Effect of patient‐centered self‐management intervention on glycemic control, self‐efficacy, and self‐care behaviors in South Asian adults with type 2 diabetes mellitus: A multicenter randomized controlled trial
Background This study aimed to test the efficacy of patient‐centered self‐management intervention (PACE‐SMI) to improve HbA1c, self‐efficacy, and self‐care behaviors in adults with type 2 diabetes mellitus (T2DM). Methods In this multicenter, parallel two‐arm randomized controlled trial, 612 adults...
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| Veröffentlicht in: | Journal of diabetes Jg. 16; H. 9; S. e13611 - n/a |
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| Hauptverfasser: | , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Melbourne
Wiley Publishing Asia Pty Ltd
01.09.2024
John Wiley & Sons, Inc Wiley |
| Schlagworte: | |
| ISSN: | 1753-0393, 1753-0407, 1753-0407 |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | Background
This study aimed to test the efficacy of patient‐centered self‐management intervention (PACE‐SMI) to improve HbA1c, self‐efficacy, and self‐care behaviors in adults with type 2 diabetes mellitus (T2DM).
Methods
In this multicenter, parallel two‐arm randomized controlled trial, 612 adults with T2DM and HbA1c ≥ 7% were enrolled and assigned to the control group (n = 310) and the intervention group (n = 302) using stratified permuted block randomization. The control group received usual care, whereas the intervention group received usual care plus nurse‐led, theory‐driven, culturally tailored PACE‐SMI, comprising eight weekly sessions of individualized education, counseling, behavioral training, and home visit. Outcomes were assessed at baseline, postintervention, and 3 months follow‐up.
Results
Data at 3 months were provided by 583 participants (control: n = 295, intervention: n = 288). Per‐protocol analysis showed that the intervention group had a lower mean HbA1c (8.49% [standard deviation (SD), 1.58]) than the control group (8.74% [SD, 1.62]), with small yet statistically significant mean difference of 0.25% (95% confidence interval [CI], −0.01 to 0.51; Cohen's d = 0.16; p = 0.03). Self‐efficacy and self‐care behaviors significantly improved in the intervention group (116.89 [SD, 25.50] and 70.01 [SD, 17.97]) compared to the control group (75.43 [SD, 18.99] and 51.54 [SD, 12.04]), with mean differences of 41.48 (95% CI, 37.83–45.13; Cohen's d = 1.84; p < 0.0001) and 18.56 (95% CI, 16.08–21.04; Cohen's d = 1.22; p < 0.0001), respectively. Linear regression analysis indicated the effect of PACE‐SMI on HbA1c was significantly mediated by improvements in self‐efficacy and self‐care behaviors (R2 = 0.232, p < 0.001).
Conclusion
PACE‐SMI led to modest but significant improvement in HbA1c and substantial enhancements in self‐efficacy and self‐care behaviors in adults with T2DM.
Highlights
T2DM dominates worldwide, especially in the low middle income countries (LMICs) of South Asia.
Despite acknowledging self‐management as the corner stone in T2DM, LMICs face an implementation gap due to lacking policies and the fragmented care systems, neglecting crucial personal, behavioral, and social factors.
In this first large‐scale multicenter randomized controlled trial conducted in Pakistan, a LMIC, the nurse‐led PACE‐SMI demonstrated significant improvement in HbA1c, self‐efficacy, and self‐care behaviors in adults with T2DM at 3 months.
Considering the substantial health and economic impact of T2DM in LMICs, evidence presented in this study holds implications for the healthcare policies, advocating for integration of PACE‐SMI into standard practice. |
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| Bibliographie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 |
| ISSN: | 1753-0393 1753-0407 1753-0407 |
| DOI: | 10.1111/1753-0407.13611 |