A Diabetes Self-Management Program: 12-Month Outcome Sustainability From a Nonreinforced Pragmatic Trial

Diabetes self-management education has been shown to be effective in controlled trials. The 6-week Better Choices, Better Health-Diabetes (BCBH-D) self-management program was also associated with an improvement in health outcomes in a 6-month translation study. The objective of this study was to det...

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Bibliographic Details
Published in:	Journal of medical Internet research 2016-12, Vol.18 (12), p.e322-e322
Main Authors:	Lorig, Kate, Ritter, Philip L, Turner, Ralph M, English, Kathleen, Laurent, Diana D, Greenberg, Jay
Format:	Article
Language:	eng
Subjects:	Adult Aerobic exercise Aerobics Blood tests Cohort Studies Consent Diabetes Diabetes Mellitus - therapy Drugs Exercise Female Health Behavior Health care policy Health status Humans Hypoglycemia Hypotheses Internet Male Management development programmes Original Paper Outcome Assessment (Health Care) Patient compliance Patient Education as Topic Physical fitness Population Questionnaires Self Care - methods Self Report Selfmanagement Surveys and Questionnaires Translation Workshops
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Summary:	Diabetes self-management education has been shown to be effective in controlled trials. The 6-week Better Choices, Better Health-Diabetes (BCBH-D) self-management program was also associated with an improvement in health outcomes in a 6-month translation study. The objective of this study was to determine whether a national translation of the BCBH-D self-management program, offered both Web-based and face-to-face, was associated with improvements in health outcomes (including HbA1c) and health behaviors (including recommended medical tests) 1 year after intervention. Web-based programs were administered nationally, whereas face-to-face workshops took place in Atlanta, Indianapolis, and St Louis. Self-report questionnaires were either Web-based or administered by mail, at baseline and 1 year, and collected health and health-behavior measures. HbA1c blood samples were collected via mailed kits. A previous 6-month study found statistically significant improvements in 13 of 14 outcome measures, including HbA1c. For this study, paired t test compared baseline with 1-year outcomes. Subgroup analyses determined whether participants with specific conditions improved (high HbA1c, depression, hypoglycemia, nonadherence to medication, no aerobic exercise). The percentage of participants with improvements in effect size of at least 0.4 in at least 1 of the 5 measures was calculated. A total of 857 participants with 1-year data (69.7% of baseline participants) demonstrated statistically significant 1-year improvements in 13 of 15 outcome measures; 79.9% (685/857) of participants showed improvements in effect size of 0.4 or greater in at least 1 of the 5 criterial measures. Participants had small but significant benefits in multiple measures. Improvements previously noted at 6 months were maintained or amplified at 1 year.
ISSN:	1438-8871 1439-4456 1438-8871