dietary habits to moderate while high-fat dietary habits of the control group remained essentially unchanged . A trend in reduction of A1C and lipids was observed . Conclusions Results suggest the effectiveness of a culturally competent dietary self-management intervention in improving health outcomes for southern African Americans , especially those at risk due to high-fat diets and body mass index ≥ 35 kg/mm2 . Given the burgeoning problem of obesity in South Carolina and the nation , the time has come to focus on aggressive weight management . Diabetes educators are in pivotal positions to assume leadership in achieving this goal for vulnerable , rural population PURPOSE The purpose of this r and omized controlled trial is to determine the effectiveness of an intervention led by promotoras ( community lay workers ) on the glycemic control , diabetes knowledge , and diabetes health beliefs of Mexican Americans with type 2 diabetes living in a major city on the Texas-Mexico border . METHODS One hundred fifty Mexican American participants were recruited at a Catholic faith-based clinic and r and omized into 2 groups . Personal characteristics , acculturation , baseline A1C level , diabetes knowledge , and diabetes health beliefs were measured . The intervention was culturally specific and consisted of participative group education , telephone contact , and follow-up using inspirational faith-based health behavior change postcards . The A1C levels , diabetes knowledge , and diabetes health beliefs were measured 3 and 6 months postbaseline , and the mean change between the groups was analyzed . RESULTS The 80 % female sample , with a mean age of 58 years , demonstrated low acculturation , income , education , health insurance coverage , and strong Catholicism . No significant changes were noted at the 3-month assessment , but the mean change of the A1C levels , F(1 , 148 ) = 10.28 , P < .001 , and the diabetes knowledge scores , F(1 , 148 ) = 9.0 , P < .002 , of the intervention group improved significantly at 6 months , adjusting for health insurance coverage . The health belief scores decreased in both groups . CONCLUSIONS The intervention result ed in decreased A1C levels and increased diabetes knowledge , suggesting that using promotoras as part of an interdisciplinary team can result in positive outcomes for Mexican Americans who have type 2 diabetes . Clinical implication s and recommendations for future research are suggested BACKGROUND Behavioral research to improve lifestyle in broadly defined population s of patients with type 2 diabetes is limited . OBJECTIVE We evaluated a behavioral intervention featuring technology-based self-monitoring on biophysiologic outcomes of glycemic control and markers of cardiovascular risk . DESIGN In this single-site , r and omized clinical trial , participants were stratified by good and poor glycemic control ( glycated hemoglobin < 8 % or ≥8 % ) and absence or presence of kidney disease , ( estimated glomerular filtration rate ≥60 or < 60 mL/min ) and r and omized within strata . Measurements were obtained at 0 , 3 , and 6 months . PARTICIPANTS / SETTING Self-referred , community-dwelling adults with type 2 diabetes mellitus . INTERVENTION The intervention group received Social Cognitive Theory-based counseling paired with technology-based self-monitoring , and results were compared with an attention control group . MAIN OUTCOME MEASURES Glycated hemoglobin , fasting serum glucose , lipid levels , blood pressure , weight , body mass index , and waist circumference were evaluated . STATISTICAL ANALYSES PERFORMED Mean differences within and between r and omization groups were compared over time . Intervention effects over time were estimated using r and om intercept models . RESULTS Two hundred ninety-six subjects were r and omized , 256 ( 86.5 % ) completed 3-month and 246 ( 83.1 % ) completed 6-month assessment s. Glycated hemoglobin was reduced in the intervention group by 0.5 % at 3 months and 0.6 % at 6 months ( P<0.001 for each ) , and the control group by 0.3 % ( P<0.001 ) at 3 months and 0.2 % ( P<0.05 ) at 6 months ; but between-group differences were not significant . In those with baseline glycated hemoglobin ≥8 % and estimated glomerular filtration rate ≥60 mL/min , glycated hemoglobin was reduced in the intervention group by 1.5 % at 3 months and 1.8 % at 6 months ( P<0.001 for each ) , and the control group by 0.9 % ( P<0.001 ) at 3 months and 0.8 % ( P<0.05 ) at 6 months ; but between-group differences were not significant . In r and om intercept models , the estimated reduction in glycated hemoglobin of 0.29 % was not significant . CONCLUSIONS Two behavioral approaches to improving general lifestyle management in individuals with type 2 diabetes mellitus were effective in improving glycemic control , but no significant between-group differences were observed 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 OBJECTIVE We hypothesized that people with type 2 diabetes in an online diabetes self-management program  , compared with usual-care control subjects , would 1 ) demonstrate reduced A1C at 6 and 18 months , 2 ) have fewer symptoms , 3 ) demonstrate increased exercise , and 4 ) have improved self-efficacy and patient activation . In addition , participants r and omized to listserve reinforcement would have better 18-month outcomes than participants receiving no reinforcement . RESEARCH DESIGN AND METHODS A total of 761 participants were r and omized to 1 ) the program  , 2 ) the program with e-mail reinforcement , or 3 ) were usual-care control subjects ( no treatment ) . This sample included 110 American Indians/Alaska Natives ( AI/ANs ) . Analyses of covariance models were used at the 6- and 18-month follow-up to compare groups . RESULTS At 6 months , A1C , patient activation , and self-efficacy were improved for program participants compared with usual care control subjects ( P < 0.05 ) . There were no changes in other health or behavioral indicators . The AI/AN program participants demonstrated improvements in health distress and activity limitation compared with usual-care control subjects . The subgroup with initial A1C > 7 % demonstrated stronger improvement in A1C ( P = 0.01 ) . At 18 months , self-efficacy and patient activation were improved for program participants . A1C was not measured . Reinforcement showed no improvement . CONCLUSIONS An online diabetes self-management program is acceptable for people with type 2 diabetes . Although the results were mixed they suggest 1 ) that the program may have beneficial effects in reducing A1C , 2 ) AI/AN population s can be engaged in and benefit from online interventions , and 3 ) our follow-up reinforcement appeared to have no value We investigated the effect of a structured group diabetes education program ( 1 ) on insulin-treated patients who had received individual counseling ( at the time of diagnosis and insulin initiation ) . A total of 1,369 type 1 and insulin-treated type 2 diabetic patients with mean disease duration of 11.7 and 13.7 years , respectively , were allocated to receive or not receive structured group education , which was delivered in 10 45-min sessions over 3–5 days . Baseline GHb levels of type 1 diabetic patients were 9.3 % for OBJECTIVE To determine whether using the chronic care model ( CCM ) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes . RESEARCH DESIGN AND METHODS This multilevel , cluster- design , r and omized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community . Eleven primary care practice s , along with their patients , were r and omized to three groups : CCM intervention ( n = 30 patients ) , provider education only ( PROV group ) ( n = 38 ) , and usual care ( UC group ) ( n = 51 ) . RESULTS A marked decline in HbA(1c ) was observed in the CCM group ( -0.6 % , P = 0.008 ) but not in the other groups . The magnitude of the association remained strong after adjustment for clustering ( P = 0.01 ) . The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group ( non-HDL cholesterol : -10.4 mg/dl , P = 0.24 ; self-monitor blood glucose : + 22.2 % , P < 0.0001 ) , with statistically significant between-group differences in improvement ( non-HDL cholesterol : P = 0.05 ; self-monitor blood glucose : P = 0.03 ) after adjustment . The CCM group also showed improvement in HDL cholesterol ( + 5.5 mg/dl , P = 0.0004 ) , diabetes knowledge test scores ( + 6.7 % , P = 0.07 ) , and empowerment scores ( + 2 , P = 0.02 ) . CONCLUSIONS These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes Background Effective self-management of diabetes is essential for the reduction of diabetes-related complications , as global rates of diabetes escalate . Methods R and omised controlled trial . Adults with type 2 diabetes ( n = 120 ) , with HbA1c greater than or equal to 7.5 % , were r and omly allocated ( 4 × 4 block r and omised block design ) to receive an automated , interactive telephone-delivered management intervention or usual routine care .  Baseline sociodemographic , behavioural and medical history data were collected by self-administered question naires and biological data were obtained during hospital appointments . Health-related quality of life ( HRQL ) was measured using the SF-36 . Results The mean age of participants was 57.4 ( SD 8.3 ) , 63 % of whom were male . There were no differences in demographic , socioeconomic and behavioural variables between the study arms at baseline . Over the six-month period from baseline , participants receiving the Australian TLC ( Telephone-Linked Care ) Diabetes program showed a 0.8 % decrease in geometric mean HbA1c from 8.7 % to 7.9 % , compared with a 0.2 % HbA1c reduction ( 8.9 % to 8.7 % ) in the usual care arm ( p = 0.002 ) . There was also a significant improvement in mental HRQL , with a mean increase of 1.9 in the intervention arm , while the usual care arm decreased by 0.8 ( p = 0.007 ) . No significant improvements in physical HRQL were observed . Conclusions These analyses indicate the efficacy of the Australian TLC Diabetes program with clinical ly significant post-intervention improvements in both glycaemic control and mental HRQL . These observed improvements , if supported and maintained by an ongoing program such as this , could significantly reduce diabetes-related complications in the longer term . Given the accessibility and feasibility of this kind of program , it has strong potential for providing effective , ongoing support to many individuals with diabetes in the future OBJECTIVE To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase  moderate-intensity physical activity ( PA ) . RESEARCH DESIGN AND METHODS In this r and omized controlled trial conducted at seven practice s in central North Carolina , 200 African-American women , > or = 40 years of age with type 2 diabetes , were r and omized to one of three treatment conditions : clinic and community ( group A ) , clinic only ( group B ) , or minimal intervention ( group C ) . The clinic-based intervention ( groups A and B ) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practice s and attitudes ; the community-based intervention ( group A ) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was design ed to provide social support and reinforce behavior change goals ; and the minimal intervention ( group C ) consisted of educational pamphlets mailed to participants . The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer , which was worn while awake for 7 days . RESULTS Totals of 175 ( 88 % ) and 167 ( 84 % ) participants completed PA assessment at 6 and 12 months , respectively . For comparison of PA , the P value for overall group effect was 0.014 . Comparing group A with C , the difference in the average adjusted mean for PA was 44.1 kcal/day ( 95 % CI 13.1 - 75.1 , P = 0.0055 ) . Comparing group B with C , the difference in the average adjusted mean was 33.1 kcal/day ( 95 % CI 3.3 - 62.8 , P = 0.029 ) . The intervention was acceptable to participants : 88 % were very satisfied with clinic-based counseling to enhance PA , and 86 % indicated that the peer counselor 's role in the program was important . CONCLUSIONS The intervention was associated with a modest enhancement of PA and was acceptable to participants OBJECTIVE To examine the effect of a 12-month pharmaceutical care ( PC ) program on  vascular risk in type 2 diabetes . RESEARCH DESIGN AND METHODS We recruited 198 community-based patients r and omized to PC or usual care . PC patients had face-to-face goal -directed medication and lifestyle counseling at baseline and at 6 and 12 months plus 6-weekly telephone assessment s and provision of other educational material . Clinical , biochemical , and medication-related data were sent regularly to each patient 's physician(s ) . The main outcome measure was change in HbA(1c ) . A diabetes-specific risk engine was used to estimate changes in 10-year coronary heart disease ( CHD ) and stroke risk in patients without a history of cardiovascular disease . RESULTS At total of 180 patients ( 91 % ) completed the study .  Mean ( 95 % CI ) reductions were greater in PC case subjects ( n = 92 ) than control subjects ( n = 88 ) for HbA(1c ) ( -0.5 % [ 95 % CI -0.7 to -0.3 ] vs. 0 [ -0.2 to 0.2 ] ) and systolic ( -14 mmHg [ -19 to -9 ] vs. -7 [ -11 to -2 ] ) and diastolic ( -5 mmHg [ -8 to -3 ] vs. -2 [ -4 to 1 ] ) blood pressure ( P < or = 0.043 ) . The improvement in HbA(1c ) persisted after adjustment for baseline value and demographic and treatment-specific variables . The median ( interquartile range ) 10-year estimated risk of a first CHD event decreased in the PC case subjects ( 25.1 % [ 15.6 - 36.2 ] to 20.3 [ 14.6 - 30.2 ] ; n = 42 , P = 0.002 ) but not in the control subjects ( 26.1 % [ 17.2 - 39.4 ] vs. 26.4 [ 16.7 - 38.0 ] ; n = 52 , P = 0.17 ) . CONCLUSIONS A 12-month PC program in type 2 diabetes reduced glycemia and blood pressure . Pharmacist involvement contributed to improvement in HbA(1c ) independently of pharmacotherapeutic changes . PC could prove a valuable component of community-based multidisciplinary diabetes care Uncontrolled diabetes is a major health problem in Thail and . The objective of this study was to determine the effects of a diabetes self-management program on glycemic control , coronary heart disease ( CHD ) risk , and quality of life in 147 diabetic patients ( aged 56.8 + /- 10.2 years ) . Type 2 diabetic patients who met the research criteria were r and omized into two groups for a period of 6 months : the experimental group received the diabetes self-management program and the control group received the usual nursing care . The findings indicated that the experimental group demonstrated a significant decrease in the hemoglobin A(1c ) level and CHD risk , with an increase in quality of life ( QOL ) compared to the control group . The diabetes self-management program was effective for improving metabolic control and the QOL for individuals with diabetes . Further studies should be replicated using larger groups over a longer time frame 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 AIMS To determine the effects of the Diabetes Manual on glycaemic control , diabetes-related distress and confidence to self-care of patients with Type 2 diabetes . METHODS A cluster r and omized , controlled trial of an intervention group vs. a 6-month delayed-intervention control group with a nested qualitative study . Participants were 48 urban general practice s in the West Midl and s , UK , with high population deprivation levels and 245 adults with Type 2 diabetes with a mean age of 62 years recruited pre-r and omization . The Diabetes Manual is 1:1 structured education design ed for delivery by practice nurses . Measured outcomes were HbA(1c ) , cardiovascular risk factors , diabetes-related distress measured by the Problem Areas in Diabetes Scale and confidence to self-care measured by the Diabetes Management Self-Efficacy Scale . Outcomes were assessed at baseline and 26 weeks . RESULTS There was no significant difference in HbA(1c ) between the intervention group and the control group [ difference -0.08 % , 95 % confidence interval ( CI ) -0.28 , 0.11 ] . Diabetes-related distress scores were lower in the intervention group compared with the control group ( difference -4.5 , 95 % CI -8.1 , -1.0 ) . Confidence to self-care Scores were 11.2 points