Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project. Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review Behavioural interventions for type 2 diabetes: an evidence-based analysis. Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients The ADDITION-Cambridge trial protocol: a cluster – randomised controlled trial of screening for type 2 diabetes and intensive treatment for screen-detected patients Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes Diabetes Self-Management Education: Miles to Go Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy The Diabetes Manual trial protocol – a cluster randomized controlled trial of a self-management intervention for type 2 diabetes [ISRCTN06315411] Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project): study protocol Effectiveness of self-management promotion educational program among diabetic patients based on health belief model Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Assessment of the function and effect of diabetes education programs in Taiwan. Community-based care for the management of type 2 diabetes: an evidence-based analysis. Nurse-led telecoaching of people with type 2 diabetes in primary care: rationale, design and baseline data of a randomized controlled trial Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country A Church-based Diabetes Self-management Education Program for African Americans With Type 2 Diabetes [Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings]. Therapeutic education among adults with type 2 diabetes: effects of a three-day intervention on perceived competence, self-management behaviours and glycaemic control Diabetes, diabetes treatment and breast cancer prognosis Self-efficacy, outcome expectations and self-care behaviour in people with type 2 diabetes in Taiwan. Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Family Interactions Among African Americans Diagnosed With Type 2 Diabetes Does self monitoring of blood glucose as opposed to urinalysis provide additional benefit in patients newly diagnosed with type 2 diabetes receiving structured education? The DESMOND SMBG randomised controlled trial protocol Physical Activity Reduces Risk of Premature Mortality in Patients With Type 1 Diabetes With and Without Kidney Disease Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention A Mobile App for the Self-Management of Type 1 Diabetes Among Adolescents: A Randomized Controlled Trial The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: study design and methodology. Psychosocial Outcomes of Telemedicine Case Management for Elderly Patients With Diabetes Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care. A mobile diabetes management and educational system for type-2 diabetics in Saudi Arabia (SAED). Effects of an Outpatient Diabetes Self-Management Education on Patients with Type 2 Diabetes in China: A Randomized Controlled Trial Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS) for Diabetes Impact of baseline patient characteristics on interventions to reduce diabetes distress: the role of personal conscientiousness and diabetes self-efficacy. Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study*. A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self-management among South Asians with diabetes in Manchester.
Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration 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 OBJECTIVE To examine demographic , socioeconomic , and biological risk factors for all-cause , cardiovascular , and noncardiovascular mortality in patients with type 2 diabetes over 8 years and to construct mortality prediction equations . RESEARCH DESIGN AND METHODS Beginning in 2000 , survey and medical record information was obtained from 8,334 participants in Translating Research Into Action for Diabetes ( TRIAD ) , a multicenter prospect i ve observational study of diabetes care in managed care . The National Death Index was search ed annually to obtain data on deaths over an 8-year follow-up period ( 2000–2007 ) . Predictors examined included age , sex , race , education , income , smoking , age at diagnosis of diabetes , duration and treatment of diabetes , BMI , complications , comorbidities , and medication use . RESULTS There were 1,616 ( 19 % ) deaths over the 8-year period . In the most parsimonious equation , the predictors of all-cause mortality included older age , male sex , white race , lower income , smoking , insulin treatment , nephropathy , history of dyslipidemia , higher LDL cholesterol , angina/myocardial infa rct ion/other coronary disease/coronary angioplasty/bypass , congestive heart failure , aspirin , β-blocker , and diuretic use , and higher Charlson Index . CONCLUSIONS Risk of death can be predicted in people with type 2 diabetes using simple demographic , socioeconomic , and biological risk factors with fair reliability . Such prediction equations are essential for computer simulation models of diabetes progression and may , with further validation , be useful for patient management Background The increasing prevalence of type 2 diabetes poses a major public health challenge . Population -based screening and early treatment for type 2 diabetes could reduce this growing burden . However , the benefits of such a strategy remain uncertain . Methods and design The ADDITION-Cambridge study aims to evaluate the effectiveness and cost-effectiveness of ( i ) a stepwise screening strategy for type 2 diabetes ; and ( ii ) intensive multifactorial treatment for people with screen-detected diabetes in primary care . 63 practice s in the East Anglia region participated . Three undertook the pilot study , 33 were allocated to three groups : no screening ( control ) , screening followed by intensive treatment ( IT ) and screening plus routine care ( RC ) in an unbalanced ( 1:3:3 ) r and omisation . The remaining 27 practice s were r and omly allocated to IT and RC . A risk score incorporating routine practice data was used to identify people aged 40–69 years at high-risk of undiagnosed diabetes . In the screening practice s , high-risk individuals were invited to take part in a stepwise screening programme . In the IT group , diabetes treatment is optimised through guidelines , target-led multifactorial treatment , audit , feedback , and academic detailing for practice teams , alongside provision of educational material s for newly diagnosed participants . Primary endpoints are modelled cardiovascular risk at one year , and cardiovascular mortality and morbidity at five years after diagnosis of diabetes . Secondary endpoints include all-cause mortality , development of renal and visual impairment , peripheral neuropathy , health service costs , self-reported quality of life , functional status and health utility . Impact of the screening programme at the population level is also assessed through measures of mortality , cardiovascular morbidity , health status and health service use among high-risk individuals . Discussion ADDITION-Cambridge is conducted in a defined high-risk group accessible through primary care . It addresses the feasibility of population -based screening for diabetes , as well as the benefits and costs of screening and intensive multifactorial treatment early in the disease trajectory . The intensive treatment algorithm is based on evidence from studies including individuals with clinical ly diagnosed diabetes and the education material s are informed by psychological theory . ADDITION-Cambridge will provide timely evidence concerning the benefits of early intensive treatment and will inform policy decisions concerning screening for type 2 diabetes . Trial registration Current Controlled trials IS RCT Patients in a low-income community health center with Type 2 diabetes ( N = 81 ) taking a one-day education workshop  as part of their diabetes medical management were r and omly assigned either to education alone or to a combination of education and acceptance and commitment therapy ( ACT ) . Both groups were taught how to manage their diabetes , but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings . Compared with patients who received education alone , after 3 months those in the ACT condition were more likely to use these coping strategies , to report better diabetes self-care , and to have glycated hemoglobin ( HbA-sub(1C ) ) values in the target range . Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA-sub(1C ) Background : Diabetes mellitus ( DM ) requires continuous medical care , patients ’ self-management , education , and adherence to prescribed medication to reduce the risk of long-term complications . The aim of this study was to assess the benefits of an education program on diabetes , patient self-management , adherence to medication , anxiety , depression and glycemic control in type 2 diabetics in Saudi Arabia . Material s and Methods : This was a prospect i ve study , conducted among 104 diabetic patients at a major tertiary hospital in Riyadh , Saudi Arabia , between May 2011 and October 2012 .  