Literature DB >> 30012812

Nurse-led psychological intervention for type 2 diabetes: a cluster randomised controlled trial (Diabetes-6 study) in primary care.

Khalida Ismail1, Kirsty Winkley1, Nicole de Zoysa2, Anita Patel1, Margaret Heslin1, Helen Graves1, Stephen Thomas3, Dominic Stringer1, Daniel Stahl1, Stephanie A Amiel4.   

Abstract

BACKGROUND: Suboptimal glycaemic control in type 2 diabetes (T2D) is common and associated with psychological barriers. AIM: To investigate whether it was possible to train practice nurses in six psychological skills (Diabetes-6 [D6]) based on motivational interviewing (MI) and basic cognitive behaviour therapy (CBT), and whether integrating these with diabetes care was associated with improved glycaemic control over 18 months compared with standard care. DESIGN AND
SETTING: Two-arm, single-blind, parallel cluster randomised controlled trial in primary care.
METHOD: Adult participants (n = 334) with T2D and persistent HbA1c ≥69.4 mmol/mol were randomised to receive 12 sessions of either the D6 intervention or standard care over 12 months. Practice nurses were trained in the six psychological skills and their competencies were measured by standardised rating scales. Primary outcome was a change in HbA1c level at 18 months from randomisation. Secondary outcomes were changes in systolic and diastolic blood pressure, body mass index, waist circumference, depressive symptoms, harmful alcohol intake, diabetes-specific distress, and cost-effectiveness.
RESULTS: Using intention-to-treat analysis, there was no significant difference between D6 intervention and standard care in HbA1c (mean difference -0.79 mmol/mol, 95% confidence interval [CI] = -5.75 to 4.18) or for any of the secondary outcomes. The competency level of D6 nurses was below the beginner proficiency level and similar to the standard-care nurses.
CONCLUSION: Training nurses in MI and basic CBT to support self-management did not lead to improvements in glycaemic control or other secondary outcomes in people with T2D at 18 months. It was also unlikely to be cost-effective. Furthermore, the increased contact with standard-care nurses did not improve glycaemic control. © British Journal of General Practice 2018.

Entities:  

Keywords:  cognitive therapy; hyperglycaemia; motivational interviewing; self-management; type 2 diabetes mellitus

Mesh：

Substances：

Year:  2018        PMID： 30012812      PMCID： PMC6058638          DOI： 10.3399/bjgp18X696185

Source DB:  PubMed          Journal:  Br J Gen Pract        ISSN： 0960-1643            Impact factor:   5.386


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