Empowerment, Motivation, and Medical Adherence (EMMA)—Results of an RCT in Patients with Poorly Regulated Type 2 Diabetes

Abstract

Background: Many studies have shown that substantial improvement of glycemic control is difficult in patients with poor glycemic control. Knowledge, competences and motivation are critical requirements for optimal self-management and good glycemic control. The aim of this RCT was to test if a consultation program, EMMA could improve self-management and glycemic control in patients with T2D and poor glycemic control compared to a control group receiving usual care. Methods: The study was a non-blinded parallel RCT targeting adults with T2D ≥ 1 year and HbA1c ≥ 64 mmol/mol in a Danish diabetes clinic. The intervention consisted of four consultations with nurses using EMMA, which provides a person-centered approach using dialogue tools designed to promote self-reflection, learning and goal-setting (3.5 months). Outcome measures were HbA1c and questionnaire scores investigating determinants of glycemic control according to Self-Determination Theory, such as autonomy support (Health Care Climate Questionnaire (HCCQ)). Consultation processes were evaluated by the level of nurse talk and the actual use of the tools. Results: Nighty-seven participants completed the study (49 in the intervention group). The HCCQ score was significantly higher in the intervention group at end of the intervention. The increase in HCCQ score was not sustained at the end of follow-up (6 months). HbA1c was slightly reduced in both groups at the end of intervention and at follow-up. Average level of nurse talk in all recorded intervention consultations (n=57) was 37% of total talk-time. Records from the consultations showed that most of the reflection and goal-setting tools were used with >90% of the participants, whereas the learning tools were used with 61%. Conclusion: The initial increase in autonomy support seemed attributed to the intervention. The non-significant decrease in HbA1c may be ascribed a short intervention period and less professional use of learning tools than intended. Disclosure A.R. Varming: None. K. Olesen: None. I. Willaing: None.