Education material s given to diabetic patients included pamphlets/h and outs written in Arabic , the national language . Special videotapes about DM were made and distributed to all participants . In addition , specific educational programs through the diabetes educators and one-on-one counseling sessions with the doctor were also arranged . Patients were interviewed using a structured interview schedule both during the baseline , and after 6 months of the program . The interview schedule included , socio-demographics , clinical characteristics , diabetes self-management , adherence to medication , anxiety , and depression . Glycemic control was considered poor , if hemoglobin A1c ( HbA1c ) was ≥ 7 % . Results : The mean age of the study population was 57.3 ± 14.4 years . Seventy one were males ( 68.3 % ) and 33 ( 31.7 % ) were females . After six months of the diabetes education program , there were significant improvements in patients ’ dietary plan ( P = 0.0001 ) , physical exercise ( P = 0.0001 ) , self-monitoring of blood glucose ( SMBG ) ( P = 0.0001 ) , HbA1c ( P = 0.04 ) , adherence to medication ( P = 0.007 ) , and depression ( P = 0.03 ) . Conclusions : Implementation of education programs on diabetes among type 2 diabetic patients is associated with better outcomes such as their dietary plan , physical exercise , SMBG , adherence to medication , HbA1c and depression This meta- analysis assessed how successfully Diabetes Self-Management Education ( DSME ) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels . We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in r and omized controlled trials . The training conditions result ed in significant reductions in A1c levels compared to control conditions . However , the impact of intervention was modest shifting of only 7.23 % more participants from diabetic to pre-diabetic or normal status , relative to the control condition . Most intervention participants did not achieve healthy A1c levels . Further , few DSME studies assessed long-term maintenance of A1c gains . Past trends suggest that gains are difficult to sustain over time . Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel . We suggest that DSME programs might do better by going beyond procedural interventions . Most DSME programs relied heavily on rules and procedures to guide decisions about diet , exercise , and weight loss . Future DSME may need to include cognitive self-monitoring , diagnosis , and planning skills to help patients detect anomalies , identify possible causes , generate corrective action , and avoid future barriers to maintaining healthy A1c levels . Finally , comprehensive descriptions of DSME programs would advance future efforts Background Mobile health apps for diabetes self-management have different functions . However , the efficacy and safety of each function are not well studied , and no classification is available for these functions . Objective The aims of this study were to ( 1 ) develop and vali date a taxonomy of apps for diabetes self-management , ( 2 ) investigate the glycemic efficacy of  mobile app-based interventions among adults with diabetes in a systematic review of r and omized controlled trials ( RCTs ) , and ( 3 ) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy . Methods We developed a 3-axis taxonomy with columns of clinical modules , rows of functional modules and cells of functions with risk assessment s. This taxonomy was vali date d by review ing and classifying commercially available diabetes apps . We search ed MEDLINE , EMBASE , the Cochrane Central Register of Controlled Trials , the Chinese Biomedical Literature Data base , and Clinical Trials.gov from January 2007 to May 2016 . We included RCTs of adult out patients with diabetes that compared using  mobile app-based interventions with usual care alone . The mean differences ( MDs ) in hemoglobin A1c ( HbA1c ) concentrations and risk ratios of adverse events were pooled using a r and om-effects meta- analysis . After taxonomic classification , we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions . Results Across 12 included trials involving 974 participants , using app-based interventions was associated with a clinical ly significant reduction of HbA1c ( MD 0.48 % , 95 % CI 0.19%-0.78 % ) without excess adverse events . Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes ( MD 0.67 % , 95 % CI 0.30%-1.03 % vs MD 0.37 % , 95 % CI –0.12%-0.86 % ) . Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction ( with complication prevention : MD 1.31 % , 95 % CI 0.66%-1.96 % vs without : MD 0.38 % , 95 % CI 0.09%-0.67 % ; intersubgroup P=.01 ) , as was having a structured display ( with structured display : MD 0.69 % , 95 % CI 0.32%-1.06 % vs without : MD 0.69 % , 95 % CI –0.18%-0.53 % ; intersubgroup P=.03 ) . However , having a clinical decision-making function was not associated with a larger HbA1c reduction ( with clinical decision making : MD 0.19 % , 95 % CI –0.24%-0.63 % vs without : MD 0.61 % , 95 % CI 0.27%-0.95 % ; intersubgroup P=.14 ) . Conclusions The use of mobile app-based interventions yields a clinical ly significant HbA1c reduction among adult out patients with diabetes , especially among those with type 2 diabetes . Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps Background The Diabetes Manual is a type 2 diabetes self-management programme based upon the clinical ly effective ' Heart Manual ' . The 12 week programme is a complex intervention theoretically underpinned by self-efficacy theory . It is a one to one intervention meeting United Kingdom requirements for structured diabetes-education and is delivered within routine primary care . Methods / design In a two-group cluster r and omized controlled trial , GP practice s are allocated by computer minimisation to an intervention group or a six-month deferred intervention group . We aim to recruit 250 participants from 50 practice s across central Engl and . Eligibility criteria are adults able to undertake the programme with type 2 diabetes , not taking insulin , with HbA1c over 8 % ( first 12 months ) and following an agreed protocol change over 7 % ( months 13 to 18 ) . Following r and omisation , intervention nurses receive two-day training and delivered the Diabetes Manual programme to participants . Deferred intervention nurses receive the training following six-month follow-up . Primary outcome is HbA1c with total and HDL cholesterol ; blood pressure , body mass index ; self-efficacy and quality of life as additional outcomes . Primary analysis is between-group HbA1c differences at 6 months powered to give 80 % power to detect a difference in HbA1c of 0.6 % . A 12 month cohort analysis will assess maintenance of effect and assess relationship between self-efficacy and outcomes , and a qualitative study is running alongside . Discussion This trial incorporates educational and psychological diabetes interventions into a single programme and assesses both clinical and psychosocial outcomes . The trial will increase our underst and ing of intervention transferability between conditions , those diabetes related health behaviours that are more or less susceptible to change through efficacy enhancing mechanisms and how this impacts on clinical outcomes Background An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030 . For the year 2010 , it is estimated that 3.96 million excess deaths in the age group 20 - 79 years are attributable to diabetes around the world . Self-management is recognised as an integral part of diabetes care . This paper describes the protocol of a r and omised controlled trial of an automated interactive telephone system aim ing to improve the uptake and maintenance of essential diabetes self-management behaviours . Methods / Design A total of 340 individuals with type 2 diabetes will be r and omised , either to the routine care arm , or to the intervention arm in which participants receive the  Telephone-Linked Care ( TLC ) Diabetes program in addition to their routine care . The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months . They receive the study h and book and a glucose meter linked to a data uploading device . The TLC system consists of a computer with software design ed to provide monitoring , tailored feedback and education on key aspects of diabetes self-management , based on answers voiced or entered during the current or previous conversations . Data collection is conducted at baseline ( Time 1 ) , 6-month follow-up ( Time 2 ) , and 12-month follow-up ( Time 3 ) . The primary outcomes are glycaemic control ( HbA1c ) and quality of life ( Short Form-36 Health Survey version 2 ) . Secondary outcomes include anthropometric measures , blood pressure , blood lipid profile , psychosocial measures as well as measures of diet , physical activity , blood glucose monitoring , foot care and medication taking . Information on utilisation of healthcare services including hospital admissions , medication use and costs is collected . An economic evaluation is also planned . Discussion Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes . Furthermore , the study will provide insight into the potential for more widespread uptake of automated telehealth interventions , globally . Trial Registration Introduction : Diabetes is a chronic disease ; it can cause serious complications . Diabetes self-management is essential for prevention of disease complications . This study was conducted to evaluate self-management promotion educational program intervention efficiency among diabetic patients in Iran and health belief model ( HBM ) was applied as a theoretical framework . Material s and Methods : Overall , 120 Type 2 diabetic patients referred to rural health centers in Gachsaran , Iran participated in this study as r and omly divided into intervention and control group . This was a longitudinal r and omized pre- and post-test series control group design panel study to implement a behavior modification based intervention to promotion self-management among diabetic patients . Cross-tabulation and t-test by using SPSS statistical package , version 16 was used for the statistical analysis . Results : Mean age was 55.07 years ( SD = 9.94 , range : 30 - 70 ) . Our result shows significant improvements in average response for susceptibility , severity , benefit and self-management among intervention group . Additionally , after intervention , average response of the barrier to self-management was decreased among intervention group . Conclusion : Our result showed education program based on HBM was improve of self-management and seems implementing these programs can be effective in the and prevention of diabetes complications AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs A multi-center prospect i ve study was conducted to assess the function and impact of diabetic education programs on diabetic control . A total of 208 subjects with type 2 diabetes were recruited .  