[Show abstract][Hide abstract] ABSTRACT: A trial was performed to establish whether our group care model for lifestyle intervention in type 2 diabetes can be exported to other clinics.
This study was a 4-year, two-armed, multicenter controlled trial in 13 hospital-based diabetes clinics in Italy (current controlled trials no. ISRCTN19509463). A total of 815 non-insulin-treated patients aged <80 years with > or =1 year known diabetes duration were randomized to either group or individual care.
After 4 years, patients in group care had lower A1C, total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, BMI, and serum creatinine and higher HDL cholesterol (P < 0.001, for all) than control subjects receiving individual care, despite similar pharmacological prescriptions. Health behaviors, quality of life, and knowledge of diabetes had become better in group care patients than in control subjects (P < 0.001, for all).
The favorable clinical, cognitive, and psychological outcomes of group care can be reproduced in different clinical settings.
Diabetes care 04/2010; 33(4):745-7. · 7.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The locus of control theory distinguishes people (internals) who attribute events in life to their own control, and those (externals) who attribute events to external circumstances. It is used to assess self-management behaviour in chronic illnesses. Group care is a model of systemic group education that improves lifestyle behaviour and quality of life in patients with Type 1 and Type 2 diabetes. This study investigated the locus of control in Type 1 and Type 2 diabetes and the possible differences between patients managed by group care and control subjects followed by traditional one-to-one care.
Cross-sectional administration of two questionnaires (one specific for diabetes and one generic for chronic diseases) to 83 patients followed for at least 5 years by group care (27 Type 1 and 56 Type 2) and 79 control subjects (28 Type 1 and 51 Type 2) of similar sex, age and diabetes duration. Both tools explore internal control of disease, the role of chance in changing it and reliance upon others (family, friends and health professionals).
Patients with Type 1 diabetes had lower internal control, greater fatalistic attitudes and less trust in others. Patients with either type of diabetes receiving group care had higher internal control and lower fatalism; the higher trust in others in those with Type 1 diabetes was not statistically significant. The differences associated with group care were independent of sex, age and diabetes duration.
Patients with Type 1 diabetes may have lower internal control, fatalism and reliance upon others than those with Type 2 diabetes. Receiving group care is associated with higher internal control, reduced fatalism and, in Type 1 diabetes, increased trust in others.
Diabetic Medicine 02/2008; 25(1):86-90. · 3.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the locus of control in patients with type 2 diabetes followed by systemic group education (Group Care) and traditional one-to-one care.
In a post-hoc analysis, two questionnaires were administered to 56 patients who had been followed for 5-7 years by Group Care and 51 controls followed by individual care, similar by age, sex, diabetes duration, glycaemia, insulinaemia, weight and other clinical variables. Patients on Group Care had lower HbA1c (7.40 +/- 1.21%) than controls (7.99 +/- 1.48%), P = 0.027. The Peyrot and Rubin questionnaire, specific for diabetes, and the Wallston and Wallston questionnaire, more generic for chronic diseases, were administered. Both questionnaires explore 3 areas: internal control of disease, and the role of chance or powerful other people, including health operators, in changing the disease.
Both questionnaires showed lower scores for chance in patients followed by Group Care (P < 0.001), while scores for powerful others did not differ from those of patients followed by traditional care. The Peyrot and Rubin tool showed increased Internal Control (P < 0.001) in the patients followed by Group Care. Multivariate analysis showed that the HOMA index of insulin resistance was inversely related to Internal Control (B = -0.144, P = 0.005) independently of BMI and HbA1c.
Fatalistic attitudes were lower and internal control higher in patients with type 2 diabetes followed by Group Care. These changes may be related to insulin resistance, above and beyond the effects of body weight and metabolic control.
[Show abstract][Hide abstract] ABSTRACT: We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes.
Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary end-points were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated. After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p<0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p=0.004) while quality of life changed independently of either (p<0.001). Among controls, quality of life worsened (p<0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p=0.027) and total cholesterol decreased in the controls (p<0.05). HbA1c decreased, though not significantly, in both. Direct costs for group and one-to-one care were Euros 933.19 and Euros 697.10 per patient, respectively, giving a cost-effectiveness ratio of Euros 19.42 spent per point gained in the quality of life scale.
Group care is applicable and also cost-effective in type 1 diabetes. It improves quality of life, knowledge and behaviours. Future programme adjustments should strive to impact more on metabolic control.
[Show abstract][Hide abstract] ABSTRACT: To evaluate retrospectively the results of a screening for gestational diabetes (GD) carried out during the period 1981-91 on pregnant women with one or more risk factors for diabetes.
An oral glucose tolerance test (OGTT) was performed between the 14th and 18th weeks of pregnancy in 423 women. Those who were positive for gestational diabetes were successively treated with diet alone or together with insulin to obtain strict metabolic control.
Positivity for GD varied between 2.2% and 2.4% in all women studied and between 20.8% and 28.8% in pregnant women with two or more risk factors. Pathological deliveries (caesarian and dystocial) and macrosomias proved more frequent, though not significantly so, in pregnant women positive for GD compared to those who proved negative. The maternal 5 years follow up of women with previous GD showed 10% positivity for IGT and 14% positivity for diabetes.
Intensive treatment of a pregnant woman with GD, allows the achievement of results similar, in terms of maternal and fetal health, to those observable in non-diabetic pregnant women. GD moreover seems highly forseeable for the appearance of diabetes mellitus and it is therefore advisable, after pregnancy, to perform a long-term follow-up for preventive purposes.
[Show abstract][Hide abstract] ABSTRACT: Patient Education in the field of Diabetes Care has been centred for many years on the health care provider’s perspective. Recently more attention has been focused on the learner’s point of view, that is how does a person learn meaningfully. Most guidelines on the management of type 2 diabetes include dietary modification and physical activity goals, but it is important to consider only the type of interventions that can make a long-term difference. Several key models have reasonable evidence for their effectiveness: cognitive behavioral, motivational interview, trans-theoretical model based on the stages of change, behavior change counselling, social learning theory and empowerment, although not all of them have been successfully tested in diabetes care. There are three areas to be considered when looking at the core requirement of an effective lifestyle modification program: the first is that the program must be integrated in routine diabetes care. The second is the philosophical approach adopted by the health care professional. The third is how you do it, focusing on importance, confidence and competence. In order to have people develop the life skills required to prevent complications we must recognize that giving information is not only a pot filling exercise. Collaboration with the patient is essential in setting any education program and initially the view point must be considered. The model of behavior change is described and further concepts of theory and practice are explored, focusing on the concepts ’learning and taking control’, rather than on ’education and teaching’.