The effect of training GPs in motivational interviewing on incident cardiovascular disease and mortality in people with screen-detected diabetes. Results from the ADDITION-Denmark randomised trial.

Morten Charles,Daniel Witte,Annelli Sandbaek,Else-Marie Dalsgaard,Marit Jorgensen,Bo Christensen,Niels Henrik Bruun,Torsten Lauritzen,Sune Rubak,Rebecca Simmons,Helle Terkildsen Maindal

doi:10.3399/bjgpopen20x101012

Abstract

BackgroundThere is no long-term evidence on the effectiveness of training for motivational interviewing in diabetes treatment.AimWithin a trial of intensive treatment of people with screen-detected diabetes, which included training in motivational interviewing for GPs, the study examined the effect of the intervention on incident cardiovascular disease (CVD) and all-cause mortality.Design & settingIn the ADDITION-Denmark trial, 181 general practices were cluster randomised in a 2:1:1 ratio to: (i) to screening plus routine care of individuals with screen-detected diabetes (control group); (ii) screening plus training and support in intensive multifactorial treatment of individuals with screen-detected diabetes (intensive treatment group); or (iii) screening plus training and support in intensive multifactorial treatment and motivational interviewing for individuals with screen-detected diabetes (intensive treatment plus motivational interviewing group). The study took place from 2001–2009.MethodAfter around 8 years follow-up, rates of first fatal and non-fatal CVD events and all-cause mortality were compared between screen-detected individuals in the three treatment groups.ResultsCompared with the routine care group, the risk of CVD was similar in the intensive treatment group (hazard ratio [HR] 1.11, 95% confidence interval [CI] = 0.82 to 1.50) and the intensive treatment plus motivational interviewing group (HR 1.26, 95% CI = 0.96 to 1.64). The incidence of death was similar in all three treatment groups.ConclusionTraining of GPs in intensive multifactorial treatment, with or without motivational interviewing, was not associated with a reduction in mortality or CVD among those with screen-detected diabetes.

Highlights

Motivational interviewing is a teachable, evidence-b ased approach to behaviour change counselling.[1]
Compared with the routine care group, the risk of cardiovascular disease (CVD) was similar in the intensive treatment group and the intensive treatment plus motivational interviewing group (HR 1.26, 95% CI = 0.96 to 1.64)
Training of GPs in intensive multifactorial treatment, with or without motivational interviewing, was not associated with a reduction in mortality or CVD among those with screen- detected diabetes. How this fits in Previous trials among individuals with type 2 diabetes have shown that motivational interviewing is associated with small, short-term improvements in some behaviours and outcomes; there is no long-term data on hard outcomes

Summary

Introduction

Motivational interviewing is a teachable, evidence-b ased approach to behaviour change counselling.[1]. Previous trials among individuals with type 2 diabetes have shown that motivational interviewing is associated with small, short-term improvements in some behaviours and outcomes, including dietary change, weight loss, and glycaemic control.[2,3] there are documented challenges with fidelity, low-quality studies, and short-term follow-u p. To the authors' knowledge, no study has evaluated the long-term effects of motivational interviewing, nor examined hard outcomes such as mortality and CVD. There is no long-term evidence on the effectiveness of training for motivational interviewing in diabetes treatment

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