Diabetes self-care , assessed by question naire , was evaluated before , and 4 months after attending a diabetes education course . A total of 121 subjects who received advanced diabetes education courses  were design ated as the experimental group . A second group of 87 cases receiving a basic course  served as controls . In addition to basic knowledge , the advanced education programs included  dietary control , blood glucose monitoring , management of hypoglycemia , medication compliance , foot care and exercise . Diabetes self-care techniques were significantly improved in the experimental group . The overall score for diabetes self-care techniques improved in both groups at the 4th month over baseline values . The change was significant with the controls ' ( P < 0.001 ) . Multiple regression analysis confirmed the intensity of diabetic education was the only significant variable correlated with the decrease of fasting blood glucose and systolic blood pressure . In conclusion , integrated and intensive diabetes education program in diabetes education centers provides an effective method for improving diabetes self-care techniques and metabolic outcome 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 the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care . CLINICAL NEED TARGET POPULATION AND CONDITION Diabetes ( i.e. diabetes mellitus ) is a highly prevalent chronic metabolic disorder that interferes with the body 's ability to produce or effectively use insulin . The majority ( 90 % ) of diabetes patients have type 2 diabetes . ( 1 ) Based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics . While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines , factors associated with glycemic control are less well studied , one of which is the provider(s ) of care . Multidisciplinary approaches to care may be particularly important for diabetes management . According guidelines from the Canadian Diabetes Association ( CDA ) , the diabetes health care team should be multi- and interdisciplinary . Presently in Ontario , the core diabetes health care team consists of at least a family physician and /or diabetes specialist , and diabetes educators ( registered nurse and registered dietician ) . Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management . Several systematic review s and meta-analyses have examined multidisciplinary care programs , but these have either been limited to a specific component of multidisciplinary care ( e.g. intensified education programs ) , or were conducted as part of a broader disease management program , of which not all were multidisciplinary in nature . Most review s also do not clearly define the intervention(s ) of interest , making the evaluation of such multidisciplinary community programs challenging . EVIDENCE -BASED ANALYSIS METHODS RESEARCH QUESTIONS What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse , registered dietician and physician ( primary care and /or specialist ) for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 2 ] INCLUSION CRITERIA English language full-reportsPublished between January 1 , 2000 and September 28 , 2008R and omized controlled trials ( RCTs ) , systematic review s and meta-analysesType 2 diabetic adult population ( ≥18 years of age)Total sample size ≥30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines ( of which at least one must be a specialist in diabetes ) with integrated communication between the care providers . Compared to usual care ( defined as health care provision by non-specialist(s ) in diabetes , such as primary care providers ; may include referral to other health care professionals/services as necessary)≥6 months follow-up EXCLUSION CRITERIA Studies where discrete results on diabetes can not be abstract edPredominantly home-based interventions Inpatient-based interventions OUTCOMES OF INTEREST The primary outcomes for this review were glycosylated hemoglobin ( rHbA1c ) levels and systolic blood pressure ( SBP ) . SEARCH STRATEGY A literature search was performed on September 28 , 2008 using 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 1 , 2000 and September 28 , 2008 . Abstract s were review ed by a single review er and , for those studies meeting the eligibility criteria , full-text articles were obtained . Reference lists were also examined for any additional relevant studies not identified through the search . Articles with unknown eligibility were review ed with a second clinical epidemiologist , then a group of epidemiologists until consensus was established . The quality of evidence was assessed as high , moderate , low or very low according to GRADE methodology . Given the high clinical heterogeneity of the articles that met the inclusion criteria , specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario , models of care that were commonly reported in the literature , as well as suggestions from an Expert Advisory Panel Meeting held on January 21 , 2009 . SUMMARY OF FINDINGS The initial search yielded 2,116 unique citations , from which 22 RCTs trials and nine systematic review s published were identified as meeting the eligibility criteria . Of these , five studies focused on care provided by at least a nurse , dietician , and physician ( primary care and /or specialist ) model of care ( Model 1 ; see Table ES 1 ) , while three studies focused on care provided by at least a pharmacist and primary care physician ( Model 2 ; see Table ES 2 ) . Based on moderate quality evidence , specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in HbA1c of 1.0 % compared with usual care . The effects of this model on SBP , however , are uncertain compared with usual care , based on very-low quality evidence . Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in both HbA1c of 1.05 % ( based on high quality evidence ) and SBP of 7.13 mm Hg ( based on moderate quality evidence ) compared to usual care . For both models , the evidence does not suggest a preferred setting of care delivery ( i.e. , primary care vs. hospital outpatient clinic vs. community clinic ) . Table ES1 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.00 [ -1.27 , -0.73]4 % (p=0.37)Moderate- quality Subgroup : Moderate-to-High Quality -0.91 [ -1.19 , -0.62]0 % (p=0.74)Systolic Blood Pressure ( mm Hg)-2.04 [ -13.80 , 9.72]89 % (p=0.002)Very-low quality * Mean change from baseline to follow-up between intervention and control groupsTable ES2 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.05 [ -1.57 , -0.52]0 % (p=0.75)High- quality Systolic Blood Pressure ( mm Hg)-7.13 [ -11.78 , -2.48]46 % (p=0.17)Moderate quality * Mean change from baseline to follow-up between intervention and control groups Background Despite the efforts of the healthcare community to improve the quality of diabetes care , about 50 % of people with type 2 diabetes do not reach their treatment targets , increasing the risk of future micro- and macro-vascular complications . Diabetes self-management education has been shown to contribute to better disease control . However , it is not known which strategies involving educational programs are cost-effective . Telehealth applications might support chronic disease management . Transferability of successful distant patient self-management support programs to the Belgian setting needs to be confirmed by studies of a high method ological quality . “ The COACH Program ” was developed in Australia as target driven educational telephone delivered intervention to support people with different chronic conditions . It proved to be effective in patients with coronary heart disease after hospitalization . Clinical and cost-effectiveness of The COACH Program in people with type 2 diabetes in Belgium needs to be assessed . Methods / Design R and omized controlled trial in patients with type 2 diabetes . Patients were selected based on their medication consumption data and were recruited by their sickness fund . They were r and omized to receive either usual care plus “ The COACH Program ” or usual care alone . The study will assess the difference in outcomes between groups . The primary outcome measure is the level of HbA1c . The secondary outcomes are : Total Cholesterol , LDL-Cholesterol , HDL-Cholesterol , Triglycerides , Blood Pressure , body mass index , smoking status ; proportion of people at target for HbA1c , LDL-Cholesterol and Blood Pressure ; self-perceived health status , diabetes-specific emotional distress and satisfaction with diabetes care . The follow-up period is 18 months . Within-trial and modeled cost-utility analyses , to project effects over life-time horizon beyond the trial duration , will be undertaken from the perspective of the health care system if the intervention is effective . Discussion The study will enhance our underst and ing of the potential of telehealth in diabetes management in Belgium . Research on the clinical effectiveness and the cost-effectiveness is essential to support policy makers in future reimbursement and implementation decisions . Trial registration Belgian number : B322201213625 . Clinical Trials.gov Identifier : Background Type 2 diabetes mellitus ( DM2 ) is a disease with high prevalence and significant impact in terms of mortality and morbidity . The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management . The Spanish Diabetes Self-Management Program ( SDSMP ) has proven to be effective in other setting s. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care setting s within the Basque Health Service – Osakidetza ( Spain ) . Method / Design This is a r and omised clinical trial in which patients diagnosed with DM2 , 18–79 years of age , from four health regions within the Basque Health Service will be r and omised into two groups : an intervention group , who will follow the SDSMP , and a control group , who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region . The intervention consists of 2,5 hour-group sessions once a week for six weeks . The sessions cover target setting and problem solving techniques , promotion of physical exercise , basic knowledge of nutrition , proper use of medication , effective communication with relatives and health professionals , and basic knowledge about DM2 and its complications . This content is complemented by educational material : books , leaflets and CDs . The primary outcome measure will be the change in glycated haemoglobin ( HbA1c ) , and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables , cardiovascular risk , quality of life , self-efficacy , number of consultations and drug prescriptions . The results will be analysed 6 , 12 and 24 months after the intervention . Discussion If the intervention were to be effective , the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases . Trial registration Clinical Trials.gov identifier Introduction Diabetes self-management education interventions in community gathering places have been moderately effective , but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes . This paper describes a church-based diabetes self-management education intervention for African Americans , a r and omized controlled trial to evaluate the intervention , and baseline characteristics of study participants . Methods A New DAWN : Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina . Each church recruited congregants with type 2 diabetes and design ated a diabetes advisor , or peer counselor , to be part of the intervention team . Participants were enrolled at each church and r and omized as a unit to either the special intervention or the minimal intervention . The special intervention included one individual counseling visit , twelve group sessions , three postcard messages from the participant 's diabetes care provider , and twelve monthly telephone calls from a diabetes advisor . Baseline data included measures of weight , hemoglobin A1c , blood pressure , physical activity , dietary and diabetes self-care practice s , and psychosocial factors . The study to evaluate the intervention ( from enrollment visit to last follow-up ) began in February 2001 and ended in August 2003 . Results Twenty-four churches ( with 201 total participants ) were r and omized . Sixty-four percent of the participants were women . On average , the participants were aged 59 years and sedentary . They had an average of 12 years of education , had been diagnosed with diabetes for 9 years , had a body mass index of 35 , had a  hemoglobin  A1c level of 7.8 % , and had a reported dietary intake of 39 % of calories from fat . Conclusion A New DAWN is a culturally sensitive , church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a r and omized controlled trial . The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority population s and help to inform the selection of approaches to improve diabetes care in this population UNLABELLED This review should be cited as : Renders CM , Valk GD , Griffin S. Wagner EH , Eijk JThM van , Assendelft WJJ . Interventions to improve the management of  diabetes mellitus  in primary care , outpatient and community setting s ( Cochrane Review ) . In : The Cochrane Library , Issue 2 , 2001 . Oxford : Up date Software . A substantive amendment to this systematic review was last made on 29 June 2000 . Cochrane review s are regularly checked and up date d if necessary . BACKGROUND Diabetes is a common chronic disease that is increasingly managed in primary care . Different systems have been proposed to manage diabetes care . OBJECTIVES To assess the effects of different interventions , targeted at health professionals or the structure in which they deliver care , on the management of patients with diabetes in primary care , outpatient and community setting s. SEARCH STRATEGY We search ed the Cochrane Effective Practice and Organisation of Care Group specialised register , the Cochrane Controlled Trials Register ( Issue 4 1999 ) , MEDLINE ( 1966 - 1999 ) , EMBASE ( 1980 - 1999 ) , Cinahl ( 1982 - 1999 ) , and reference lists of articles . SELECTION CRITERIA R and omised trials ( RCTs ) , controlled clinical trials ( CCTs ) , controlled before and after studies ( CBAs ) and interrupted time series ( ITS ) analyses of professional , financial and organisational strategies aim ed at improving care for people with Type 1 or Type 2 diabetes . The participants were health care professionals , including physicians , nurses and pharmacists . The outcomes included objective ly measured health professional performance or patient outcomes , and self-report measures with known validity and reliability . DATA COLLECTION AND ANALYSIS Two review ers independently extracted data and assessed study quality . MAIN RESULTS Forty-one studies were included involving more than 200 practice s and 48,000 patients . Twenty-seven studies were RCTs , 12 were CBAs , and two were ITS . The studies were heterogeneous in terms of interventions , participants , setting s and outcomes . The method ological quality of the studies was often poor . In all studies the intervention strategy was multifaceted . In 12 studies the interventions were targeted at health professionals , in nine they were targeted at the organization of care , and 20 studies targeted both . In 15 studies patient education was added to the professional and organisational interventions . A combination of professional interventions improved process outcomes . The effect on patient outcomes remained less clear as these were rarely assessed . Arrangements for follow-up ( organisational intervention ) also showed a favourable effect on process outcomes . Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients ' health outcomes . REVIEW ERS ' CONCLUSION : Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes .  Organisational interventions that improve regular prompted recall and review of patients  ( central computerised tracking systems or nurses who regularly contact the patient ) can also improve diabetes management . The addition of patient-oriented interventions can lead to improved patient health outcomes . Nurses can play an important role in patient-oriented interventions , through patient education or facilitating adherence to treatment The purpose of this study was to evaluate the impact of a three-day therapeutic education programme on perceived competence , self-management behaviours ( i.e. physical activity , diet and medication ) and glycaemic control among adults with type 2 diabetes . A total of 120 participants were included in this r and omized , wait list control group trial . The results confirm that therapeutic education may be a powerful healthcare intervention to improve lifestyle and health status of people with type 2 diabetes . We observed that the education programme used in this study generated positive changes in glycaemic control and adherence to physical activity and diet after three months follow-up . Furthermore , the intervention positively impacted participants ’ perceived competence towards physical activity and diet . The latter finding is of particular importance , given that perceived competence has been found to be involved in long-term adherence to self-management behaviours The objectives of this study are to assess the impact of pre-existing diabetes and diabetes treatment on breast cancer prognosis . 