Abstract
We examined the impact of a group-based self-empowerment intervention among diabetes patients, which uses multidisciplinary education, collaborative learning, peer support, and development of diabetes-specific social capital to improve glycemic control and weight management. Thirty-five patients who had primary care established at the Prisma Health Upstate, Internal Medicine Resident clinic and held the diagnosis of diabetes for longer than one year were recruited for our single-arm pilot intervention. Each group intervention session involved one to two internal medicine resident physician facilitators, a clinical diabetic educator, and 5–10 patients. Each session had a framework facilitated by the resident, with most of the discussion being patient-led, aiming to provide a collaborative learning environment and create a support group atmosphere to encourage self-empowerment. Patients’ hemoglobin A1c level and body mass index (BMI) before the intervention and 3 to 6 months after completion were collected from the laboratory results obtained in the participants’ routine clinic visits. All graduates from this three-week intervention were invited to attend monthly maintenance sessions, and we tracked the HgbA1c measures of 29 JUMP graduates one year after the intervention, even though 13 of the 29 chose not to participate in the monthly maintenance sessions. The pre-intervention HgbA1c level averaged 8.84%, whereas the post-intervention HgbA1c level averaged 7.81%. A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007). For BMI, there was an average decline of 0.78 from the pre-intervention mean value of 40.56 to the post-intervention mean value of 39.78 (p = 0.03). Among the 29 participants who agreed to participate in our follow-up measure of their HgbA1c status one year after the intervention, a paired t test showed that there was no significant difference between the post-JUMP measure and the follow-up measure (p = 0.808). There was no statistically significant difference between the HgbA1c level of those participating in the maintenance program and that of those not participating (post-intervention t test of between-group difference: p = 0.271; follow-up t test of between-group difference: p = 0.457). Our single-arm, pilot study of the three-week group intervention of self-empowerment shows promising results in glycemic control and weight loss. The short duration and small number of sessions expected could make it more feasible for implementation and dissemination as compared with popular intervention protocols that require much longer periods of attendance, if the effectiveness of this patient group-based self-empowerment approach can be further established by randomized controlled studies in the future.
Highlights
In 2015, there were approximately 29.1 million people in the United States with diabetes mellitus, around 9.3% of the population [1]
A review of new approaches to diabetes care identifies a range of patient-centered strategies, including shared decision-making, motivational interviewing, shared medical appointments (SMAs), and multidisciplinary team collaboration as potential positive diabetic management interventions [9]
A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007)
Summary
In 2015, there were approximately 29.1 million people in the United States with diabetes mellitus, around 9.3% of the population [1]. SMAs, a patient-centered approach in diabetes care [10], have been shown to yield improvement in various outcomes for patients with diabetes (e.g., HgbA1c, patient satisfaction, and depression) when compared with the more traditional physician–patient office visits [10,11,12,13,14], even though the statistical significance varies across different studies. Another patient-centered strategy is motivational interviewing [15], a psychotherapeutic concept that focuses on enhancing patient’s intrinsic motivation to initiate behavior change and accomplish a desired goal
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