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Optimization of Care for Adult Outpatients With Type 2 Diabetes Through the Diabetes Self-Management Multidisciplinary Program: A Randomized Clinical Trial

Published:January 28, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.01.006

      Abstract

      Objectives

      Our aim in this study was to evaluate the efficacy of a Self-Management Multidisciplinary Program (MP) on glycemic management, quality of life and diabetes self-care activities.

      Methods

      People with type 2 diabetes and glycated hemoglobin (A1C) of >7.5% were randomized to participate in the MP or to usual care (UC). The MP consisted of face-to-face meetings with each health-care provider (nurse, pharmacist, dietitian, physical educator and social worker) to approach diabetes self-management issues. MP topics were tailored toward local habits and culture. Three different modules were offered over 12 weeks. The primary outcome was change in A1C from baseline to 12 months. Diabetes Quality of Life and Summary of Diabetes Self-Care Activities questionnaires were assessed at baseline and at 6 and 12 months.

      Results

      Ninety-six participants were included (mean 59 years of age, 60% women, diabetes duration 16±10 years, 62% of lower middle/low socioeconomic status). Change in A1C at 12 months (UC: 0.52% [95% confidence interval, −1.07 to 0.04]; MP: −0.30% [95% confidence interval, −1.05 to 0.44]; p=0.33) was not different between the groups. There was an increase in satisfaction and a reduction in worry about future effects of diabetes in the MP group, which was not found in the UC group.

      Conclusions

      A short-term self-management multidisciplinary program improved diabetes-related quality of life but failed to reduce A1C in individuals with longstanding type 2 diabetes and a low socioeconomic status.

      Résumé

      Objectifs

      L’objectif de notre étude était d’évaluer l’efficacité d’un programme multidisciplinaire (PM) sur la prise en charge autonome sur la régulation de la glycémie, la qualité de vie et les activités d’auto-soins du diabète.

      Méthodes

      Nous avons réparti les personnes atteintes du diabète de type 2 qui ont une hémoglobine glyquée (A1c) de > 7,5 % au groupe du PM ou au groupe des soins courants (SC). Le PM prenait la forme de rencontres en personne avec chacun des professionnels de la santé (infirmier, pharmacien, diététicien, éducateur physique et travailleur social) pour aborder les questions liées à la prise en charge autonome du diabète. Les thèmes du PM étaient adaptés à la culture et aux habitudes locales. Trois modules différents étaient offerts pendant 12 semaines. Le principal critère d’évaluation était la variation de l’A1c du début au 12e mois. Les questionnaires Diabetes Quality of Life et Summary of Diabetes Self-Care Activities étaient évalués au début, après 6 mois et après 12 mois.

      Résultats

      Nous avons retenu 96 participants (âge moyen de 59 ans, 60 % de femmes, durée du diabète de 16 ± 10 ans, 62 % de statut socioéconomique de catégorie moyenne inférieure/faible). La variation de l’A1c après 12 mois (SC : 0,52 % [intervalle de confiance à 95 % de −1,07 à 0,04]; PM : −0,30 % [intervalle de confiance à 95 % de −1,05 à 0,44]; p = 0,33) n’était pas différente entre les groupes. Au sein du groupe du PM, mais non au sein du groupe des SC, nous avons observé une augmentation de la satisfaction et une diminution de l’inquiétude sur les répercussions futures du diabète.

      Conclusions

      Un programme multidisciplinaire à court terme sur la prise en charge autonome du diabète a contribué à l’amélioration de la qualité de vie liée au diabète, mais n’a pas permis de réduire l’A1c chez les individus atteints d’un diabète de type 2 de longue date et ayant un statut socioéconomique faible.

      Keywords

      Mots clés

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