8,108 women with central ly confirmed invasive breast cancer in the Women ’s Health Initiative diagnosed between 1998 and 2013 were followed through the date of death or September 20 , 2013 . Information on diabetes and diabetes therapy were obtained via self-report and face-to-face review of current medication containers , respectively . Cox proportional hazard regression was used to estimate adjusted relative hazard ratios for overall mortality . The proportional subdistribution hazard model was used to estimate hazard ratios for breast cancer-specific mortality . Compared with women without diabetes , women with diabetes had significantly increased risk of overall mortality ( HR 1.26 95 % CI 1.06–1.48 ) , especially among those who took insulin or had longer duration of diabetes . However , diabetes was not associated with increased risk of breast cancer-specific mortality , regardless of type of treatment and duration of diabetes , despite the significant association of diabetes with unfavorable tumor characteristics . Our large prospect i ve cohort study provides additional evidence that pre-existing diabetes increases risk of total mortality among women with breast cancer . The increased total mortality associated with diabetes was mainly driven by increased risk of dying from diseases other than breast cancer . Thus , the continuum of care for breast cancer patients with diabetes should include careful attention to CVD risk factors and other non-cancer conditions AIMS To explore differences in self-care behaviour according to demographic and illness characteristics ; and relationships among self-care behaviour and demographic and illness characteristics , efficacy expectations and outcome expectations of people with type 2 diabetes in Taiwan . BACKGROUND Most people with diabetes do not control their disease appropriately in Taiwan . Enhanced self-efficacy towards managing diseases can be an effective way of improving disease control as proposed by the self-efficacy model which provides a useful framework for underst and ing adherence to self-care behaviours . DESIGN AND METHODS The sample comprised 145 patients with type 2 diabetes aged 30 years or more from diabetes outpatient clinics in Taipei . Data were collected using a self-administered question naire for this study . One-way anova , t-tests , Pearson product moment correlation and hierarchical regression were analysed for the study . RESULTS Significant differences were found : between self-care behaviour and complications ( t = -2.52 , p < 0.01 ) and patient education ( t = -1.96 , p < 0.05 ) . Self-care behaviour was significantly and positively correlated with duration of diabetes ( r = 0.36 , p < 0.01 ) , efficacy expectations ( r = 0.54 , p < 0.01 ) and outcome expectations ( r = 0.44 , p < 0.01 ) . A total of 39.1 % of variance in self-care behaviour can be explained by duration of diabetes , efficacy expectations and outcome expectations . CONCLUSIONS Findings support the use of the self-efficacy model as a framework for underst and ing adherence to self-care behaviour . RELEVANCE TO CLINICAL PRACTICE Using self-efficacy theory when design ing patient education interventions for people with type 2 diabetes will enhance self-management routines and assist in reducing major complications in the future Background : The benefits of self-monitoring blood glucose levels are unclear in patients with type 2 diabetes mellitus who do not use insulin , but there are considerable costs . We sought to determine the cost effectiveness of self-monitoring for patients with type 2 diabetes not using insulin . Methods : We performed an incremental cost-effectiveness analysis of the self-monitoring of blood glucose in adults with type 2 diabetes not taking insulin . We used the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) model to forecast diabetes-related complications , corresponding quality -adjusted life years and costs . Clinical data were obtained from a systematic review comparing self-monitoring with no self-monitoring .  Costs and utility decrements were derived from published sources . We performed sensitivity analyses to examine the robustness of the results . Results : Based on a clinical ly modest reduction in hemoglobin A1C of 0.25 % ( 95 % confidence interval 0.15–0.36 ) estimated from the systematic review , the UKPDS model predicted that self-monitoring performed 7 or more times per week reduced the lifetime incidence of diabetes-related complications compared with no self-monitoring , albeit at a higher cost ( incremental cost per quality -adjusted life year $ 113 643 ) . The results were largely unchanged in the sensitivity analysis , although the incremental cost per quality -adjusted life year fell within widely cited cost-effectiveness thresholds when testing frequency or the price per test strip was substantially reduced from the current levels . Interpretation : For most patients with type 2 diabetes not using insulin , use of blood glucose test strips for frequent self-monitoring ( ≥ 7 times per week ) is unlikely to represent efficient use of finite health care re sources , although periodic testing ( e.g. , 1 or 2 times per week ) may be cost-effective . Reduced test strip price would likely also improve cost-effectiveness In recent years , great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes . Studies have reported that nurses , compared to other healthcare professionals , are more likely to promote preventive healthcare seeking behaviors . The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin . A two-arm parallel-group r and omized controlled trial with the blinded outcome assessors was design ed . One hundred forty-two adults with type 2 diabetes were r and omized to receive either usual diabetes care ( control group ) or usual care plus a nurse-led diabetes self-management education ( intervention group ) . Duration of the intervention was 12 weeks . The primary outcome was glycosylated hemoglobin ( HbA1c values ) . Secondary outcomes were changes in blood pressure , body weight , lipid profiles , self-efficacy ( efficacy expectation and outcome expectation ) , self-management behaviors , quality of life , social support , and depression . Outcome measures were assessed at baseline and at 12-week and 24-week postr and omizations . Patients in the intervention group showed significant improvement in HbA1c , blood pressure , body weight , efficacy expectation , outcome expectation , and diabetes self-management behaviors . The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial result ing in sustained improvements in clinical , lifestyle , and psychosocial outcomes . This trial is registered with I RCT 2016062528627N1 Background Self-management support for people with type 2 diabetes is essential in diabetes care . Thus , mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management . Objectives The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application ( FTA ) diabetes diary with or without health counseling improved glycated hemoglobin ( HbA1c ) levels , self-management , behavioral change , and health-related quality of life , and to describe the sociodemographic , clinical , and lifestyle characteristics of the participants after 4 months . Methods A 3-armed r and omized controlled trial was conducted in Norway during 2011 - 2013 . In the 2 intervention groups , participants were given a mobile phone for 1 year , which provided access to the FTA diary , a self-help tool that recorded 5 elements : blood glucose , food habits , physical activity , personal goal setting , and a look-up system for diabetes information . One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline . Both intervention groups and the  control group were provided usual care according to the national guidelines . Adults with type 2 diabetes and HbA1c ≥7.1 % were included ( N=151 ) . There were 3 assessment points : baseline , 4 months , and 1 year . We report the short-term findings after 4 months . HbA1c was the primary outcome and the secondary outcomes were self-management ( Health Education Impact Question naire , heiQ ) , behavioral change ( diet and physical activity ) , and health-related quality of life ( SF-36 question naire ) . The data were analyzed using univariate methods ( ANOVA ) , multivariate linear , and logistic regression . Results Data were analyzed from 124 individuals ( attrition rate was 18 % ) . The groups were well balanced at baseline . There were no differences in HbA1c between groups after 4 months , but there was a decline in all groups . There were changes in self-management measured using the health service navigation item in the heiQ , with improvements in the FTA group compared to the control group ( P=.01 ) and in the FTA with health counseling group compared with both other groups ( P=.04 ) . This may indicate an improvement in the ability of patients to communicate health needs to their health care providers . Furthermore , the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group ( P=.02 ) . There were no significant changes in any of the domains of the SF-36 . Conclusions The primary outcome , HbA1c , did not differ between groups after 4 months . Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes .  Diabetes self-management education ( DSME ) is an essential component of effective self-care . Yet , little research has compared the effect of mindful eating to DSME-based treatment . This study compared the impact of these two interventions in adults with type 2 diabetes mellitus . A prospect i ve r and omized controlled trial with two parallel interventions was used . Participants included adults age 35 to 65 years with type 2 diabetes mellitus for 1 year or more , body mass index ( BMI ) of 27 or more , and hemoglobin A1c ( HbA1c ) of 7 % or more who were r and omly assigned to a 3-month mindful eating ( MB-EAT-D ; n=27 ) or Smart Choices ( SC ) DSME-based ( n=25 ) intervention . Follow-up occurred 3 months after intervention completion . Dietary intake , physical activity , weight , HbA1c and fasting plasma glucose , and fasting insulin were assessed using repeated measures analysis of variance with contrast analysis . There was no significant difference between groups in the change in weight or glycemia at study end . Significant difference occurred between groups in the change in dietary intake/1,000 kcal of trans fats , total fiber , and sugars ( all P<0.05 ) . Mean ( ± st and ard error ) reduction in weight ( -2.92 ± 0.54 kg for SC vs -1.53 ± 0.54 kg for MB-EAT-D ) and HbA1c ( -0.67 ± 0.24 % for SC and -0.83 ± 0.24 % for MB-EAT-D ) were significant ( P<0.01 ) . Significant reduction in energy intake and glycemic load occurred ( all P<0.0001 ) for both groups . Training in mindful eating and diabetes self-management  facilitate improvement in dietary intake , modest weight loss , and glycemic control . The availability of effective treatments gives patients with diabetes choices in meeting their self-care needs Purpose The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes  and their willingness to be involved in a culturally tailored program . Methods This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual st and ard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes . Twenty-one participants were r and omly assigned to an individual education group or a culturally tailored intervention group . Family members/ peers ( n = 6 ) attended invited group sessions to obtain information about diabetes and family/peer support . The facilitator of the invited group sessions used a guide to help with group discussion s. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide , thus identifying recurring themes within the participants ' responses . Results The data revealed that family and friends made a difference in the diabetes management of individuals with dia- betes . Although family and friends may have been helpful at times , they also created moments of problems and an environment that made it more difficult to care for diabetes . The data also revealed that diabetes is hard to manage and control . Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging . Conclusions These findings confirm that family and peers greatly influence diabetes management among rural African Americans . The study 's results will help health care providers underst and the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes , particularly within rural African American communities where re sources are limited Background The benefit of self-monitoring of blood glucose ( SMBG ) in people with type 2 diabetes on diet or oral agents other than sulphonylureas  remains uncertain . Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results . A recent systematic review concluded that SMBG was not cost-effective . However , what was unclear was whether a cheaper method of self-monitoring ( such as urine glucose monitoring ) could produce comparable benefit and patient acceptability for less cost . Methods / Design The DESMOND SMBG trial is comparing two monitoring strategies ( blood glucose monitoring and urine testing ) over 18 months when incorporated into a comprehensive self-management structured education programme . It is a multi-site cluster r and omised controlled trial , conducted across 8 sites ( 7 primary care trusts ) in Engl and , UK involving individuals with newly diagnosed Type 2 diabetes . The trial has 80 % power to demonstrate equivalence in mean HbA1c ( the primary end-point ) at 18 months of within ± 0.5 % assuming 20 % drop out and 20 % non-consent . Secondary end-points include blood pressure , lipids , body weight and psychosocial measures as well as a qualitative sub- study . Practice s were r and omised to one of two arms : participants attend a  DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose . The programme is delivered by accredited educators who received specific training about equipoise . Biomedical data are collected and psychosocial scales completed at baseline , and 6 , 12 , and 18 months post programme . Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring . Discussion The DESMOND SMBG trial is design ed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes . Strengths include a setting in primary care , a cluster design , a health economic analysis , a comparison of different methods of monitoring while controlling for other components of training within the context of a quality assured structured education programme and a qualitative sub- study .Trial registration IS RCT N : IS RCT N95696668 OBJECTIVE The aims of the study were to assess how baseline  leisure-time physical activity ( LTPA )  and its exercise components intensity , duration , and frequency are associated with all-cause and cardiovascular mortality in patients with type 1 diabetes 1 ) overall , 2 ) stratified by presence or absence of chronic kidney disease ( CKD ) , and 3 ) stratified by sex . RESEARCH DESIGN AND METHODS The study design was prospect i ve and observational and included 2,639 patients with type 1 diabetes from the ongoing nationwide multicenter Finnish Diabetic Nephropathy ( FinnDiane ) Study . Mean follow-up time was 11.4 ± 3.5 years . LTPA was assessed by using a vali date d self-report question naire .  Three hundred ten patients ( 11.7 % ) had CKD defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2 . RESULTS During follow-up , 270 deaths occurred . LTPA and all its components were associated with all-cause mortality , even after adjustment for the potential confounders sex , diabetic nephropathy , duration of diabetes , age at onset of diabetes , systolic blood pressure , triglycerides , BMI , and HbA1c . Only exercise intensity was associated with cardiovascular mortality after adjustment for the confounders . Of the patients with CKD , 127 died during follow-up . The total amount of LTPA and exercise frequency were independently associated with lower risk of all-cause mortality when adjusted for covariates . CONCLUSIONS Exercise is associated with a lower risk of premature all-cause and cardiovascular mortality in patients with type 1 diabetes . This study also demonstrates that physical activity is associated with a lower risk of mortality in patients with type 1 diabetes and CKD Objective : To assess quality of life ( QoL ) and glycemic control in adolescents with type 1 diabetes and to investigate the impact of an educational program . Methods : A quasiexperimental study with nonr and omized experimental and control groups was conducted in which a total of 503 adolescents with type 1 diabetes completed a question naire using the Diabetes Quality of Life Instrument for Youth . Adolescents were then assigned to experimental and control groups . The experimental group was subjected to four 120-minute sessions of an educational program over a period of 4 months . Extracted medical chart data included the duration of diabetes , insulin dosage , and most recent hemoglobin A1c levels . Analysis of covariance was used to detect the impact of intervention . Results : The overall mean QoL score ( % ) was 76.51 ± 9.79 , with good QoL in 38 % of all adolescents . Poorer QoL was significantly associated with older age ( P < 0.001 ) , more hospital admissions in the last 6 months ( P = 0.006 ) , higher levels of depression ( P < 0.001 ) , poor self-esteem ( P < 0.001 ) , and poor self-efficacy ( P < 0.001 ) . There was significant deterioration in all domains of QoL in the experimental group after intervention . However , this deterioration was significantly less severe than in the control group . Between-group effects on total knowledge , adherence to exercise , glucose monitoring , treatment , self-efficacy , family contribution to management , glycemic control , and satisfaction with life were significantly in favor of the experimental group . Conclusion : Education intervention for adolescents with type 1 diabetes could be a safeguard against possible deterioration in QoL and glycemic control over time Background While optimal blood glucose control is known to reduce the long-term complications associated with type 1 diabetes mellitus , adolescents often struggle to achieve their blood glucose targets . However , their strong propensity toward technology presents a unique opportunity for the delivery of novel self-management interventions . To support type 1 diabetes self-management in this population , we developed the diabetes self-management app bant , which included wireless blood glucose reading transfer , out-of-range blood glucose trend alerts , coaching around out-of-range trend causes and fixes , and a point-based incentive system . Objective The primary objective was to evaluate bant ’s effect on hemoglobin A1c ( HbA1c ) through a r and omized controlled trial ( RCT ) . Secondary measures ( eg , self-monitoring of blood glucose [ SMBG ] ) were also collected to assess bant ’s impact on the self-management behaviors of adolescents with type 1 diabetes . Methods We enrolled 92 adolescents into a 12-month RCT , with 46 receiving usual care and 46 receiving usual care plus bant .  