higher ( 95 % CI 4.4 , 18.0 ) in the intervention group compared with the control group . The patient response rate was 18.5 % . CONCLUSIONS In this population , the Diabetes Manual achieved a small improvement in patient diabetes-related distress and confidence to self-care over 26 weeks , without a change in glycaemic control . Further study is needed to optimize the intervention and characterize those for whom it is more clinical ly and psychologically effective to support its use in primary care BACKGROUND Group education for patients with suboptimally controlled diabetes has not been rigorously studied . METHODS A total of 623 adults from Minnesota and New Mexico with type 2 diabetes and glycosylated hemoglobin ( HbA(1c ) ) concentrations of 7 % or higher were r and omized to ( 1 ) group education ( using the US Diabetes Conversation Map program ) , ( 2 ) individual education , or ( 3 ) usual care ( UC ; ie , no assigned education ) . Both education methods covered content as needed to meet national st and ards for diabetes self-management education and were delivered through accredited programs from 2008 to 2009 . General linear mixed-model methods assessed patient-level changes between treatment groups in mean HbA(1c ) levels from baseline to follow-up at 6.8 months . Secondary outcomes included mean change in general health status ( Medical Outcomes Study 12-Item Short Form Health Survey [ SF-12 ] ) , Problem Areas in Diabetes ( PAID ) , Diabetes Self-Efficacy ( DES-SF ) , Recommended Food Score ( RFS ) , and Physical Activity ( PA , min/wk ) . RESULTS Mean HbA(1c ) concentration decreased in all groups but significantly more with individual ( -0.51 % ) than group education ( -0.27 % ) ( P = .01 ) and UC ( -0.24 % ) ( P = .01 ) . The proportion of subjects with follow-up HbA(1c ) concentration lower than 7 % was greater for individual education ( 21.2 % ) than for group ( 13.9 % ) and UC ( 12.8 % ) ( P = .03 ) . Compared with UC , individual education ( but not group ) improved SF-12 physical component score ( + 1.88 ) ( P = .04 ) , PA ( + 42.95 min/wk ) ( P = .03 ) , and RFS ( + 0.63 ) ( P = .05 ) . Compared with group education , individual education reduced PAID ( -3.62 ) ( P = .02 ) and increased self-efficacy ( + 0.1 ) ( P = .04 ) . CONCLUSIONS Individual education for patients with established suboptimally controlled diabetes result ed in better glucose control outcomes than did group education using Conversation Maps . There was also a trend toward better psychosocial and behavioral outcomes with individual education . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00652509 OBJECTIVE In this r and omized controlled trial we evaluated the effect of registered dietitian – led management of diabetes on glycemic control and macronutrient intake in type 2 diabetic patients in primary care clinics in Taiwan and studied the association between changes in macronutrient intake and glycemic measures . RESEARCH DESIGN AND METHODS We recruited 154 adult patients with type 2 diabetes and r and omly assigned them to a routine care control group ( n = 79 ) or a registered dietitian – led intervention group ( n = 75 ) who received on-site diabetic self-management education every 3 months over 12 months . RESULTS Over the 1-year period , neither the intervention group ( n = 75 ) nor the control group ( n = 79 ) had significant changes in A1C , whereas the intervention patients with poorly controlled baseline A1C ( ≥7 % ) ( n = 56 ) had significantly greater improvements in A1C and fasting plasma glucose than the control subjects ( n = 60 ) ( −0.7 vs. −0.2 % , P = 0.034 ; −13.4 vs. 16.9 mg/dl , P = 0.007 ) during the same period . We also found significant net intervention-control group differences in overall energy intake ( −229.06 ± 309.16 vs. 56.10 ± 309.41 kcal/day ) and carbohydrate intake ( −31.24 ± 61.53 vs. 7.15 ± 54.09 g/day ) ( P < 0.001 ) in patients with poorly controlled A1C . Multivariable adjusted modeling revealed an independent association between changes in carbohydrate intake and A1C in the intervention group ( n = 56 ; β = 0.10 , SEM = 0.033 , P = 0.004 ) . CONCLUSIONS On-site registered dietitian – led management of diabetes can improve glycemic control in patients with poorly managed type 2 diabetes in primary care clinics in Taiwan . A reduction in carbohydrate intake may improve glycemic status OBJECTIVE To evaluate the efficacy of ongoing group based diabetes self-management education ( DSME ) for patients with type 2 diabetes . METHODS 146 patients were r and omised to either group education or waiting list control . Primary outcomes were A1C and patient activation measured with patient activation measure ( PAM ) . RESULTS There were no differences in the primary outcomes between the groups at 12 months , but the control group had an increase in A1C of 0.3 % points during follow-up . Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group . A sub group analysis was conducted for the quartile with the highest A1C at baseline ( > 7.7 , n=18 in both groups ) . There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control . CONCLUSIONS The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level . PRACTICE IMPLICATION S Locally developed programs may be less effective than programs developed for studies BACKGROUND : This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center ( IEMRC ) from April 2008 to January 2009 . METHODS : In a r and omized controlled clinical trial , a total of 172 patients with uncontrolled type 2 diabetes were selected and r and omly allocated into control and intervention groups . After taking informed written consent , the intervention group received an educational program about oral anti-hyperglycemic medications , adherence , diabetes dairy log and pill box usage . Patient 's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist .  Fasting blood glucose and HbA1c were measured at the start and end of the pharmacistled drug education program for both intervention and control groups . RESULTS : After a three months follow-up , mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group ( p < 0.001 ) . CONCLUSIONS : This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics . The results suggest the benefits of adding adherence education to the diabetic education programs OBJECTIVES We tested the effectiveness of a culturally tailored , behavioral theory-based community health worker intervention for improving glycemic control . METHODS We used a r and omized , 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit , Michigan . Our study was guided by the principles of community-based participatory research . Hemoglobin A1c ( HbA1c ) level was the primary outcome measure . Using an empowerment-based approach , community health workers provided participants with diabetes self-management education and regular home visits , and accompanied them to a clinic visit during the 6-month intervention period . RESULTS Participants in the intervention group had a mean HbA1c value of 8.6 % at baseline , which improved to a value of 7.8 % at 6 months , for an adjusted change of -0.8 percentage points ( P < .01 ) . There was no change in mean HbA1c among the control group ( 8.5 % ) . Intervention participants also had significantly greater improvements in self-reported diabetes underst and ing compared with the control group . CONCLUSIONS This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery Objective To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years . Design Three year follow-up of a multicentre cluster r and omised controlled trial in primary care , with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 731 of the 824 participants included in the original trial were eligible for follow-up . Biomedical data were collected on 604 ( 82.6 % ) and question naire data on 513 ( 70.1 % ) participants . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) levels . The secondary outcomes were blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , emotional impact of diabetes , and drug use at three years . Results HbA1c levels at three years had decreased in both groups . After adjusting for baseline and cluster the difference was not significant ( difference −0.02 , 95 % confidence interval −0.22 to 0.17 ) . The groups did not differ for the other biomedical and lifestyle outcomes and drug use . The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years ( P<0.01 ) . Depression scores and quality of life did not differ at three years . Conclusion A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs . Trial registration Current Controlled Trials IS RCT N17844016 AIM Patient education that enhances one 's self-management ability is of utmost importance for improving patient outcomes in chronic diseases . We developed a 12 month self-management education program for type 2 diabetes , based on a previous 6 month program , and examined its efficacy . METHODS A r and omized controlled trial was carried out on out patients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate . They were r and omly divided into an intervention group that followed the program and a control group that followed usual clinical practise . The intervention group received < 30 min of monthly interviews based on the program 's textbook and biweekly telephone calls from a nurse educator throughout the 12 months . RESULTS Of the 50 participants in the intervention group and the 25 participants in the control group , 42 and 23 , respectively , completed the program ( a completion rate of 84.0 % ) . The body weight , HbA1c , self-efficacy , dietary and exercise stages , quality of life , diastolic blood pressure , and total cholesterol level were significant by two-way repeated- measures anova . As for changes over time within the groups , only the intervention group showed significant differences by Friedman 's test . The complication prevention behaviors showed a high implementation rate in the intervention group . The overall evaluation of this program by the participants was very high and , therefore , they highly recognized the need for this type of program . CONCLUSIONS Self-management education works successfully in relation to patients ' behavior modification skills , degree of goal attainment , and self-efficacy , consequently improving their health outcomes The aim of the present study was to evaluate the impact of empowerment group education on  type 2 diabetes patients '  confidence in diabetes knowledge , self-efficacy , satisfaction with daily life , BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up . In this r and omized controlled trial , conducted at 7 primary care centres in central Sweden , 101 patients were r and omly assigned either to  empowerment group education ( intervention group )  or to  routine diabetes care ( control group )  . Out of these , 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up . Before the intervention and at the 1-year follow-up , the patients answered a 27-item question naire , and weight , BMI and HbA1c were measured . The question naire comprised three domains : confidence in diabetes knowledge , self-efficacy and satisfaction with daily life . At 1-year follow-up , the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group ( p<0.05 ) . No significant differences were found in self-efficacy , satisfaction with daily life , BMI and HbA1c between the intervention and control group . The empowerment group education did improve  patients ' confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease Background Epidemiologic data have shown that the prevalence of Type 2 diabetes varies with ethnic origin . Type 2 diabetes is up to four times more common in British South Asians than in the indigenous white population . The aim of this study was to develop a culturally appropriate educational intervention programme for South Asians with Type 2 diabetes . We then investigated whether this intervention could produce an improvement , and finally whether any improvement was greater than background changes in knowledge in comparison groups . Methods A multi-site prospect i ve , r and omised controlled study was conducted in all day care centres and three general practice registers with high proportion patients from different ethnic minority groups in Glasgow , Scotl and . The intervention consisted of 18 educational sessions in 6 separate programmes . A modified question naire was used to measure the knowledge , attitudes , and practice of diabetes before and after intervention . Results Baseline assessment showed that Indian and Pakistani subjects had less knowledge about diabetes , regarded the disease less seriously , and had a lesser underst and ing of the relationship between control and complications than the white population . No differences in initial responses were found between those who completed the second assessment and those who did not . The intervention group showed significant improvements in scores for Knowledge ( + 12.5 % ) ; Attitudes toward seriousness ( + 13.5 % ) , complications ( + 8.1 % ) , Practice ( + 20.0 % ) . However there were also changes in the ethnic control group scores ; respectively + 5.0 % , + 16.3 % ( significant P < 0.001 ) , + 1.5 % , + 1.7 % . The single white control group also showed some improvements ; respectively + 12.2 % , + 12.4 % ( P = 0.04 ) , + 6.0 % , + 25.0 % ( P = 0.007 ) , but the differences in improvement between these two control groups were not significant . Overall , the improvement seen was similar in both intervention and ethnic control groups and there was no significant difference in the amount of change ( P = 0.36 CI -0.9 to + 2.6 ) . Conclusion This study has shown that conducting a culturally-competent educational intervention in patients with Type 2 diabetes from ethnic minority groups is feasible and can improve their knowledge and attitudes and practice . However there was no net benefit compared with the control group OBJECTIVE To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes . MATERIAL S AND METHODS Engaging and Motivating Patients Online With Enhanced Re sources for Diabetes was a 12-month parallel r and omized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin ( A1C ) values ≥7.5 % from primary care sites sharing an electronic health record . The intervention included : ( 1 ) wirelessly uploaded home glucometer readings with graphical feedback ; ( 2 ) comprehensive patient-specific diabetes summary status report ; ( 3 ) nutrition and exercise logs ; ( 4 ) insulin record ; ( 5 ) online messaging with the patient 's health team ; ( 6 ) nurse care manager and dietitian providing advice and medication management ; and ( 7 ) personalized text and video educational ' nuggets ' dispensed electronically by the care team . A1C was the primary outcome variable . RESULTS Compared with usual care ( UC , n=189 ) , patients in the intervention ( INT , n=193 ) group had significantly reduced A1C at 6 months ( -1.32 % INT vs -0.66 % UC ; p<0.001 ) . At 12 months , the differences were not significant ( -1.14 % INT vs -0.95 % UC ; p=0.133 ) . In post hoc analysis , significantly more INT patients had improved diabetes control ( > 0.5 % reduction in A1C ) than UC patients at 12 months ( 69.9 ( 95 % CI 63.2 to 76.5 ) vs 55.4 ( 95 % CI 48.4 to 62.5 ) ; p=0.006 ) . CONCLUSIONS A nurse-led , multidisciplinary health team can manage a population of diabetic patients in an online disease management program . INT patients achieved greater decreases in A1C at 6 months than UC patients , but the differences were not sustained at 12 months . More INT than UC patients achieved improvement in A1C ( > 0.5 % decrease ) . Trial registered in clinical trials.gov : # NCT00542204 OBJECTIVE To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes . RESEARCH DESIGN AND METHODS A prospect i ve , r and omized , repeated measures study was conducted on the Texas-Mexico border in Starr County . A total of 256 r and omly selected individuals with type 2 diabetes between 35 and 70 years of age , diagnosed with type 2 diabetes after 35 years of age , and accompanied by a family member or friend were included . The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses , dietitians , and community workers . The intervention involved 3 months of weekly instructional sessions on nutrition , self-monitoring of blood glucose , exercise , and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes . The approach was culturally competent in terms of language , diet , social emphasis , family participation , and incorporation of cultural health beliefs . Outcomes included indicators of metabolic control ( HbA(1c ) and fasting blood glucose ) , diabetes knowledge , and diabetes-related health beliefs . RESULTS Experimental groups showed significantly lower levels of HbA(1c ) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores . At 6 months , the mean HbA(1c ) of the experimental subjects was 1.4 % below the mean of the control group ; however , the mean level of the experimental subjects was still high ( > 10 % ) . CONCLUSIONS This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans , particularly for those individuals with HbA(1c ) levels > 10 % OBJECTIVE We evaluated automated telephone disease management ( ATDM ) with telephone nurse follow-up as a strategy for improving diabetes treatment processes and outcomes in Department of Veterans Affairs ( VA ) clinics . We also compared the results with those of a prior ATDM trial conducted in a county health care system . RESEARCH DESIGN AND METHODS A total of 272 VA patients with diabetes using hypoglycemic medications were r and omized . During the 1-year study period , intervention patients received biweekly ATDM health assessment and self-care education calls , and a nurse educator followed up with patients based on their ATDM assessment reports . Telephone surveys were used to measure patients ' self-care , symptoms , and satisfaction with care . Outpatient service use was evaluated using electronic data bases and self-reports , and glycemic control was measured by HbA1c and serum glucose testing . RESULTS At 12 months , intervention patients reported more frequent glucose self-monitoring and foot inspections than patients receiving usual care and were more likely to be seen in podiatry and diabetes specialty clinics . Intervention patients also were more likely than control patients to have had a cholesterol test . Among patients with baseline HbA1c levels > or = 8 % , mean end-point values were lower among intervention patients than control patients ( 8.7 vs. 9.2 % , respectively ; P = 0.04 ) . Among intervention and control patients with baseline values > or = 9 % , mean end-point values were 9.1 and 10.2 % , respectively ( P = 0.04 ) . At follow-up , intervention patients reported fewer symptoms of poor glycemic control than control patients and greater satisfaction with their health care . CONCLUSIONS This intervention improved the quality of VA diabetes care . Intervention effects for most end points replicated findings from the prior county clinic trial , although intervention-control differences in the current study were smaller because of the relatively good self-care and health status among the current study 's enrollees This article describes the design and implementation of an online diabetes self-management intervention for a sample of inner-city African Americans with diabetes . Study participants were r and omly assigned to the treatment ( 26 ) and control ( 21 ) conditions . The results indicate that treatment group participants were more likely to achieve positive outcomes in terms of lowered hemoglobin A1c and body mass index measurements than were control group members . These findings support the development of telehealth interventions to promote effective chronic disease management in medically underserved communities OBJECTIVE To evaluate the effect of a culturally sensitive diabetes self-management education program that uses a low-cost , peer-educator format ( Project Dulce ) on glucose control and metabolic parameters in low-income Mexican Americans with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 207 Mexican-American patients recruited from federally funded community health centers in San Diego County with HbA1c > 8 % were r and omly assigned to the  Project Dulce peer intervention or continuation of st and ard diabetes care . The primary outcome of interest was HbA1c . RESULTS The majority of subjects were born in Mexico , were female , were middle-aged , had less than an eighth- grade education , and had high baseline HbA1c levels . Significant time-by-group interaction effects for HbA1c ( P = 0.02 ) and diastolic blood pressure ( P = 0.04 ) indicated that the Project Dulce group exhibited greater improvement ( i.e. , decreases ) across time . Within-group analyses showed that the intervention group exhibited significant improvements from baseline to month 4 in absolute levels of HbA1c ( −1.7 % , P = 0.001 ) and HDL cholesterol ( + 1.4 mg/dL , P = 0.01 ) and from baseline to month 10 in absolute levels of HbA1c ( −1.5 % , P = 0.01 ) , total cholesterol ( −7.2 mg/dL , P = 0.04 ) , HDL cholesterol ( + 1.6 mg/dL , P = 0.01 ) , and LDL cholesterol ( −8.1 mg/dL , P = 0.02 ) . No significant changes were noted in the control group . CONCLUSIONS This r and omized trial , using the Project Dulce model of culturally sensitive , peer-led education , demonstrates improvement in glucose and metabolic control and suggests that this low-cost approach to self-management education for high-risk diabetic population s is effective Objective To improve glycaemic control among Type 2 diabetics using patient-physician consultations guided by the Stages of Change ( SOC ) model . Design and Methods A r and omised trial was conducted . After ensuring concealment of allocation , Type 2 diabetics were r and omly assigned to receive the intervention or the control . The intervention consisted of identifying each patient 's Stage of Change for managing their diabetes by diet , exercise and medications , and applying personalised , stage-specific care during the patient-physician consultations based on the SOC model . Patients in the control group received routine care . The variables of interest were effect on glycaemic control ( measured by the difference in HbA1c levels ) and patients ' readiness to change ( measured by identifying patients ' SOC for managing their diabetes by diet , exercise and medications ) . Results Participants were primarily over age 50 , male and Indo-Trinidadian . Most had received only a primary school education and over 65 % had a monthly income of $ 320 USD/month or less . Sixty-one Type 2 diabetics participated in each arm . Three patients were lost to follow-up in the intervention arm . After 48 weeks , there was an overall increase in HbA1c of 0.52 % ( SE 0.17 ) and 1.09 % ( SE 0.18 ) for both the intervention and control groups respectively . There was a relative reduction in HbA1c of 0.57 % ( 95 % CI 0.07 , 1.07 ) with the intervention group compared to the control ( p = 0.025 ) . For exercise and diet there was an overall tendency for participants in the intervention arm to move to a more favourable SOC , but little change was noted with regards medication use . Conclusions The result suggests a tendency to a worsening of glycaemic control in this population despite adopting more favourable SOC for diet and exercise . We hypothesized that harsh social conditions prevailing at the time of the study overrode the clinical intervention OBJECTIVE —To determine 1 ) whether participants in the Spanish Diabetes Self-Management Program ( SDSMP ) , when compared at 6 months to r and omized control subjects , would demonstrate improvements in health status , health behaviors , and self-efficacy ; and 2 ) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement . RESEARCH DESIGN AND METHODS —A total of 567 Spanish-speaking adults with type 2 diabetes were r and omized to a usual-care control group or 6-week community-based , peer-led SDSMP . SDSMP participants were re-r and omized to receive 15 months of automated telephone messages or no reinforcement . A1C was measured at baseline and 6 and 18 months . All other data were collected by self-administered question naires . RESULTS —At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C ( −0.4 % ) , health distress , symptoms of hypo- and hyperglycemia , and self-efficacy ( P < 0.05 ) . At 18 months all improvements persisted ( P < 0.05 ) . SDSMP participants also demonstrated improvements in self-rated health and communication with physicians , had fewer emergency room visits ( −0.18 visits in 6 months , P < 0.05 ) , and trended toward fewer visits to physicians . At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group . CONCLUSIONS —The SDSMP  demonstrated effectiveness in lowering A1C and improving health status . Reinforcement did not add to its effectiveness . Given the high needs of the Spanish-speaking population , the SDSMP deserves consideration for implementation We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design . One hundred and sixty-four participants with poorly controlled diabetes from two setting s were r and omized using computer-generated list into control ( n = 82 ) and intervention ( n = 82 ) groups , of which 151 completed the study . Monthly interventions over 12 weeks addressed the self-care practice s of diet , physical activity , medication adherence and self-monitoring of blood glucose ( SMBG ) . These self-care practice s were assessed at Weeks 0 and 12 using pre- and post- question naires in both groups together with glycated haemoglobin A1c ( HbA1c ) and diabetes knowledge . In the intention-to-treat analysis ( n = 164 ) , the intervention group improved their SMBG ( P = < 0.001 ) , physical activity ( P = 0.001 ) , HbA1c ( P = 0.03 ) , diabetes knowledge ( P = < 0.001 ) and medication adherence . At Week 12 , HbA1c difference adjusted for SMBG frequency , medication adherence and weight change remained significant ( P = 0.03 ) compared with control group . For within group comparisons , diabetes knowledge ( P = < 0.001 ) , HbA1c level ( P = < 0.001 ) , SMBG ( P = < 0.001 ) and medication adherence ( P = 0.008 ) improved from baseline in the intervention group . In the control group , only diabetes knowledge improved ( P = < 0.001 ) . These findings can contribute to the development of self-management diabetes education in Malaysia OBJECTIVE Few multiple lifestyle behavior change programs have been design ed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes . This study tested the effectiveness of the Mediterranean Lifestyle Program ( MLP ) , a comprehensive lifestyle self-management program ( Mediterranean low-saturated fat diet , stress management training , exercise , group support , and smoking cessation ) , in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes . RESEARCH DESIGN AND METHODS Postmenopausal women with type 2 diabetes ( n = 279 ) were r and omized to either usual care ( control ) or treatment ( MLP ) conditions . MLP participants took part in an initial 3-day retreat , followed by 6 months of weekly meetings , to learn and practice program components . Biological end points were changes in HbA(1c ) , lipid profiles , BMI , blood pressure , plasma fatty acids , and flexibility . Impact on quality of life was assessed . RESULTS Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA(1c ) , BMI , plasma fatty acids , and quality of life at the 6-month follow-up . Patterns favoring intervention were seen in lipids , blood pressure , and flexibility but did not reach statistical significance . CONCLUSIONS These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinical ly significant improvements in glycemic control , some coronary heart disease risk factors , and quality of life This study evaluated the 12-month follow-up results and costs of a personalized , medical office-based intervention focused on behavioral issues related to dietary self-management . Two hundred and six adults having diabetes attending an internal medicine outpatient clinic visit were r and omized to either Usual Care or to Brief Intervention . The single session intervention involved touchscreen computer-assisted assessment that provided immediate feedback on key barriers to dietary self-management , goal setting and problem-solving counselling . Follow-up components included phone calls and videotape intervention relevant to each participant . Brief Intervention produced significantly greater improvement than Usual Care on multiple measures of change in dietary behaviour ( e.g. , covariate adjusted difference of 2.2 % of calories from fat ; p = 0.023 ) and on serum cholesterol levels ( covariate adjusted difference of 15 mg/dl ; p = 0.002 ) at 12-month follow-up . There were also significant differences favouring intervention on patient satisfaction ( p < 0.02 ) but not on HbA1c levels . The costs of intervention ( $ 137 per patient ) were modest relative to many commonly used practice The aim of this study was to examine whether motivating patients to gain expertise and closely follow their risk parameters will attenuate the course of microvascular and cardiovascular sequelae of diabetes . A r and omized , prospect i ve study was conducted of 165 patients who had type 2 diabetes , hypertension , and hyperlipidemia and were referred for consultation to a diabetes clinic in an academic hospital . Patients were r and omly allocated to st and ard consultation ( SC ) or to a patient participation ( PP ) program . Both groups were followed by their primary care physicians . The mean follow-up was 7.7 yr . The SC group attended eight annual consultations . The PP patients initiated on average one additional consultation per year . There were 80 cardiovascular events ( eight deaths ) in the SC group versus 47 events ( five deaths ) in the PP group ( P = 0.001 ) . The relative risk ( RR ) over 8 yr for a cardiovascular event in the intervention ( PP ) versus the control ( SC ) group was 0.65 ( 95 % confidence interval , 0.89 to 0.41 ) . There were 17 and eight cases of stroke in the SC and PP groups , respectively ( P = 0.05 ) . RR for stroke was 0.47 ( 95 % confidence interval , 0.85 to 0.32 ) . In the SC group , 14 patients developed overt nephropathy ( four ESRD ) versus seven ( one ESRD ) in the PP group ( P = 0.05 ) . Throughout the study period , BP , LDL cholesterol , and hemoglobin A1c were significantly lower in the PP than in the SC patients . Well informed and motivated patients were more successful in obtaining and maintaining good control of their risk factors , result ing in reduced cardiovascular risk and slower progression of microvascular disease OBJECTIVE To evaluate the effect of case management by a clinical pharmacist on glycemic control and preventive measures in patients with type 2 diabetes mellitus . STUDY DESIGN R and omized controlled trial in a university-affiliated primary care internal medicine clinic . METHODS We recruited 80 patients with poorly controlled type 2 diabetes mellitus . A clinical pharmacist provided evaluation and modification of pharmacotherapy , self-management diabetes education , and reinforcement of diabetes complications screening processes through clinic visits and telephone follow-up . The main clinical outcome was hemoglobin A1C ( HbA1C ) level ; process measures included HbA1C and low-density lipoprotein measurement , retinal examination , urine microalbumin testing ( or use of angiotensin-converting enzyme inhibitors ) , and monofilament screening for diabetic neuropathy . RESULTS Patients in the intervention and control groups were similar in age , sex , mean HbA1C levels ( 10.1 % and 10.2 % , respectively ; P = .65 ) , and current treatment regimens at baseline . Patients who received case management by the clinical pharmacist achieved greater reduction in HbA1C levels than those in the control group ( 2.1 % vs 0.9 % , P = .03 ) . Three of the 5 process measures were conducted more frequently in the intervention group than the control group , including low-density lipoprotein measurement ( 100.0 % vs 85.7 % , P = .02 ) , retinal examination ( 97.3 % vs 74.3 % ) , and monofilament foot screening ( 92.3 % vs 62.9 % ) . CONCLUSIONS Proactive diabetes case management by a pharmacist substantially improved glycemic control and diabetes process-of-care measures . This approach , integrated with and based in the primary care setting , was an effective and efficient approach to improving care , especially for those with poor glycemic control at baseline PURPOSE Peer health coaches offer a potential model for extending the capacity of primary care practice s to provide self-management support for patients with diabetes . We conducted a r and omized controlled trial to test whether clinic-based peer health coaching , compared with usual care , improves glycemic control for low-income patients who have poorly controlled diabetes . METHOD We undertook a r and omized controlled trial enrolling patients from 6 public health clinics in San Francisco . Twenty-three patients with a glycated hemoglobin ( HbA1C ) level of less than 8.5 % , who completed a 36-hour health coach training class  , acted as peer coaches .  