Narrative Medicine in Diabetes—A Randomized Trial

Abstract

Background and Aims: Group dynamics in diabetes have positive outcomes. This study attempts to determine if a group dynamic using narrative and reading is non-inferior to a conventional group approach. Material and Methods: We studied 49 patients (32 - intervention, 17 - control) with type 2 diabetes, were randomized to two different Group Care dynamics. “Control group” - Classical structured educational approach of six monthly sessions. “Intervention group” - Close reading and creative writing using literary narratives. They were evaluated before the first session and after the third and the sixth, including weight, A1c and satisfaction questionnaire (GSS). A1c in the six previous years were collected from clinical records. The statistical procedures were based on ANOVA and Pearson bivariate correlations. Results: The entire sample had an initial BMI of 29,1 (SD- 4,67) and A1c of 7,51% (SD- 1,13). There were 7 drop-outs, (5 intervention; 2 control). 5 other patients didn’t finished the evaluations by medical reasons. Both groups showed a reduction of A1c between the first and the last session (intervention group initial A1c 7,55% (SD-1,13); last A1c 6,83% (SD - 0,94) p<0,001; control group initial A1c 7,44% (SD- 1,11); last A1 7,21% (SD - 1,48) p<0,001. Regarding patients previous records, a decrease of A1c levels was observed in the trial (p<0,05). A significant increase (p<0,05) in satisfaction with therapist and with group process was observed. Conclusions: This is the first randomized trial evaluating a Group Care intervention to manage type 2 diabetes using narrative skills. A significant reduction of A1c in the intervention group showed non-inferiority in relation to the classical approach. A significant decrease in A1c was observed in relation with the A1c levels of the previous six years. A significant increase in satisfaction with therapist and with group process was observed. This may be a useful model for patients with several years of formal education, and may constitute an alternative for the long term educational process. Disclosure F. Rosário: None. I. Correia: None. J. Oliveira: None. J. Raposo: Advisory Panel; Self; Boehringer Ingelheim GmbH, Sanofi, Novo Nordisk A/S, Eli Lilly and Company, AstraZeneca.