Clinical outcome data were collected at quarterly research visits via vali date d tools , electronic chart review , glucometer downloads , and semistructured interviews . App satisfaction was assessed at 6 and 12 months , and at trial end , users ranked bant components based on perceived usefulness . Mobile analytics captured frequency of blood glucose uploads , which were used to categorize participants into high , moderate , low , or very low engagement levels . Results Linear mixed models showed no changes in primary and secondary clinical outcomes . However , exploratory regression analysis demonstrated a statistically significant association between increased SMBG and improved HbA1c in the intervention group . For a subgroup of bant users taking SMBG ≥5 daily , there was a significant improvement in HbA1c of 0.58 % ( P=.02 ) , while the parallel subgroup in the control arm experienced no significant change in HbA1c ( decrease of 0.06 % , P=.84 ) . Although app usage did diminish over the trial , on average , 35 % ( 16/46 participants ) were classified as moderately or highly engaged ( uploaded SMBG ≥3 days a week ) over the 12 months . Conclusion Although primary analysis of clinical outcomes did not demonstrate differences between the bant and control groups , exploratory analysis suggested that bant may positively impact the use of SMBG data and glycemic control among youth . The next generation of bant will aim to remove barriers to use , such as deploying the app directly to personal devices instead of secondary research phones , and to explore the utility of integrating bant into routine clinical care to facilitate more frequent feedback . Future evaluations of mHealth apps should consider more robust research tools ( eg , Research Kit ) and alternative RCT study design s to enable more rapid and iterative evaluations , better suited to the nature of rapidly evolving consumer technology . Trial Registration Clinical Trials.gov NCT01899274 ; https:// clinical trials.gov/ct2/show/NCT01899274 ( Archived by WebCite at http://www.webcitation.org/6qWrqF1yw BACKGROUND Cardiovascular disease ( CVD ) and diabetes account for over one third of the mortality difference between African Americans and white patients . The increased CVD risk in African Americans is due in large part to the clustering of multiple CVD risk factors . OBJECTIVES The current study is aim ed at improving CVD outcomes in African-American adults with diabetes by addressing the modifiable risk factors of systolic blood pressure , glycosylated hemoglobin , and low-density lipoprotein cholesterol . METHODS A sample of African American patients with diabetes ( N = 400 ) will receive written education material at baseline and be r and omized to one of 2 arms : ( 1 ) usual primary care or ( 2 ) nurse-administered disease-management intervention combining patient self-management support and provider medication management . The nurse administered intervention is delivered monthly over the telephone . The nurses also interacts with the primary care providers at 3 , 6 , and 9 months to provide concise patient up date s and facilitate changes in medical management . All patients are followed for 12 months after enrollment . The primary outcomes are change in glycosylated hemoglobin , systolic blood pressure , and low-density lipoprotein cholesterol over 12-months . Secondary outcomes include change in overall cardiovascular risk , aspirin use , and health behaviors . CONCLUSION Given the continued racial disparities in CVD , the proposed study could result in significant contributions to cardiovascular risk reduction in African-American patients Diabetes case management ( DCM ) may improve medical outcomes ( 1,2 ) . Case managers coordinate care and often provide a mix of interventions , e.g. , telephone outreach , education , reminders . However , the efficacy of DCM is unclear . Three systematic review s lend only limited support for the efficacy of DCM for improving glycemic control but none for lipid , weight , or blood pressure benefits ( 3–5 ) . DCM studies typically target biomedical outcomes and ignore potential psychosocial effects . Yet , psychosocial variables ( e.g. , depression , anxiety , social support ) relate to hyperglycemia , complications , adherence , and quality of life ( 6–11 ) . Thus , a positive impact of DCM on these factors is important . Two studies did assess psychosocial outcomes of DCM and found improved self-efficacy and satisfaction ( cluster visit ) ( 12 ) and quality of life ( dietitian-led DCM group ) ( 13 ) . Because barriers ( e.g. , distance , weather ) limit DCM access , telemedicine can be used . A review of telemedicine versus face-to-face trials concluded that , while feasible and acceptable , there is little evidence that telemedicine has clinical benefits ( 14 ) . Our team published results of a trial of telemedicine DCM versus usual care for elderly diabetic patients ( 15 ) . The intervention result ed in significant improvements in glycemic control , blood pressure , and total and LDL cholesterol ( 16 ) . The purpose of the Informatics for Diabetes Education and Telemedicine ( IDEATel ) project , funded by the Centers for Medicare and Medicaid Services , is to evaluate the feasibility and effectiveness of telemedicine with a diverse , medically underserved , elderly diabetic sample . The purpose of this study is to assess the impact of the IDEATel intervention on secondary psychosocial outcomes . A detailed description of the IDEATel study design has been previously reported ( 15,16 ) . Medicare recipients were recruited if they were aged ≥55 years , diagnosed with diabetes , and without moderate/severe impairments or comorbidities . Research nurses blinded to the groups 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 Diabetes is a chronic disease , with high prevalence across many nations , which is characterized by elevated level of blood glucose and risk of acute and chronic complication . The Kingdom of Saudi Arabia ( KSA ) has one of the highest levels of diabetes prevalence globally . It is well-known that the treatment of diabetes is complex process and requires both lifestyle change and clear pharmacologic treatment plan . To avoid the complication from diabetes , the effective behavioural change and extensive education and self-management is one of the key approaches to alleviate such complications . However , this process is lengthy and expensive . The recent studies on the user of smart phone technologies for diabetes self-management have proven to be an effective tool in controlling hemoglobin ( HbA1c ) levels especially in type-2 diabetic ( T2D ) patients . However , to date no reported study addressed the effectiveness of this approach in the in Saudi patients . This study investigates the impact of using mobile health technologies for the self-management of diabetes in Saudi Arabia . METHODS In this study , an intelligent mobile diabetes management system ( SAED ) , tailored for T2D patients in KSA was developed . A pilot study of the SAED system was conducted in Saudi Arabia with 20 diabetic patients for 6 months duration . The patients were r and omly categorized into a control group who did not use the SAED system and an intervention group whom used the SAED system for their diabetes management during this period . At the end of the follow-up period , the HbA1c levels in the patients in both groups were measure together with a diabetes knowledge test was also conducted to test the diabetes awareness of the patients . RESULTS The results of SAED pilot study showed that the patients in the intervention group were able to significantly decrease their HbA1c levels compared to the control group . The SAED system also enhanced the diabetes awareness amongst the patients in the intervention group during the trial period . These outcomes confirm the global studies on the effectiveness of smart phone technologies in diabetes management . The significance of the study is that this was one of the first such studies conducted on Saudi patients and of their acceptance for such technology in their diabetes self-management treatment plans . CONCLUSIONS The pilot study of the SAED system showed that a mobile health technology can significantly improve the HbA1C levels among Saudi diabetic and improve their disease management plans . The SAED system can also be an effective and low-cost solution in improving the quality of life of diabetic patients in the Kingdom considering the high level of prevalence and the increasing economic burden of this disease Objective This study is aim ed at assessing the effectiveness of a simple outpatient diabetes self-management education programme . Methods In the study , 60 patients with type 2 diabetes mellitus were r and omly allocated into the control group ( n = 30 ) and intervention group ( n = 30 ) . Regular and 2-session health education programmes were provided . The summary of diabetes self-care activity measure , problem areas in the diabetes scale , fasting blood glucose , postpr and ial 2 h blood glucose , and HbA1c were measured before and after the intervention to assess the effects of this 2-session diabetes education programme . Results