Patients from the same clinics with HbA1C levels of 8.0 % or more were recruited and r and omized to receive health coaching ( n = 148 ) or usual care ( n = 151 ) . The primary outcome was the difference in change in HbA1C levels at 6 months . Secondary outcomes were proportion of patients with a decrease in HbA1C level of 1.0 % or more and proportion of patients with an HbA1C level of less than 7.5 % at 6 months . Data were analyzed using a linear mixed model with and without adjustment for differences in baseline variables . RESULTS At 6 months , HbA1C levels had decreased by 1.07 % in the coached group and 0.3 % in the usual care group , a difference of 0.77 % in favor of coaching ( P = .01 , adjusted ) . HbA1C levels decreased 1.0 % or more in 49.6 % of coached patients vs 31.5 % of usual care patients ( P = .001 , adjusted ) , and levels at 6 months were less than 7.5 % for 22.0 % of coached vs 14.9 % of usual care patients ( P = .04 , adjusted ) . CONCLUSIONS Peer health coaching significantly improved diabetes control in this group of low-income primary care patients Background Diabetes outcomes are worse for underserved patients from certain ethnic/racial minority population s.  Telephonic disease management is a cost-effective strategy to deliver self-management services and possibly improve diabetes outcomes for such patients . Objective We conducted a trial to test the effectiveness of a supplemental telephonic disease management program compared to usual care alone for patients with diabetes cared for in a community health center . Design R and omized controlled trial . Participants All patients had type 2 diabetes , and the majority was Hispanic or African American . Most were urban-dwelling with low socioeconomic status , and nearly all had Medicaid or were uninsured . Measurements Clinical measures included glycemic control , blood pressure , lipid levels , and body mass index . Vali date d surveys were used to measure dietary habits and physical activity . Results A total of 146 patients were r and omized to the intervention and 149 to the control group .  Depressive symptoms were highly prevalent in both groups . Using an intention to treat analysis , there were no significant differences in the primary outcome ( HbA1c ) between the intervention and control groups at 12 months . There were also no significant differences for secondary clinical or behavioral outcome measures including BMI , systolic or diastolic blood pressure , LDL cholesterol , smoking , or intake of fruits and vegetables , or physical activity . Conclusions A clinic-based telephonic disease management support for underserved patients with diabetes did not improve clinical or behavioral outcomes at 1 year as compared to patients receiving usual care alone Self-management has been described as the cornerstone of care for diabetes . Many self-management studies are limited by poor methodology and poor descriptions of the intervention . The current study developed a theoretically based self-management programme for patients with type 2 diabetes , which was evaluated via a r and omized controlled trial . At immediate post-intervention and three-month follow-up the intervention group showed significant improvement relative to controls on self-management behaviours , quality of life and illness beliefs . A trend towards improved HbA1c was also observed . Documentation in a manual and development of a training programme for facilitators ensures the programme is replicable OBJECTIVES To evaluate whether outcomes from diabetes self-management education for patients with suboptimal control were sustained . STUDY DESIGN A r and omized controlled trial of 623 adults with type 2 diabetes and glycated hemoglobin ( A1C ) > 7 % assigned to receive conventional individual education ( IE ) , group education ( GE ) using US Diabetes Conversation Maps , or usual care ( UC ) with no education . METHODS A1C tests , Problem Areas in Diabetes ( PAID ) , Diabetes Self-Efficacy ( DES ) , Recommended Food Score ( RFS ) , physical activity , and medication use were quantified at baseline and 1 year of follow-up through electronic health records and quarterly mailed surveys . Short-term ( mean 6.8 months ) and long-term ( 12.8 months ) outcomes were evaluated using linear mixed models . In addition , follow-up trajectories were plotted in a r and om effects generalized additive model with smooth splines . RESULTS Compared with UC , IE result ed in long-term improved DES and PAID scores ( DES , + .11 , P = .03 and PAID , -2.94 , P = .04 ) , but not significantly improved long-term RFS or physical activity change . The A1C trajectory declined more steeply in IE than GE and UC for the first 150 days post r and omization . However , by 250 days , there was no treatment group A1C difference . The model fit likelihood ratio test for A1C intervention trends was significant for 3 distinct non-linear trajectories ( P = .02 ) . CONCLUSIONS Conventional IE ( but not GE ) result ed in significant and sustained improvements in self-efficacy and reduced diabetes distress compared with UC , but short-term improvements in A1C , nutrition , and physical activity were not sustained . Patients may need ongoing reinforcement to achieve lasting behavioral change and glucose control We studied the impact of  nurse case management ( NCM ) on  blood pressure ( BP ) , hemoglobin A1C , lipids , and diabetes complication screening . A 1-year r and omized-controlled trial was conducted in two primary care clinics of the Penn State Hershey Medical Center . Diabetes patients were r and omized to control group ( CG ) ( n=182 ) who received usual care by their primary care provider and intervention group ( IG ) ( n=150 ) who received additional NCM care , including self-management education , and implementation of diabetes guidelines .  Primary outcomes included BP , A1C , lipid , process measures , and secondary outcome was diabetes-related emotional distress as assessed by Problem Areas in Diabetes ( PAID ) . BP significantly decreased from 137/77 to 129/72 in IG as compared to an increase from 136/77 to 138/79 in CG after 1 year . PAID scores improved significantly in IG ( from 23 to 10 ) due to reduced emotional stress . A1C ( 7.4 ) and LDL ( 105 ) were unaffected . Complications screening significantly improved in IG compared to CG : opthalmologic exam 26 to 68 % , foot exam 47 to 64 % , and nephropathy screening 34 to 72 % . NCM improved BP , diabetes-related emotional distress , and process measures in primary care . Unchanged A1C and lipids might be due to a threshold effect . Intervention based upon initial risk assessment may prove more cost-effective OBJECTIVE Internet and other interactive technology-based programs offer great potential for practical , effective , and cost-efficient diabetes self-management ( DSM ) programs capable of reaching large numbers of patients . This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program , compared to an enhanced usual care condition . RESEARCH DESIGN AND METHODS A three-arm practical r and omized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program , offered in English and Spanish , compared to enhanced usual care .  A heterogeneous sample of 463 type 2 patients was r and omized and 82.5 % completed a 4-month follow-up . Primary outcomes were behavior changes in healthy eating , physical activity , and medication taking . Secondary outcomes included hemoglobin A1c , body mass index , lipids , and blood pressure . RESULTS The Internet-based intervention produced significantly greater improvements than the enhanced usual care condition on three of four behavioral outcomes ( effect sizes [ d ] for healthy eating = 0.32 ; fat intake = 0.28 ; physical activity= 0.19 ) in both intent-to-treat and complete-cases analyses . These changes did not translate into differential improvements in biological outcomes during the 4-month study period . Added contact did not further enhance outcomes beyond the minimal contact intervention . CONCLUSIONS The Internet intervention meets several of the RE- AIM criteria for potential public health impact , including reaching a large number of persons , and being practical , feasible , and engaging for participants , but with mixed effectiveness in improving outcomes , and consistent results across different subgroups . Additional research is needed to evaluate longer-term outcomes , enhance effectiveness and cost-effectiveness , and underst and the linkages between intervention processes and outcomes Objective : There is a need for practical , efficient and broad-reaching diabetes self-management interventions that can produce changes in lifestyle behaviours such as healthy eating and weight loss . The objective of this study was to evaluate such a computer-assisted intervention . Methods : Type 2 diabetes primary care patients ( n=335 ) from fee-for-service and health maintenance organization setting s were r and omized to social cognitive theory-based tailored self-management ( TSM ) or computer-aided enhanced usual care ( UC ) .  Intervention consisted of computer-assisted self-management assessment and feedback , tailored goal - setting , barrier identification , and problem-solving , followed by health counsellor interaction and follow-up calls . Outcomes were changes in dietary behaviours ( fat and fruit/vegetable intake ) , haemoglobin A1c ( HbA1c ) , lipids , weight , quality of life , and depression . Results : TSM patients reduced dietary fat intake and weight significantly more than UC patients at the 2-month follow-up . Among patients having elevated levels of HbA1c , lipids or depression at baseline , there were consistent directional trends favouring intervention , but these differences did not reach significance . The intervention proved feasible and was implemented successfully by a variety of staff . Conclusions : This relatively low-intensity intervention appealed to a large , generally representative sample of patients , was well implemented , and produced improvement in targeted behaviours . Implication s of this practical clinical trial for dissemination are discussed OBJECTIVE To evaluate a weight loss and exercise program design ed to improve diabetes management in older African-Americans . RESEARCH DESIGN AND METHODS Overweight African-Americans ( n = 64 ) ages 55–79 years with NIDDM were r and omized to either an intervention ( 12 weekly group sessions , 1 individual session , and 6 biweekly group sessions ) or usual care ( 1 class and 2 informational mailings ) . Clinical and behavioral variables were assessed at 0 , 3 , and 6 months of treatment . RESULTS Significant net differences in the intervention versus usual care were observed for weight ( −2.0 kg , P = 0.006 ) , physical activity , and dietary intake of fat , saturated fat , cholesterol , and nutrition knowledge at 3 months ( all P < 0.05 ) and for weight at 6 months ( −2.4 kg ; P = 0.006 ) and mean HbA1c values at 3 and 6 months ( respectively , −1.6 and −2.4 % , both P < 0.01 ) . After the adjustment for changes in weight and activity , the intervention participants were ∼ twice as likely to have a one unit decrease in HbA1c value as those in usual care . Blood pressure increase sin usual care participants result ed in net differences ( intervention minus control ) at 3 and 6 months of −3.3 ( P = 0.09 ) and −4.0 ( P = 0.05 ) mmHg diastolic , respectively , and −8.4 ( P = 0.06 ) and −5.9 ( P > 0.10 ) mmHg systolic , respectively . Blood lipid profiles improved more in intervention than usual care participants , but not significantly . CONCLUSIONS The intervention program was effective in improving glycemic and blood pressure control . The decrease in HbA1c values was generally independent of the relatively modest changes in dietary intake , weight , and activity and may reflect indirect program effects on other aspects of self-care Objective To evaluate the effectiveness of a structured group education programme on biomedical , psychosocial , and lifestyle measures in people with newly diagnosed type 2 diabetes . Design Multicentre cluster r and omised controlled trial in primary care with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 824 adults ( 55 % men , mean age 59.5 years ) . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures Haemoglobin A1c levels , blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , and emotional impact of diabetes at baseline and up to 12 months . Main results Haemoglobin A1c levels at 12 months had decreased by 1.49 % in the intervention group compared with 1.21 % in the control group . After adjusting for baseline and cluster , the difference was not significant : 0.05 % ( 95 % confidence interval −0.10 % to 0.20 % ) . The intervention group showed a greater weight loss : −2.98 kg ( 95 % confidence interval −3.54 to −2.41 ) compared with 1.86 kg ( −2.44 to −1.28 ) , P=0.027 at 12 months . The odds of not smoking were 3.56 ( 95 % confidence interval 1.11 to 11.45 ) , P=0.033 higher in the intervention group at 12 months . The intervention group showed significantly greater changes in illness belief scores ( P=0.001 ) ; directions of change were positive indicating greater underst and ing of diabetes . The intervention group had a lower depression score at 12 months : mean difference was −0.50 ( 95 % confidence interval −0.96 to −0.04 ) ; P=0.032 . A positive association was found between change in perceived personal responsibility and weight loss at 12 months ( β=0.12 ; P=0.008 ) . Conclusion A structured group education programme for patients with newly diagnosed type 2 diabetes result ed in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A1c levels up to 12 months after diagnosis . Trial registration Current Controlled Trials IS RCT N17844016 AIMS Education is an essential part of the management of patients with Type 2 diabetes , but the long-term effects are unclear and not well investigated in primary care . METHODS Fifty-four patients ( 39 - 75 years ) treated with maximal dosages of oral hypoglycaemic agents , needing to start insulin ( HbA(1c ) > or = 7.0 % ) , were r and omly allocated to a 6-month educational programme by a diabetes nurse ( DN group ) or usual care ( UC group ) . Main outcome measures were HbA(1c ) , number of patients with HbA(1c ) < 7.0 % , and number of patients treated with insulin 18 months after baseline . RESULTS Six weeks after the intervention HbA(1c ) levels had improved from 8.2 ( 1.1 ) to 7.2 ( 1.3 ) in the DN group , and from 8.8 ( 1.5 ) to 8.4 ( 1.7 ) in the UC group . Adjusted for baseline values , at 6 weeks HbA(1c ) improved 0.7 % ( 95 % confidence interval 0.1 , 1.4 ) more in DN than in UC . Of the patients in DN , 60 % reached HbA(1c ) < 7.0 % compared with 17 % in UC ( P < 0.01 ) . However , at 18 months there were no significant differences for HbA(1c ) , number of patients with HbA(1c ) < 7.0 % , or number treated with insulin . CONCLUSIONS Education was effective in improving glycaemic control and in delaying the need for insulin therapy in patients treated with maximal oral hypoglycaemic therapy . The reduced effect after 1 year was probably due to the discontinuation of the educational programme . Short-term education should not be offered without regular reinforcements integrated into st and ard diabetes care BACKGROUND Disease management programs that include ongoing telephone support for patients with diabetes have shown promise , but published studies have enrolled few socially and economically disadvantaged patients . METHODS We conducted a r and omized controlled trial with 201 patients with poorly controlled type 2 diabetes mellitus ( 72 % African American or Latino ; 74 % with incomes of ≤$15,000 ) . Participants were r and omized to an intervention package consisting of a 24-minute video behavior support intervention with a workbook and 5 sessions of telephone coaching by a trained diabetes nurse or a 20-page brochure developed by the National Diabetes Education Program . Study measures were completed at baseline , 1 month , and 6 months . Participants ' review of the intervention material s was assessed at 1 month . The primary trial end point was hemoglobin A(1c ) value . Secondary end points included lipid levels , blood pressure , diabetes knowledge , and self-care behaviors . Data were analyzed with repeated measures analysis of variance . RESULTS Most participants in both groups ( 94 % ) review ed the intervention provided , and 73 % of participants assigned to the experimental group completed 5 sessions of telephone coaching . There was a significant overall reduction in mean ( SD ) hemoglobin A(1c ) value from baseline ( 9.6 % [ 2.0 % ] ) to 6 months ( 9.1 % [ 1.9 % ] ) ( P < .001 ) , but differences between groups were nonsignificant . Differences on other clinical measures ( lipid levels and blood pressure ) and measures of diabetes knowledge and self-care behaviors were also nonsignificant . CONCLUSIONS There was no significant effect of the experimental intervention compared with the control condition . The dose of intervention provided was less than in previously published studies . More intensive interventions may be necessary for the most disadvantaged patients . