TY - JOUR
T1 - No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: A cluster randomised trial
AU - Jansink, Renate
AU - Braspenning, Joze
AU - Keizer, Ellen
AU - van der Weijden, Trudy
AU - Elwyn, Glyn
AU - Grol, Richard
PY - 2013/6
Y1 - 2013/6
N2 - Objective. To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices. Intervention. Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting. Subjects. Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m(2). Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires). Results. Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI -0.8-0.35) and diet (fat (difference between groups = 0.19; CI -0.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = -0.02; CI - 0.26-0.22)), and physical activity (difference between groups = -1.15; CI - 12.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life. Conclusion. A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.
AB - Objective. To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices. Intervention. Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting. Subjects. Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m(2). Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires). Results. Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI -0.8-0.35) and diet (fat (difference between groups = 0.19; CI -0.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = -0.02; CI - 0.26-0.22)), and physical activity (difference between groups = -1.15; CI - 12.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life. Conclusion. A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.
KW - General practice
KW - lifestyle
KW - primary health care
KW - quality of health care
KW - randomised controlled trial
KW - the Netherlands
KW - type 2 diabetes mellitus
U2 - 10.3109/02813432.2013.797178
DO - 10.3109/02813432.2013.797178
M3 - Article
C2 - 23659710
SN - 0281-3432
VL - 31
SP - 119
EP - 127
JO - Scandinavian Journal of Primary Health Care
JF - Scandinavian Journal of Primary Health Care
IS - 2
ER -