Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample

Felicia Hill-Briggs, Mariana Lazo-Elizondo, Mark Peyrot, Angela Doswell, Yi Ting Chang, Martha Hill, David Levine, Nae Yuh Wang, Frederick L. Brancati

Research output: Contribution to journalArticle

Abstract

Background: Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change. Objective: To pilot test feasibility, acceptability, and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility. Design: Two-arm randomized controlled trial powered to detect a 0.50% change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis. Participants: Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar, blood pressure, or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization. Interventions: A group, problem-based diabetes self-management training designed for delivery in an intensive and a condensed program format. Three intensive and three condensed program groups were conducted during the trial. Main Measures: Clinical (A1C, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL and HDL cholesterol) and behavioral (knowledge, problem solving, self-management behavior) data were measured at baseline, post-intervention, and 3 months post-intervention (corresponding with 6-9 months following baseline). Results: Adoption of both programs was high (>85% attendance rates, 95% retention). At 3 months post-intervention, the between-group difference in A1C change was -0.72% (p = 0.02), in favor of the intensive program. A1C reduction was partially mediated by problem-solving skill at follow-up (β = -0.13, p = 0.04). Intensive program patients demonstrated within-group improvements in knowledge (p <0.001), problem-solving (p = 0.01), and self-management behaviors (p = 0.04). Among the subsets of patients with suboptimal blood pressure or lipids at baseline, the intensive program yielded clinically significant individual improvements in SBP, DBP, and LDL cholesterol. Patient satisfaction and usability ratings were high for both programs. Conclusions: A literacy-adapted, intensive, problem-solving-based diabetes self-management training was effective for key clinical and behavioral outcomes in a lower income patient sample.

Original languageEnglish (US)
Pages (from-to)972-978
Number of pages7
JournalJournal of General Internal Medicine
Volume26
Issue number9
DOIs
StatePublished - Sep 2011

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Self Care
Blood Pressure
LDL Cholesterol
Managed Care Programs
Patient Satisfaction
Social Class
African Americans
Type 2 Diabetes Mellitus
HDL Cholesterol
Registries
Blood Glucose
Randomized Controlled Trials
Cholesterol
Organizations
Lipids

Keywords

  • diabetes
  • problem-solving
  • self-management
  • training

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample. / Hill-Briggs, Felicia; Lazo-Elizondo, Mariana; Peyrot, Mark; Doswell, Angela; Chang, Yi Ting; Hill, Martha; Levine, David; Wang, Nae Yuh; Brancati, Frederick L.

In: Journal of General Internal Medicine, Vol. 26, No. 9, 09.2011, p. 972-978.

Research output: Contribution to journalArticle

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AU - Doswell, Angela

AU - Chang, Yi Ting

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AU - Levine, David

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