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00668590 Few studies have demonstrated an effect of educational interventions on glycaemic control in persons with Type 2 diabetes longer than 3 - 6 months after baseline . We aim ed to investigate the effectiveness of an experience-based group educational programme 24 months after baseline and to pinpoint mediators that might play a role in achieving desired metabolic outcomes . We conducted a r and omised controlled trial inviting self-referred persons with Type 2 diabetes ( N=77 r and omised ) . The pharmacist-led , year-long intervention was based on participants ' experiences of glucose regulation during the monthly group discussion s. We measured HbA1c at 0 , 6 , 12 , and 24 months and a question naire was administered at baseline and final follow-up . Our findings indicated that participating in the intervention programme significantly decreased HbA1c by 0.4 % at 24 months after baseline . Initial HbA1c , satisfaction with own diabetes-related knowledge , and treatment were found directly related to glycaemic outcomes . The intervention group exercised more in order to lower blood-glucose levels and was also more able to predict current blood-glucose levels before measuring it . Experience-based group education was effective in decreasing participants ' HbA1c 1-year after completed intervention . Early effect of the intervention was followed by relapse after 12 months and a new , significant decrease at 24 months ; this dual course implies that follow-up of educational interventions should involve several consecutive measurements to capture possible late effects . Both biomedical and subjective factors played a role in accounting for the variance of HbA1c at 2-year follow-up after baseline BACKGROUND Group medical clinics ( GMCs ) are widely used in the management of diabetes and hypertension , but data on their effectiveness are limited . OBJECTIVE To test the effectiveness of GMCs in the management of comorbid diabetes and hypertension . DESIGN R and omized , controlled trial . ( Clinical Trials.gov registration number : NCT00286741 ) SETTING 2 Veterans Affairs Medical Centers in North Carolina and Virginia . PATIENTS 239 patients with poorly controlled diabetes ( hemoglobin A(1c ) [ HbA(1c ) ] level > or = 7.5 % ) and hypertension ( systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg ) . INTERVENTION Patients were r and omly assigned within each center to either attend a GMC or receive usual care . Clinics comprised 7 to 8 patients and a care team that consisted of a primary care general internist , a pharmacist , and a nurse or other certified diabetes educator . Each session included structured group interactions moderated by the educator . The pharmacist and physician adjusted medication to manage each patient 's HbA(1c ) level and blood pressure . MEASUREMENTS Hemoglobin A(1c ) level and systolic blood pressure , measured by blinded research personnel at baseline , study midpoint ( median , 6.8 months ) , and study completion ( median follow-up , 12.8 months ) . Linear mixed models , adjusted for clustering within GMCs , were used to compare HbA(1c ) levels and systolic blood pressure between the intervention and control groups . RESULTS Mean baseline systolic blood pressure and HbA(1c ) level were 152.9 mm Hg ( SD , 14.2 ) and 9.2 % ( SD , 1.4 ) , respectively . At the end of the study , mean systolic blood pressure improved by 13.7 mm Hg in the GMC group and 6.4 mm Hg in the usual care group ( P = 0.011 by linear mixed model ) , whereas mean HbA(1c ) level improved by 0.8 % in the GMC group and 0.5 % in the usual care group ( P = 0.159 ) . LIMITATION Measurements of effectiveness may have been limited by concomitant improvements in the usual care group that were due to co-intervention . CONCLUSION Group medical clinics are a potent strategy for improving blood pressure but not HbA(1c ) level in diabetic patients . PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs Health Services Research and Development Service The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study . Forty patients from a family practice clinic with type 2 diabetes were r and omly assigned to control or experimental groups . The control group received st and ard care , whereas the experimental group received st and ard care plus home visits from a nurse , as well as consultation with an exercise specialist and /or nutritionist . Follow-up continued for 3 months . Clinical end points included st and ard measures of diabetes activity as well as quality -of-life indicators .  Focus group interviews were used to explore patients ’ responses to the program . Although findings were not statistically significant , a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure . Quality oflife measures also showed a trend toward small to moderate , but nonsignificant , improvements in physical functioning , bodily pain , vitality , social and global functioning , energy , impact of diabetes , and health distress . Focus group interviews indicated a very positive response from patients , who expressed feelings of empowerment . In this study , patients treated with  nurse-physician collaboration  demonstrated small , but nonsignificant , improvements in blood chemistry after only 3 months . Physical and social functioning , energy , and bodily pain also showed a small improvement . Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term 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 AIMS To determine whether tighter cardiovascular risk factor control with structured education in individuals with type 2 diabetes ( T2DM ) and microalbuminuria benefits cardiovascular risk factors . METHODS Participants from a multiethnic population , recruited from primary care and specialist clinics were r and omised to intensive intervention with structured patient ( DESMOND model ) education ( n=94 ) or usual care by own health professional ( n=95 ) . PRIMARY OUTCOME change in HbA1c at 18months . SECONDARY OUTCOMES changes in blood pressure ( BP ) , cholesterol , albuminuria , proportion reaching risk factor targets , modelled cardiovascular risk scores . RESULTS Mean ( SD ) age and diabetes duration of participants were 61.5 ( 10.5 ) and 11.5 ( 9.3 ) years , respectively . At 18months , intensive intervention showed significant improvements in HbA1c ( 7.1(1.0 ) vs. 7.8(1.4)% , p<0.0001 ) , systolic BP ( 129(16 ) vs. 139(17 ) mmHg , p<0.0001 ) , diastolic BP ( 70(11 ) vs. 76(12 ) mmHg , p<0.001 ) , total cholesterol ( 3.7(0.8 ) vs. 4.1(0.9 ) mmol/l , p=0.001 ) . Moderate and severe hypoglycaemia was 11.2 vs. 29.0 % ; p=0.001 and 0 vs. 6.3 % ; p=0.07 , respectively . More intensive participants achieved ≥3 risk factor targets with greater reductions in cardiovascular risk scores . CONCLUSIONS Intensive intervention showed greater improvements in metabolic control and cardiovascular risk profile with lower rates of moderate and severe hypoglycaemia . Intensive glycaemic interventions should be underpinned by structured education promoting self-management in T2DM BACKGROUND Type 2 diabetes is a serious and growing problem in Taiwan where it is the fifth leading cause of death , and health care costs are 4.3 times higher than for people without diabetes . OBJECTIVES The purpose of this study was to determine whether participation in a motivational interview for  people with type 2 diabetes would improve their self-management , psychological and glycemic outcomes . DESIGN A r and omized controlled trial to assess the effects of the motivational interviewing intervention . SETTING S Participants were drawn from the diabetes outpatient clinic of a large teaching hospital in South Taiwan . PARTICIPANTS A sample of 250 type 2 diabetes people . METHODS Type 2 diabetes people were r and omly allocated into either the motivational interview group or the usual care group from baseline to 3 months follow-up . The intervention was based on motivational interviewing which encompassed a variety of interviewing techniques , and reflected each person 's readiness stage to change . The control group was provided with usual care by nursing staff . RESULTS A total of 250 type 2 diabetic participants were r and omized . The retention rate in the intervention group was 83 % ( n=104 ) . The motivational interview did improve participants significantly in self-management , self-efficacy , quality of life , and HbA1c among diabetes people with appropriate baseline value ( < 121.24 , < 174.57 , < 107.18 , and > 7.62 , respectively ) but not in depression , anxiety and stress ( F=0.13 , p=0.72 ) compared to the control group at 3 months follow-up . CONCLUSION The findings provided important evidence concerning the positive effect of motivational interventions in self-management , psychological and glycemic outcomes . This research provided evidence for future clinical practice s in diabetes care Background : Type 2 diabetes affects one in five African American women older than 60 years . These women face distinct challenges in managing diabetes self-care . Therefore , tailored self-care interventions for this population need to be developed and tested . Objectives : The effectiveness of a tailored , four-visit , in-home symptom-focused diabetes intervention with and without booster telephone calls was compared with an attentional control focused on skills training for weight management and diet . Methods : African American women ( n = 180 ; > 55 years old , Type 2 diabetes mellitus > 1 year , HbA1c > 7 % ) were r and omly assigned to the intervention or attentional control condition . Half the intervention participants were assigned to also receive a telephone-delivered booster intervention . Participants were evaluated at baseline and 3 , 6 , and 9 months . Results : Baseline HbA1 was 8.3 in the intervention group ( n = 60 ) , 8.29 in the intervention with booster group ( n = 55 ) , and 8.44 in the attentional control condition ( n = 59 ) . HbA1c declined significantly in the whole sample ( 0.57 % ) with no differences between study arms . Participants in the booster arm decreased HbA1c by 0.76 % . Symptom distress , perceived quality of life , impact of diabetes , and self-care activities also improved significantly for the whole sample with no significant differences between study arms . Discussion : Parsimonious interventions of four in-person visits yielded clinical ly significant decreases in HbA1c . Although the weight and diet program was intended as an attentional control , the positive effects suggest it met a need in this population . Because the contents of both the intervention and the attentional control were effective despite different approaches , a revised symptom-focused intervention that incorporates weight and diet skills training may offer even better results UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT After diabetes education , 39 adult diabetic patients were r and omized to either an education group or control group . The two groups received identical medical care and follow-up , except that the education group met with their diabetes educator on at least a quarterly basis . Neither group showed any statistically significant change in their glycosylated hemoglobin values , although the education group did have a 4 % drop after initial education compared to a 6 % rise in the control group . The education group had a lower attrition rate and a better improvement in self-rated dietary compliance . Education remains the cornerstone of diabetes management . Our team identified some trends between the two groups as well as some ideas to improve motivating and developing a stronger and more effective relationship with our patients OBJECTIVE The aim of this study was to evaluate the effectiveness of lay diabetes facilitators ( LDFs ) to increase knowledge and improve control among persons with diabetes . Methodology . A prospect i ve cohort study was conducted among persons with diabetes in 16 health care centres in Jamaica to evaluate the effect of LDFs on glycaemia [ haemoglobin A1c ( HbA1c ) ] and body mass index ( BMI ) .  One hundred and fifty-nine persons with diabetes were recruited for the intervention from eight clinical setting s in which LDFs had been recruited and trained . A matched group of 159 were recruited as a comparison sample from eight clinical setting s without LDFs .  HbA1c and BMI were measured at baseline and 6 months . RESULTS Mean HbA1c at baseline for the intervention and comparison groups were 7.9 % and 8 % , respectively . After 6 months , the intervention group showed a mean decrease of 0.6 % while the comparison group showed an increase of 0.6 % , significant after control for potential confounders ( P < 0.05 ) . There was no statistically significant change in BMI between groups . CONCLUSION Patients educated by LDFs showed improved metabolic control over the first 6 months of observation AIM The purpose of this study was to examine the effect of the diabetes outpatient intensive management programme ( DOIMP ) on glycaemic control over a 12 week follow-up period for type 2 diabetic patients in Korea . BACKGROUND Diabetic complications can be prevented if the glycaemic status of diabetes patients is maintained within a nearly normal range . Patient education is critical in controlling blood glucose levels of patients with diabetes within the optimal range . METHODS DOIMP was composed of multidisciplinary education , complication monitoring and telephone counselling .  Twenty-five patients in the intervention group participated in the DOIMP and 24 patients in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses . RESULTS Patients in the intervention group had a mean decrease of 2.3 % , which those in the control group having a mean decrease 0.4 % in glycosylated haemoglobin ( HbA(1)c ) . There was no difference between the two groups in the change in fasting blood glucose ( FBG ) and two-hour postpr and ial blood glucose ( 2-h PBG ) . The proportion of the patients with HbA(1)c < 7 % was higher in the intervention group than in the control group at the post-test compare with the pretest . CONCLUSION DOIMP can reduce HbA(1)c in type 2 diabetes patients . RELEVANCE TO CLINICAL PRACTICE These findings indicated that DOIMP could be effective in glycaemic control in type 2 diabetes patients Medicare began reimbursing for outpatient diabetes self-management training ( DSMT ) in 2000 ; however , little is known about program utilization . Individuals diagnosed with diabetes in 2010 were identified from a 20 % r and om selection of the Medicare fee-for-service population ( N = 110,064 ) . Medicare administrative and cl aims files were used to determine DSMT utilization . Multivariate logistic regression analyses evaluated the association of demographic , health status , and provider availability factors with  DSMT utilization . Approximately 5 % of Medicare beneficiaries with newly diagnosed diabetes used  DSMT services . The adjusted odds of any utilization were lower among men compared with women , older individuals compared with younger , non-Whites compared with Whites , people dually eligible for Medicare and Medicaid compared with nondual eligibles , and patients with comorbidities compared with individuals without those conditions . Additionally , the adjusted odds of utilizing DSMT  increased as the availability of providers who offered DSMT services increased and varied by Census region . Utilization of DSMT  among Medicare beneficiaries with newly diagnosed diabetes is low . There appear to be marked disparities in access to  DSMT  by demographic and health status factors and availability of DSMT providers . In light of the increasing prevalence of diabetes , future research should identify barriers to DSMT access , describe DSMT providers , and explore the impact of DSMT services . With preventive services being increasingly covered by insurers , the low utilization of  DSMT  , a preventive service benefit that has existed for almost 15 years , highlights the challenges that may be encountered to achieve widespread dissemination and uptake of the new services Background : : Depression is associated with poor glycemic control , increased number of microvascular and macrovascular complications , functional impairment , mortality , and 4.5 times higher total health care costs in patients with diabetes .  Shared medical appointments ( SMAs ) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support , counseling , problem solving , and improved access to care . Objective : To test the efficacy as assessed by attainment of a hemoglobin A1c ( A1C ) < 7 % of pharmacistted group SMA visits , Veterans Affairs Multidisciplinary Education in Diabetes and Intervention for Cardiac Risk Reduction in Depression ( VA-MEDIC-D ) , in patients with type 2 diabetes mellitus . Methods : This was a r and omized controlled trial of VA-MEDIC-D added to st and ard care versus st and ard care alone in depressed patients with diabetes with A1C > 6.5 % .  VA-MEDIC-D consisted of 4 once-weekly , 2-hour sessions followed by 5 monthly 90-minute group sessions . Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes , lipids , smoking , and blood pressure . No pharmacologic interventions for depression were provided . The change in the proportion of participants who achieved an A1C < 7 % at 6 months was compared . Results : Compared to st and ard care ( n = 44 ) , a lower proportion of patients in VA-MEDIC-D ( n = 44 ) had systolic blood pressure ( SBP ) < 130 mm Hg at baseline , but were similar in other cardiovascular risk factors and psychiatric comorbidity . The change in the proportion of participants achieving an A1C < 7 % was greater in the VA-MEDIC-D arm than in the st and ard care arm ( 29.6 % vs 11.9 % ) , with odds ratio 3.6 ( 95 % CI 1.1 to 12.3 ) . VA-MEDIC-D participants also achieved significant reductions in SBP , low-density lipoprotein cholesterol , and non – high-density lipoprotein ( HDL ) cholesterol from baseline , whereas significant reductions were attained only in non – HDL cholesterol with st and ard care . There was no significant change in depressive symptoms for either arm . Conclusions : Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms BACKGROUND Lifestyle modifications may affect the development of diabetes and prevent complications . However , there is no direct evidence to show that lifestyle intervention is beneficial for patients with established type 2 diabetes . OBJECTIVE The ultimate goal is to determine whether long-term lifestyle intervention can improve glycemic control and prevent complications in patients with type 2 diabetes . This initial report on a multi-year study describes protocol s and the analysis of baseline data and three-year interim results . DESIGN The study was a r and omized , controlled , multi-centre , prospect i ve intervention trial . The trial included patients from 59 Japanese institutes specializing in diabetes care . PATIENTS The study enrolled 2 205 patients with previously diagnosed type 2 diabetes . INTERVENTION The lifestyle modification program included intensive lifestyle management at each outpatient clinic visit and frequent telephone counseling . The intervention group received educational material s concerning the importance of lifestyle and behavioural changes , a diary to record progress of laboratory and other data , and a pedometer . MEASUREMENTS Parameters and indices related to glycemic control , diabetic complications , dyslipidemia , hypertension , obesity , and atherosclerosis were measured several times a year . RESULTS Small but significant differences in HbA1c levels between the intervention ( INT ) and conventional ( CON ) therapy groups appeared as early as two years after the start of intervention and were maintained in the third year ( CON group , 7.78 + /- 1.27 % vs. INT group , 7.62 + /- 1.20 % , the initial HbA1c level was 7.80 + /- 1.42 % for the CON group and 7.68 + /- 1.28 % for the INT group ) . Data on differences in occurrence of micro- or macrovascular complications are not yet available . CONCLUSIONS The effect of lifestyle modification on improving the glycemic control of patients with established type 2 diabetes mellitus was small but significant three years after initiation of the intervention OBJECTIVE To evaluate the effect of an educational intervention program on clinical outcomes and on compliance with medical therapy in patients with type 2 diabetes mellitus ( DM ) , hypertension , or both . STUDY DESIGN Six-month r and omized unblinded study . METHODS Three hundred fifty-two patients were screened , and 347 were r and omized to the intervention group  ( education through the Know Your Health [ KYH ] program [ n = 174 ] ) or to the  control group ( usual care [ n = 173 ] ) . Evaluation of the effectiveness of the KYH program was based on the cohort of patients who were not at goal at baseline ( 124 in the intervention group and 115 in the control group ) . The primary research interests were to assess patient acceptance of the KYH material s and to compare the clinical outcomes of the intervention group with those of the control group . RESULTS After 6 months , significantly more patients in the intervention group than in the control group were at goal ( 44.2 % vs 29.2 % , P = .046 ) . Among patients with hypertension , reductions in the mean diastolic blood pressure were significantly greater in the intervention group compared with the control group at month 6 ( -6.7 vs -3.6 mm Hg , P = .04 ) . The groups did not differ significantly on other primary end points ( percentage of patients with DM who were at goal , change from baseline glycosylated hemoglobin level , and change in Morisky score ) . CONCLUSIONS Participation in the KYH educational program during a 6-month period improved clinical outcomes in patients with type 2 DM or hypertension . The KYH material s were well received and were considered informative and easily comprehensible by patients who completed the program 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 OBJECTIVE This study evaluated the efficacy of a nurse-care management system design ed to improve outcomes in patients with complicated diabetes . RESEARCH DESIGN AND METHODS In this r and omized controlled trial that took place at Kaiser Permanente Medical Center in Santa Clara , CA , 169 patients with longst and ing diabetes , one or more major medical comorbid conditions , and HbA(lc ) > 10 % received a special intervention ( n = 84 ) or usual medical care ( n = 85 ) for 1 year . Patients met with a nurse-care manager to establish individual outcome goals , attended group sessions once a week for up to 4 weeks , and received telephone calls to manage medications and self-care activities .  HbA(lc ) , LDL , HDL , and total cholesterol , triglycerides , fasting glucose , systolic and diastolic blood pressure , BMI , and psychosocial factors were measured at baseline and 1 year later . Annualized physician visits were determined for the year before and during the study . RESULTS At 1 year , the mean reductions in HbA(lc ) , total cholesterol , and LDL cholesterol were significantly greater for the intervention group compared with the usual care group . Significantly more patients in the intervention group met the goals for HbA(1c ) ( < 7.5 % ) than patients in usual care ( 42.6 vs. 24.6 % , P < 0.03 , chi(2 ) ) . There were no significant differences in any of the psychosocial variables or in physician visits . CONCLUSIONS A nurse-care management program can significantly improve some medical outcomes in patients with complicated diabetes without increasing physician visits Abstract Aims /hypothesis . Metabolic control worsens progressively in Type II ( non-insulin-dependent ) diabetes mellitus despite intensified pharmacological treatment and lifestyle intervention , when these are implemented on a one-to-one basis . We compared traditional individual diabetes care with a model in which routine follow-up is managed by interactive group visits while individual consultations are reserved for emerging medical problems and yearly checks for complications . Methods . A r and omized controlled clinical trial of 56 patients with non-insulin-treated Type II diabetes managed by systemic group education and 56 control patients managed by individual consultations and education .  Results . Observation times were 51.2±2.1 months for group care and 51.2±1.8 for control subjects . Glycated haemoglobin increased in the control group but not in the group of patients ( p<0.001 ) , in whom BMI decreased ( p<0.001 ) and HDL-cholesterol increased ( p<0.001 ) . Quality of life , knowledge of diabetes and health behaviours improved with group care ( p<0.001 , all ) and worsened among the control patients ( p=0.004 to p<0.001 ) . Dosage of hypoglycaemic agents decreased ( p<0.001 ) and retinopathy progressed less ( p<0.009 ) among the group care patients than the control subjects . Diastolic blood pressure ( p<0.001 ) and relative cardiovascular risk ( p<0.05 ) decreased from baseline in group patients and control patients alike . Over the study period , group care required 196 min and 756.54 US $ per patient , compared with 150 min and 665.77 US $ for the control patients , result ing in an additional 2.12 US $ spent per point gained in the quality of life score . Conclusion /interpretation . Group care by systemic education is feasible in an ordinary diabetes clinic and cost-effective in preventing the deterioration of metabolic control and quality of life in Type II diabetes without increasing pharmacological treatment Abstract .Practicing physicians as well as diabetes specialists are confronted with the often-frustrating experience of dealing with patients with poorly controlled diabetes . It is not always obvious why these patients fail to improve . The aims of this study were two-fold : ( a ) to determine if the interdisciplinary approach offered by the Western Negev  Mobile Clinic Diabetes Program ( WNMDCP ) is of benefit in patients with poorly controlled type 2 diabetes and ( b ) to more fully characterize patients refractory to treatment . Two primary -care clinics of the Western Negev were r and omly selected as control and intervention . All patients from both clinics with hemoglobin ( HbA1C ) ≥10 % ( tested during June-July 2000 ) were studied for 6 months . Patients from the control clinic continued the usual treatment . Patients from the intervention clinic received the interdisciplinary approach offered by WNMCDP . The rate of improvement of diabetes control , measured as a decrease in HbA1C values of at least 0.5 % , and compliance to treatment were determined . Overall , 48 of 258 patients in the intervention clinic and 34 of 179 patients in the control clinic met the inclusion criteria . At the 6-month follow-up , we observed significant improvements in plasma glucose ( -1.5 mmol/l ; p=0.003 ) and HbA1C ( -1.8 % ; p=0.00001 ) in the intervention group but not in the control group . The compliance and response rates were 85 % and 71 % for the intervention group and 32 % and 35 % for the control group , respectively . Patients from the intervention clinic showed significant improvement in the endpoints compared to patients from the control clinic . More than 70 % of patients with poorly controlled diabetes mellitus responded to the interdisciplinary treatment approach offered by WNMDCP . The group of non-responders comprised patients with poor compliance ( 15 % ) and those with serious concomitant diseases or limitations of mobility OBJECTIVES : This study was conducted to determine if an empowerment-based Diabetes Self-Management Consultant ( DSMC ) was more effective than a group receiving Mailed metabolic Assessment s Only ( MAO ) in improving diabetes-related quality of life and blood glucose control . MATERIAL S AND METHODS : A two-year clinical trial , in which 310 patients with type 2 diabetes were r and omized to the DSMC intervention or the MAO group .  The DSMC met with the patient to review the baseline assessment s , then met with this review was patient and the patient 's physician . Subsequently patients received monthly telephone calls from the DSMC who used the empowerment approach to help patients identify self-management problems , consider options , set goals and make adjustments to their diabetes self-management plans . RESULTS : The Diabetes Self-Management Consultant ( DSMC ) intervention result ed in improvements in diabetes related quality of life ( PAID ) p= .008 , the Empowerment Scale p= .024 , A1C p= .016 , Perceived underst and ing of diabetes p= .001 and satisfaction with diabetes care p= .019 as compared to the MAO group . DISCUSSION / CONCLUSION : The DSMC the intervention result ed in a broad array of modest diabetes related improvements . A promising area for future research would be to test the efficacy of combining an empowerment-based DSMC intervention with case management using algorithm-based medication adjustments for higher risk patients OBJECTIVES To examine the relationships among patient characteristics , labor inputs , and improvement in glycosylated hemoglobin ( A1C ) level in a successful primary care-based diabetes disease management program ( DDMP ) . STUDY DESIGN We performed subanalyses to examine the relationships among patient characteristics , labor inputs , and improvement in A1C level within a r and omized controlled trial .  Control patients  received usual care , while  intervention patients received usual care plus a comprehensive DDMP . METHODS The primary outcome was improvement in A1C level over 12 months stratified by intervention status and patient characteristics . Process outcomes included the number of actions or contacts with patients , time spent with patients , and number of glucose medication titrations or additions . RESULTS One hundred ninety-three of 217 enrolled patients ( 88.9 % ) had complete 12-month followup data . Patients in the intervention group had significantly greater improvement in A1C level than the control group ( -2.1 % vs -1.2 % , P = .007 ) . In multivariate analysis , no significant differences were observed in improvement in A1C level when stratified by age , race/ethnicity , income , or insurance status , and no interaction effect was observed between any covariate and intervention status . Among intervention patients , we observed similar labor inputs regardless of age , race/ethnicity , sex , education , or whether goal A1C level was achieved . CONCLUSIONS Among intervention patients in a successful DDMP , improvement in A1C level was achieved regardless of age , race/ethnicity , sex , income , education , or insurance status . Labor inputs were similar regardless of age , race/ethnicity , sex , or education and may reflect the nondiscriminatory nature of providing algorithm-based disease management care This study evaluated a structured and integrated intervention program on diabetes management in individuals with type 2 diabetes in Shanghai , China . Men and women with type 2 diabetes and body mass index > 23 kg/m2 were r and omized into a 24-week , prospect i ve , r and omized clinical trial . The Reference Group ( n=50 ) received diabetes education including diet and physical activity instruction only ; the Intervention Group ( n=100 ) received more intensive intervention , including diabetes education with frequent blood glucose monitoring , nutritional counseling , meal plans with diabetes-specific nutritional meal replacement , and weekly progress up date s with study staff . Major study assessment s were obtained at baseline , and after 12 and /or 24 weeks of intervention . The Intervention Group improved fasting blood glucose , insulin , systolic and diastolic blood pressures compared to Reference Group ( p < 0.05 ) . Importantly , HbA1c was lower ( p < 0.001 ) in the Intervention Group at 12 weeks ( -0.6 + /- 0.1 % ) and 24 weeks ( -0.8 + /- 0.1 % ) . Weight loss was modest , but significant differences were observed between groups ( p < 0.05 ) . Weight change from baseline after 12 and 24 weeks was -2.8 + /- 0.2 % and -3.7 + /- 0.3 % , respectively , in the Intervention Group vs -1.8 + /- 0.4 % and -2.5 + /- 0.4 % in the Reference Group . Additionally , waist and hip circumferences and waist : hip ratio decreased in the Intervention compared to the Reference Group ( p < 0.05 ) . In conclusion , this study demonstrates that Chinese men and women with type 2 diabetes following an integrated intervention program including diabetes education , frequent blood glucose monitoring and daily use of a diabetes-specific meal replacement , can achieve significant improvements in glycemic control and markers of cardiovascular health This study was performed to investigate the effect of a telephone-delivered intervention on glycemic control and body mass index in Korean type 2 diabetic patients . 38 patients were r and omly selected , with 20 assigned to a telephone group and 18 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range . The intervention was applied to the telephone group for 12 weeks . It consisted of continuous education and reinforcement of diet , exercise and medication adjustment , 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 months . Subjects were requested to write self- management logs , including blood glucose , diet and an exercise diary . The  diet diaries  were analyzed by a dietitian , and subjects instructed about the results by telephone counseling or mail . All medication adjustments were communicated to the subjects ' diabetes specialist . Glycosylated hemoglobin ( HbA1c ) , fasting blood glucose ( FBG ) and 2-hour postpr and ial glucose were measured before , and after , the intervention . Patients in the telephone group had a mean decrease of 1.2 % , with those in the control group having a mean increase of 0.6 % , in HbA1c . There were no significant differences in the body mass index ( BMI ) between the two groups . These findings indicated that a telephone-delivered intervention would improve HbA1c , but would not affect BMI OBJECTIVES To demonstrate that pharmacists working with physicians and other providers in an ambulatory care setting can improve glucose , blood pressure , and lipid control for patients with type 2 diabetes and to report patient adherence to screening and general preventive measures . DESIGN Prospect i ve , r and omized , clinical practice study . SETTING Burlington , MA , between January 2001 and August 2003 . PATIENTS 164 patients patients with type 2 diabetes older than 18 years with glycosylated hemoglobin ( A1C ) greater than 8 % . INTERVENTION Pharmacist-patient clinic visits included obtaining a comprehensive medication review ; performing targeted physical assessment ; ordering laboratory tests ; review ing , modifying , and monitoring patients ' medication therapy and providing detailed counseling on all therapies ; facilitating self-monitoring of blood glucose ; and providing reinforcement of dietary guidelines and exercise . MAIN OUTCOME MEASURE Effect of clinical pharmacists working with physicians in an ambulatory setting on health measures ( e.g. , A1C , blood pressure , cholesterol ) of patients with diabetes . RESULTS Baseline characteristics were similar between the two groups . After 1 year , significant improvements occurred for A1C and low-density lipoprotein ( LDL ) cholesterol in the intervention group compared with the control group ( A1C , 7.7 % vs. 8.4 % ; LDL , 93.7 vs. 105.1 mg/dL ; P < 0.05 ) . Systolic blood pressure improved for all study patients without a difference between the two groups . Diastolic blood pressure improved significantly in the intervention group compared with the control group ( 73.4 mm Hg vs. 77.6 mm Hg , P < 0.05 ) . Significantly more intervention patients were screened for retinopathy , neuropathy , and microalbuminuria than control patients ( P < 0.05 ) . CONCLUSION For all indices measured , this study demonstrated that collaborative diabetes management with a clinical pharmacist can improve overall care Aims Intensive management of risk parameters in diabetic patients may retard the progression of both micro‐ and macrovascular complications . Intensified care requires expert staff and is expensive . The aim of the present study was to examine whether sharing the therapeutic responsibility with the patients will improve the outcome The purpose of this pilot study was to test the effectiveness of an in-home , nurse-delivered , symptom-focused teaching/counseling intervention with older rural African American women who have type 2 diabetes . Forty-one participants were r and omly assigned to either the intervention or the comparison group . Participants in the intervention showed statistically significant improvement in their medication , diet , home glucose monitoring self-care practice s , perceptions of quality of life , and distress from symptoms . Both groups evidence d improvement of HbA(1c ) levels . The intervention group achieved greater improvement , but the difference was not statistically significant . Participant satisfaction was high . Further studies should look into the cost of the intervention , as compared with that of usual care , and its long-term effects PURPOSE The purpose of this pilot study was to determine the efficacy of a 6-month nurse-coaching intervention that was provided after diabetes education for women with type 2 diabetes . METHODS In this pilot study , 53 women were r and omized to the nurse-coaching intervention or a st and ard care control condition .  The nurse-coaching intervention consisted of 5 individualized sessions and 2 follow-up phone calls over 6 months . The nurse-coaching sessions included educational , behavioral , and affective strategies . Data were collected on physiologic adaptation ( hemoglobin A1c [ A1C ] and body mass index [ BMI ] ) , self-management ( dietary and exercise ) , psychosocial adaptation ( diabetes-related distress and integration ) , and treatment satisfaction at baseline , 3 months , and 6 months . RESULTS Women in the treatment group demonstrated better diet self-management , less diabetes-related distress , better integration , and more satisfaction with care , and had trends of better exercise self-management and BMI . The A1C levels improved in both groups at 3 months , yet the difference between the groups was not significant . Attendance at nurse-coaching sessions was 96 % . CONCLUSIONS This nurse-coaching intervention demonstrates promise as a means of improving self-management and psychosocial outcomes in women with type 2 diabetes AIMS Patient education is a very important part of diabetes care . However , until now , little data has been presented about the long-term effectiveness of structured intensive diabetes education programmes ( SIDEP ) for people with Type 2 diabetes mellitus . METHODS People with Type 2 diabetes ( n = 547 ) hospitalized from December 1999 to December 2000 were r and omly assigned to two groups . Two hundred and nineteen patients undertook an inpatient SIDEP and the remaining patients received conventional glycaemic control without intensive education . After discharge , all patients were monitored regularly . Laboratory data were obtained , and adherence to self-care behaviour was determined on a five-point scale by question naires completed annually . RESULTS Of the patients who completed the SIDEP , 160 ( 73.1 % ) were followed up for more than 4 years . The mean HbA(1c ) ( 7.9 + /- 1.2 vs. 8.7 + /- 1.6 % ; P < 0.05 ) and the frequency of hospitalization related to diabetes per patient per year ( 0.3 + /- 0.6 vs. 0.8 + /- 0.9 ; P < 0.05 ) was significantly lower in the SIDEP group than in the control group . The SIDEP group adhered more closely to self-care behaviour than the control group over 4 years ( P < 0.05 ) . People with Type 2 diabetes mellitus of longer duration and those treated with insulin had poorer HbA(1c ) at follow-up . CONCLUSIONS A well- design ed , intensive patient education programme is necessary for people with diabetes . However , regular and sustained reinforcement with encouragement is also required to maintain optimal glycaemic control , especially in insulin-treated patients BACKGROUND Glycemic goals ( hemoglobin A1c < 7 % ) are often not achieved in patients with type 2 diabetes despite the availability of many effective treatments and the documented benefits of glycemic control in the reduction of long-term microvascular and macrovascular complications . Several studies have established the important positive effects of pharmacist-led management on achieving glycemic control and other clinical outcomes in patients with diabetes . Diabetes prevalence and mortality are increasing rapidly in Jordan . Nevertheless , clinical pharmacists in Jordan do not typically provide pharmaceutical care ; instead , the principal responsibilities of pharmacists in Jordan are dispensing and marketing of medical products to physicians . OBJECTIVE To assess the primary clinical outcome of glycemic control ( A1c ) and secondary outcomes , including blood pressure , lipid values , self-reported medication adherence , and self-care activities for patients with type 2 diabetes in an outpatient diabetes clinic r and omly assigned to either usual care or a pharmacist-led pharmaceutical care intervention program . METHODS Patients with type 2 diabetes attending an outpatient diabetes clinic of a large teaching hospital were recruited over a 4-month period from January through April 2011 and r and omly assigned to intervention and usual care groups using the Minim software technique . The intervention group at baseline received face-to-face objective -directed education from a clinical pharmacist about type 2 diabetes , prescription medications , and necessary lifestyle changes , followed by 8 weekly telephone follow-up calls to discuss and review the prescribed treatment plan and to resolve any patient concerns . The primary outcome measure was glycemic control ( A1c ) , and secondary measures included systolic and diastolic blood pressure , complete lipid profile ( i.e. , total cholesterol , low-density lipoprotein cholesterol [ LDL-C ] , high-density lipoprotein cholesterol [ HDL-C ] , serum triglycerides ) , and self-reported medication adherence ( 4-item Morisky Scale ) and self-care activities ( Summary of Diabetes Self-Care Activities question naire ) . Data were collected at baseline and at 6 months follow-up . Changes from baseline to follow-up were calculated for biomarker values , and between-group differences in the change amounts were tested using the t test for independent sample s. A P value of < 0.05 was considered statistically significant . RESULTS A total of 77 of 85 patients ( 90.6 % ) r and omly assigned to the intervention group and 79 of 86 patients ( 91.9 % ) assigned to usual care had baseline and 6-month follow-up values . Compared with baseline values , patients in the intervention group had a mean reduction of 0.8 % in A1c versus a mean increase of 0.1 % from baseline in the usual care group ( P = 0.019 ) . The intervention group compared with the usual care group had small but statistically significant improvements in the secondary measures of fasting blood glucose , systolic and diastolic blood pressure , total cholesterol , LDL-C , serum triglycerides , self-reported medication adherence , and self-care activities . Between-group differences in changes in the secondary measures of HDL-C and body mass index were not significant . CONCLUSIONS Patients with type 2 diabetes who received pharmacist-led pharmaceutical care in an outpatient diabetes clinic experienced reduction in A1c at 6 months compared with essentially no change in the usual care group . Six of 8 secondary biomarkers were improved in the intervention group compared with usual care OBJECTIVE This study evaluated the Diabetes Outpatient Intensive Treatment ( DOIT ) program , a multiday group education and skills training experience combined with daily medical management , followed by case management over 6 months . Using a r and omized control design , the study explored how DOIT affected glycemic control and self-care behaviors over a short term . The impact of two additional factors on clinical outcomes were also examined ( frequency of case management contacts and whether or not insulin was started during the program ) . RESEARCH DESIGN AND METHODS Patients with type 1 and type 2 diabetes in poor glycemic control ( A1c > 8.5 % ) were r and omly assigned to DOIT or a second condition , entitled EDUPOST , which was st and ard diabetes care with the addition of quarterly educational mailings . A total of 167 patients ( 78 EDUPOST , 89 DOIT ) completed all baseline measures , including A1c and a question naire assessing diabetes-related self-care behaviors . At 6 months , 117 patients ( 52 EDUPOST , 65 DOIT ) returned to complete a follow-up A1c and the identical self-care question naire . RESULTS At follow-up , DOIT evidence d a significantly greater drop in A1c than EDUPOST . DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents ( ACFC ) of food compared with EDUPOST patients . An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients . Also , the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes . The addition of insulin did not appear to be a significant contributor to glycemic change . CONCLUSIONS DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors . However , it dem and s significant time , commitment , and careful coordination with many health care professionals . The role of the nurse case manager in providing ongoing follow-up contact seems important OBJECTIVE To assess the effectiveness of a culturally sensitive , structured education programme ( CSSEP ) on biomedical , knowledge , attitude and practice measures among Arabs with type two diabetes . RESEARCH DESIGN S AND METHODS A total of 430 patients with type II diabetes mellitus living in Doha , Qatar were enrolled in the study . They were r and omized to either intervention ( n = 215 ) or a control group  ( n = 215 ) . A baseline and one-year interval levels of biomedical variables including HbA1C , lipid profile , urine for microalbuminuria ; in addition to knowledge , attitude and practice ( KAP ) scores were prospect ively measured . The intervention was based on theory of empowerment , health belief models and was culturally sensitive in relation to language ( Arabic ) , food habits and health beliefs . It consisted of four educational sessions for each group of patients ( 10 - 20 patients per session ) , lasting for 3 - 4 h. The first session discussed diabetes pathophysiology and complications ; while the second session discussed healthy life style incorporating the Idaho plate method ; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counselling techniques . Outcomes were assessed at base line and 12 months after intervention . RESULTS After 12 months participation in the intervention was shown to have led to a statistically significant reduction in HbA1C in the ( CSSEP ) group ( -0.55 mmol/L , P = 0.012 ) , fasting blood sugar ( -0.92 mmol/L , P = 0.022 ) , body mass index ( 1.70 , P = 0.001 ) and albumin/creatinine ratio ( -3.09 , P < 0.0001 ) but not in the control group . The intervention group also had improvement in Diabetes knowledge ( 5.9 % , P < 0.0001 ) , attitude ( 6.56 % , P < 0.0001 ) , and practice ( 6.52 % , P = 0.0001 ) . CONCLUSION This study demonstrates the effectiveness of culturally sensitive , structured , group-based diabetes education in enhancing biomedical and behavioural outcomes in Diabetic patients Aims /hypothesisThe aim of this study was to measure the efficacy of motivational interviewing ( MI ) compared with usual care on changes in glycaemic control and competence of diabetes self-management in patients with diabetes mellitus . Methods Patients were eligible if they had type 1 or 2 diabetes mellitus , were over 18 years of age and had participated in a 4 day group education programme offered at a diabetes clinic at a university hospital in Denmark . Exclusion criteria included pregnancy , severe debilitating disease and cognitive deficit . Out of 469 patients who attended the group education programme , 349 patients were r and omised to either a usual care control group or an intervention group , which received up to five individual counselling sessions in 1 year based on MI , in addition to usual care . A r and omised parallel design was used and open-label allocation was done by r and om permuted blocks , with allocation concealment by sequentially numbered , sealed , opaque envelopes . The primary outcome was glycated haemoglobin ( HbA1c ) . Analysis regarding measurements of glycated haemoglobin ( HbA1c ) and competence of self-management ( using the Problem Areas in Diabetes Scale [ PAID ] and Perceived Competence for Diabetes Scale [ PCDS ] ) was based on 298 participants followed for a 24 month period . Data were collected at the Department of Endocrinology at Odense University Hospital . Our hypotheses were that MI could : ( 1 ) reduce HbA1c levels ; ( 2 ) increase self-efficacy ; and ( 3 ) increase diabetes self-care , compared with usual care . Results Out of the 176 included in the control group and 173 in the intervention group , 153 and 145 were analysed in the groups , respectively . When using the baseline value as covariate there were no significant differences in change score between the two study groups with regard to mean level of HbA1c ( 0.131 , p = 0.221 ) , PAID scores ( −1.793 , p = 0.191 ) or PCDS scores ( 0.017 , p = 0.903 ) at the 24 month follow-up , using a mixed effects regression model . The patients in the intervention group showed significantly higher levels of perceived competence in dealing with diabetes compared with the control group ( mean change score = −0.387 , p = 0.002 ) following 1 year of intervention . Conclusion /interpretationWe were unable to demonstrate any benefit , over or above usual care , of MI in patients with diabetes who have just completed a diabetes education programme , and who have well-regulated diabetes . Trial registration Clinical Trials NCT00555854 . Funding The National Board of Health , Funen County , Danish Association of Diabetes , Odense University Hospital , University of Southern Denmark and TRYG Fonden PURPOSE To assess the efficacy of a pharmacist-led , primary care-based , disease management program to improve cardiovascular risk factors and glycated hemoglobin ( A(1C ) ) levels in vulnerable patients with poorly controlled diabetes . METHODS A r and omized controlled trial of 217 patients with type 2 diabetes and poor glycemic control ( A(1C ) level > or=8.0 % ) was conducted at an academic general medicine practice from February 2001 to April 2003 . Intervention patients received intensive management from clinical pharmacists , as well as from a diabetes care coordinator who provided diabetes education , applied algorithms for managing glucose control and decreasing cardiovascular risk factors , and addressed barriers to care . Control patients received a one-time management session from a pharmacist followed by usual care from their primary care provider . Outcomes were recorded at baseline and at 6 and 12 months . Primary outcomes included blood pressure , A(1C ) level , cholesterol level , and aspirin use . Secondary outcomes included diabetes knowledge , satisfaction , use of clinical services , and adverse events . RESULTS For the 194 patients ( 89 % ) with 12-month data , the intervention group had significantly greater improvement than did the control group for systolic blood pressure ( -9 mm Hg ; 95 % confidence interval [ CI ] : -16 to -3 mm Hg ) and A(1C ) level ( -0.8 % ; 95 % CI : -1.7 % to 0 % ) . Change in total cholesterol level was not significant . At 12 months , aspirin use was 91 % in the intervention group versus 58 % among controls ( P < 0.0001 ) . Intervention patients had greater improvements in diabetes knowledge and satisfaction than did control patients . There were no significant differences in use of clinical services or adverse events . CONCLUSION Our comprehensive disease management program reduced cardiovascular risk factors and A(1C ) levels among vulnerable patients with type 2 diabetes and poor glycemic control We examine whether one-to-one lifestyle counseling for non-insulin-treated diabetic out patients by a Certified Expert Nurse ( CEN ) can improve patients ' health outcomes . Participants were r and omly assigned to a 1-year lifestyle intervention ( n=67 ) or to a usual care group ( n=67 ) . Main outcome measures were changes from baseline in : HbA(1C ) and score of health related quality of life scales ( SF-36 and Problem Areas in Diabetes Scale ) . Cognitive/behavioral modification for 1 year and satisfaction in CEN counseling was also measured by self-produced items . We found no significant differences in HbA(1C ) , BMI , blood pressure , serum lipids , or health related quality of life over 1 year between the two groups . Patients in the intervention group , however , showed modest but more favorable modification of cognition ( p=0.004 ) and behavior ( p<0.001 ) than subjects in usual care group . The low attrition rate ( 9 % ) , more frequent hospital visit ( 12+/-2 times versus 11+/-3 times ; p=0.03 ) and high degree of satisfaction ( 95 % ) in the intervention group indicate feasibility of the monthly CEN counseling in the outpatient setting s of Japanese hospitals . Future research should confirm the long-term effectiveness of the CEN counseling on clinical outcomes and the cost effectiveness of a possibly time-consuming intervention OBJECTIVES We evaluated lifestyle interventions for diabetic persons who live in rural communities . METHODS We conducted a 12-month r and omized clinical trial ( n = 152 ) of " intensive-lifestyle " ( modeled after the NIH Diabetes Prevention Program ) and " reimbursable-lifestyle " ( intensive-lifestyle intervention delivered in the time allotted for Medicare reimbursement for diabetes education related to nutrition and physical activity ) interventions with usual care as a control . RESULTS Modest weight loss occurred by 6 months among intensive-lifestyle participants and was greater than the weight loss among usual-care participants ( 2.6 kg vs 0.4 kg , P<.01 ) . At 12 months , a greater proportion of intensive-lifestyle participants had lost 2 kg or more than usual-care participants ( 49 % vs 25 % , P<.05 ) . No differences in weight change were observed between reimbursable-lifestyle and usual-care participants . Glycated hemoglobin was reduced among all groups ( P<.05 ) but was not different between groups . CONCLUSIONS Improvement in both weight and glycemia was attainable by lifestyle interventions design ed for persons who had type 2 diabetes and lived in rural communities OBJECTIVE To determine whether Pro-Active Call Center Treatment Support ( PACCTS ) , using trained nonmedical telephonists supported by specially design ed software and a diabetes nurse , can effectively improve glycemic control in type 2 diabetes . RESEARCH DESIGN AND METHODS A r and omized controlled implementation trial of 1-year duration was conducted in Salford , U.K. The trial comprised 591 r and omly selected individuals with type 2 diabetes . By r and om allocation , 197 individuals were assigned to the usual care ( control ) group and 394 to the PACCTS ( intervention ) group . Lifestyle advice and drug treatment in both groups followed local guidelines . PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA(1c ) level . The primary outcome was absolute reduction in HbA(1c ) , and the secondary outcome was the proportion of patients reducing HbA(1c ) by at least 1 % . RESULTS A total of 332 patients ( 84 % ) in the PACCTS group and 176 patients ( 89 % ) in the control group completed the study .  Final HbA(1c ) values were available in 374 patients ( 95 % ) in the PACCTS group and 180 patients ( 92 % ) in the usual care group . Compared with usual care , HbA(1c ) improved by 0.31 % ( 95 % CI 0.11 - 0.52 , P = 0.003 ) overall in the PACCTS patients . For patients with baseline HbA(1c ) > 7 % , the improvement increased to 0.49 % ( 0.21 - 0.77 , P < 0.001 ) , whereas in patients with baseline HbA(1c ) < 7 % there was no change . The difference in the proportions of patients achieving a > /=1 % reduction in HbA(1c ) significantly favored the PACCTS intervention : 10 % ( 4 - 16 , P < 0.001 ) overall and 15 % ( 7 - 24 , P < 0.001 ) for patients with baseline HbA(1c ) > 7 % . CONCLUSIONS In an urban Caucasian trial population with blood glucose HbA(1c ) > 7 % , PACCTS facilitated significant improvement in glycemic control . Further research should extend the validity of findings to rural communities and other ethnic groups , as well as to smoking and lipid and blood pressure control BACKGROUND We evaluated intensive intervention in poorly controlled patients with type 2 diabetes mellitus involving weekly clinic visits and adjustment of therapy with analysis of three seven-point glucose profiles and intervention from an interdisciplinary staff . METHODS Sixty-three patients were r and omized to an intensive treatment group that obtained self-monitoring of blood glucose ( SMBG ) profiles  ( six or seven values per day , 3 days/week ) and were seen in the clinic at Weeks 1 - 6 and 12 . SMBG results were downloaded , analyzed using Accu-Chek ( ® ) 360 ° software ( Roche Diagnostics , Indianapolis , IN ) , and used to adjust therapy . Control group subjects obtained  glucose profiles and had clinic visits only at Weeks 0 , 6 , and 12 . RESULTS There were highly statistically significant improvements in the intensive treatment group compared with the control group between Weeks 0 and 6 with greater reductions in weekly mean glycemia ( WMG ) ( -76.7±8.9 mg/dL vs. -20.5±8.1 mg/dL ) , glycemic variability ( SD ) ( -16.3±3.1 mg/dL vs. -5.0±3.1 mg/dL ) , and glycated hemoglobin ( -1.82±0.16 % vs. -0.66±0.22 % ) without significant changes in frequency of hypoglycemia or weight . Improvements were sustained in the intensive treatment group through Week 12 . A minimal but statistically significant degree of improvement was seen in the control group at Week 12 . CONCLUSIONS This short-term pilot study of an intensive monitoring , educational , and pharmacological interventions program result ed in dramatic improvement of glycemic control within 6 weeks , and these effects are sustained through Week 12 . SMBG glucose profiles , calculation of WMG and SD , and graphical displays of glucose data can improve the effectiveness of adjustment of therapy at weekly clinic visits when combined with intensive support from a multidisciplinary team Purpose The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education . Methods In this r and omized controlled trial , 134 participants ( 75 % white , 51 % female , 59 ± 9 years old , 13 ± 8 years with diabetes , A1C = 8.4 % ± 1.2 % ) were r and omized  to either a group map-based program ( intervention ) or group education on cholesterol and blood pressure ( control ) . Participants were assessed for A1C levels , diabetes self-care behaviors ( 3-day pedometer readings , 6-minute walk test , blood glucose checks , frequency of self-care ) , and psychosocial factors ( distress , frustration , quality of life ) at baseline , 3 , 6 , and 12 months post intervention and health literacy at baseline . Results Groups did not differ on baseline characteristics including A1C levels , health literacy , or self-care ; however , the intervention group had more years of education than controls . Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up . Importantly , frequency of self-reported self-care , diabetes quality of life , diabetes-related distress , and frustration with diabetes self-care improved in both groups over time . Conclusions Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care . The best method to accomplish reinforcement needs to be established BACKGROUND Although maintaining nearly normal glycemia delays onset and slows progression of diabetes complications , many patients with diabetes and their physicians struggle to achieve glycemic targets . The best methods to support patients as they follow diabetes prescriptions and recommendations are unclear . METHODS To test the efficacy of a behavioral diabetes intervention in improving glycemia in long- duration , poorly controlled diabetes , we r and omized 222 adults with diabetes ( 49 % type 1 ) ( mean [ SD ] age , 53 [ 12 ] years ; mean [ SD ] disease duration 18 [ 12 ] years ; mean [ SD ] hemoglobin A(1c ) [ HbA(1c ) ] concentration , 9.0 % [ 1.1 % ] ) to attend ( 1 ) a 5-session manual-based , educator-led structured group intervention with cognitive behavioral strategies ( structured behavioral arm ) ; ( 2 ) an educator-led attention control group education program ( group attention control ) ; or ( 3 ) unlimited individual nurse and dietitian education sessions for 6 months ( individual control ) . Outcomes were baseline and 3- , 6- , and 12-month postintervention HbA(1c ) levels ( primary ) and frequency of diabetes self-care , 3-day pedometer readings , 24-hour diet recalls , average number of glucose checks , physical fitness , depression , coping style , self-efficacy , and quality of life ( secondary ) . RESULTS Linear mixed modeling found that all groups showed improved HbA(1c ) levels ( P < .001 ) . However , the structured behavioral arm showed greater improvements than the group and individual control arms ( 3-month HbA(1c ) concentration changes : -0.8 % vs -0.4 % and -0.4 % , respectively ( P = .04 for group × time interaction ) . Furthermore , participants with type 2 disease showed greater improvement than those with type 1 ( P = .04 for type of diabetes × time interaction ) . Quality of life , glucose monitoring , and frequency of diabetes self-care did not differ by intervention over time . CONCLUSIONS A structured , cognitive behavioral program is more effective than 2 control interventions in improving glycemia in adults with long- duration diabetes . Educators can successfully use modified psychological and behavioral strategies . TRIAL REGISTRATION clinical trials.gov Identifier : NCT000142922 Purpose The purpose of this study was to evaluate the impact of an innovative intervention that utilized a certified medical assistant with specific diabetes training to work with a multidisciplinary diabetes care team to help provide basic diabetes education and self-care support in low-income minority population s with type 2 diabetes . Methods Enrolled participants were r and omized to either the medical assistant coaching ( MAC ) group ( N = 25 ) or the treatment as usual ( TAU ) group ( N = 25 ) . Deidentified data was obtained on a matched no contact control ( NCC ) group ( N = 50 ) . Results Analysis of covariance ( ANCOVA ) comparisons revealed no significant differences between the 3 groups on A1C , but a trend was observed . A1Cs decreased across time for the MAC group , while increasing for the TAU and NCC groups . ANCOVA comparisons also indicated that the MAC group experienced significantly greater increases in perceived empowerment and a larger , although non-significant , reduction in perceived diabetes related problems than the TAU group . Conclusions This r and omized controlled pilot study suggests that the inclusion of a medical assistant self-care coach as part of the diabetes care team holds promise in improving outcomes and should be further examined in a large-scale study
target: This systematic review found robust data demonstrating that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels .
  PRACTICE IMPLICATION S The data suggest mode of delivery , hours of engagement , and baseline A1C can affect the likelihood of achieving statistically significant and clinical ly meaningful improvement in A1C
background: OBJECTIVE Assess effect of diabetes self-management education and support methods , providers , duration , and contact time on glycemic control in adults with type 2 diabetes .