Abstract
Background: Today most guidelines on the management of type 2 diabetes incorporate lifestyle intervention including patient education, physical activity and dietary modification. However, the content and organization of lifestyle intervention programs are still debatable. Aims: To compare the longer term effectiveness of a group-based rehabilitation program with an individual counseling program at improving glycemic control, cardiovascular risk factors and quality of life among type 2 diabetes patients. Methods: We randomized 143 type 2 diabetes patients to either a 6-month group-based rehabilitation program, including patient education, supervised exercise, and diet intervention, or a 6-month individual counseling program. Follow-up time was 12 months after baseline. Outcome measures were glycated hemoglobin (HbA1c), cardiovascular risk factors, quality-of-life and self-rated health. Results: In the rehabilitation group, HbA1c decreased 0.2%-point (95% confidence interval [CI] = -0.4, -0.03), systolic blood pressure decreased 6 mmHg (95% CI = -9.3, -2.5), diastolic blood pressure decreased 4 mmHg (95% CI = -6.3, -2.4), weight decreased 2.2 kg (95% CI = -3.2, -1.3), and waist circumference decreased 2.0 cm (95% CI = -2.9, -1.1). In the individual group, HbA1c decreased 0.4% (95% CI = -0.6, -0.1), systolic blood pressure decreased 3 mmHg (95% CI = -6.3, -0.7), diastolic blood pressure decreased 3 mmHg (95% CI = -4.7, -0.7), weight decreased 1.6 kg (95% CI = -2.6, -.7]), and waist circumference decreased 1.6 cm (95% CI = -2.5, -0.6). Vitality, fatigue distress, physical functioning and cardiovascular distress improved over time (P < 0.05) in the two groups combined. Repeated measurement analysis did not result in significant differences between the groups of any outcome. Conclusions: This study demonstrates that group-based rehabilitation in a primary healthcare center is a comparable alternative to individual counseling in an outpatient clinic. However, the resource use of the rehabilitation program was twice as much as the individual program.
Highlights
Lifestyle intervention plays an important role in the management of type 2 diabetes
HbA1c decreased by 0.2%-point (95% confidence interval [CI] = −0.4 to 0.03) in the rehabilitation group and by 0.4%point in the individual group compared with baseline values
The systolic blood pressure decreased by 6 mmHg in the rehabilitation group but only by 3 mmHg in the individual group
Summary
Educational interventions with or without physical activity and dietary advice have resulted in beneficial effects on glycemic control [1,2,3], diabetes knowledge [4,5] and quality of life [6]. Compared with individual education, groupbased education were or more effective at improving glycated hemoglobin (HbA1c), cardiovascular risk factors and quality of life [8,9]. Today most guidelines on the management of type 2 diabetes incorporate lifestyle intervention including patient education, physical activity and dietary modification. Aims: To compare the longer term effectiveness of a group-based rehabilitation program with an individual counseling program at improving glycemic control, cardiovascular risk factors and quality of life among type 2 diabetes patients.
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