The total mean score of the summary of diabetes self-care activities measure was 17.60 ± 6.63 points . The problem areas in the diabetes scale revealed that the total mean score was 29.82 ± 15.22 points ; 27 % of the patients had diabetes-related distress , while 9 % suffered from severe emotional distress . Compared with the control group , scores of the summary of diabetes self-care activities measure and problem areas in the diabetes scale , fasting blood glucose , postpr and ial 2 h blood glucose , and HbA1c were significantly improved in the intervention group after the intervention ( P < 0.01 ) . Conclusion This study showed that the 2-session diabetes education programme could effectively improve the level of self-reported self-management , psychological distress , and glycemic control in patients with type 2 diabetes mellitus Background Multiple r and omized controlled trials ( RCTs ) show that behavioral lifestyle interventions are effective in improving diabetes management and that comprehensive risk factor management improves cardiovascular disease ( CVD ) outcomes . The role of technology has been gaining strong support as evidence builds of its potential to improve diabetes management ; however , evaluation of its impact in minority population s is limited . This study intends to provide early evidence of a theory-driven intervention , Tablet-Aided BehavioraL intervention EffecT on Self-management skills ( TABLETS ) , using real-time videoconferencing for education and skills training . We examine the potential for TABLETS to improve health risk behaviors and reduce CVD risk outcomes among a low-income African American ( AA ) population with poorly controlled type 2 diabetes . Methods The study is a two-arm , pilot controlled trial that r and omizes 30 participants to the TABLETS intervention and 30 participants to a usual care group . Blinded outcome assessment s will be completed at baseline , 2.5 months ( immediate post-intervention ) , and 6.5 months ( follow-up ) . The TABLETS intervention consists of culturally tailored telephone-delivered diabetes education and skills training delivered via videoconferencing on tablet devices , with two booster sessions delivered via tablet-based videoconferencing at 3 months and 5 months to stimulate ongoing use of the tablet device with access to intervention material s via videoconferencing slides and a manual of supplementary material s. The primary outcomes are physical activity , diet , medication adherence , and self-monitoring behavior , whereas the secondary outcomes are HbA1c , low-density lipoprotein cholesterol ( LDL-C ) , BP , CVD risk , and quality of life . Discussion This study provides a unique opportunity to assess the feasibility and efficacy of a theory-driven , tablet-aided behavioral intervention that utilizes real-time videoconferencing technology for education and skills training on self-management behaviors and quality of life among a high-risk , low-income AA population with an uncontrolled dyad or triad of CVD risk factors ( diabetes with or without hypertension or hyperlipidemia ) . The intervention leverages the use of novel technology for education and skill-building to foster improved diabetes self-management . The findings of this study will inform the process of disseminating the intervention to a broader and larger sample of people and can potentially be refined to align with clinical workflows that target a sub sample of patients with poor diabetes self-management . Trial registration The trial was registered in April 2014 with the United States National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier NCT02128854 ) , available online at : http:// clinical trials.gov/ct2/show/NCT02128854 AIMS To improve patient-centred care by determining the impact of baseline levels of conscientiousness and diabetes self-efficacy on the outcomes of efficacious interventions to reduce diabetes distress and improve disease management . METHODS Adults with Type 2 diabetes with diabetes distress and self-care problems ( N = 392 ) were r and omized to one of three distress reduction interventions : computer-assisted self-management ; computer-assisted self-management plus problem-solving therapy ; and health education . The baseline assessment included conscientiousness and self-efficacy , demographics , diabetes status , regimen distress , emotional burden , medication adherence , diet and physical activity . Changes in regimen distress , emotional burden and self-care between baseline and 12 months were recorded and ancova models assessed how conscientiousness and self-efficacy qualified the significant improvements in distress and management outcomes . RESULTS Participants with high baseline conscientiousness displayed significantly larger improvements in medication adherence and emotional burden than participants with low baseline conscientiousness . Participants with high baseline self-efficacy showed greater improvements in diet , physical activity and regimen distress than participants with low baseline self-efficacy . The impact of conscientiousness and self-efficacy were independent of each other and occurred across all three intervention groups . A significant interaction indicated that those with both high self-efficacy and high conscientiousness at baseline had the biggest improvement in physical activity by 12 months . CONCLUSIONS Both broad personal traits and disease-specific expectations qualify the outcomes of efficacious interventions . These findings reinforce the need to change from a one-size-fits-all approach to diabetes interventions to an approach that crafts clinical interventions in ways that fit the personal traits and skills of individual people BACKGROUND Healthy lifestyle behaviors are among the cornerstones of diabetes self-management , but the extent to which healthy lifestyle factors could potentially prevent premature mortality among people with diabetes remains unknown . The aim of the present study was to estimate the reduction in mortality that could be achieved if people with diabetes did not smoke , had a body mass index < 30 kg/m(2 ) , performed physical activity for ≥3.5 h/week , reported better dietary habits , and consumed alcohol moderately . METHODS A prospect i ve cohort study of 1263 German men and women with diabetes aged 35 - 65 years who were followed for an average of 7.8 years was used and multivariate Cox regression models for all-cause and cause-specific mortality were calculated . RESULTS Approximately 7 % of study participants had no favorable factors , 24 % had one , 35 % had two , and 34 % had three or more . Compared with participants who had no favorable factors , the reduction in risk was 34 % [ 95 % confidence interval ( CI ) 19 % , 63 % ] for those with one favorable factor , 49 % ( 95 % CI 9 % , 71 % ) for those with two , and 63 % ( 95 % CI 31 % , 80 % ) for those with three or more . Furthermore , a competing risk analysis did not show any difference in the inverse associations with mortality due to cardiovascular disease , cancer , or other causes . CONCLUSIONS Favorable lifestyle factors can potentially achieve substantial reductions in premature mortality among people with diabetes . Our results emphasize the importance of helping people with diabetes optimize their lifestyle behaviors AIMS To investigate whether a secondary - primary care partnership education package could improve underst and ing of diabetes care among South Asians . METHODS In a pilot r and omized controlled trial , in the setting of eight general practice s r and omized to intervention or control , patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse , dietician or chiropodist working with general practice staff . Participants were from lists of South Asian patients with known Type 2 diabetes in each ( general ) practice . RESULTS Patients and practice scores at baseline and 1-year follow-up , from an interview using a question naire on knowledge , awareness and self-management of diabetes . Responses were developed into educational packages used during intervention . Of the 411 patients listed at baseline only 211 were traced for interview ( refusal only 4 % ) . Mean age was 55.4 years , age of diabetes onset 47.1 years . Fourteen percent were employed and 35 % were able to communicate in English fluently . Only 118 could be traced and interviewed at 1 year , although there was no significant difference in demography between those who completed the study and those who did not . Despite a mean of four visits/patient , intervention had no impact on scores for diabetes knowledge , or awareness [ score change 0.14 , 95 % confidence interval ( CI ) -0.20 , 0.49 ] or self-management ( -0.05 , 95 % CI -0.48 , 0.39 ) between baseline and 1 year . CONCLUSIONS This form of secondary / primary care support did not transfer information effectively , and we suspect similar problems would arise in other similar communities . Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group
Conclusions The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients .
Background Diabetes self-management education is an essential part of diabetes care , but its impact on all-cause mortality risk of type 2 diabetes patients is unclear .
A systematic review and meta- analysis aim ing to eluci date the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed .