Effect Of Diabetes Self-management Education Research Articles

Effect of diabetes self-management education on health-related quality of life of Tunisian children with type1 diabetes mellitus and their parents: A randomized controlled trial.

To assess the effect of diabetes self-management education (DSME) on health related quality of life (HRQoL) of Tunisian children/adolescents with type 1 diabetes mellitus and their parents. This monocentral study used a randomized controlled trial design, during five-month intervention and five-month follow-up and including 110 patients (54 in the DSME intervention group and 56 in the Individual Education by Pediatrician (IEP) control group) and their parents. Pediatric Generic Core Quality-of-Life Inventory 4.0-Scale (PedsQL4.0) evaluated HRQoL. At baseline, both groups had similar clinical features and PedsQL4.0 scores (p>0.05). In DSME, clinical outcomes were significantly improved from baseline to follow-up (p<0.001), while in the IEP group, which received no intervention, these outcomes remained unchanged. During follow-up, DSME showed higher PedsQL4.0 scores in parents' proxy-report and children/adolescents self-report (p<0.001). According to parents' proxy-report, PedsQL4.0 scores were significantly higher during follow-up compared to baseline in DSME (p<0.001) while they remained the same in IEP (p>0.05). DSME had higher percentage of change in the PedsQL4.0 scores than IEP (p<0.01). The median change varied from -5.01% to 0% vs 5.41% to 36.36% in IEP and DSME, respectively. Encouraging healthcare professionals to incorporate these interventions could enhance the HRQoL of diabetic children and bolster their self-esteem.

The Effect of Diabetes Self-management Education Provided by Certified Diabetes Educator Compared to Usual Diabetes Education on Glycemic Level and Stage of Behavior Change in Adult with Types 2 Diabetes Mellitus

Objective: To explore the effect of diabetes self-management education and support (DSMES) provided by Siriraj certified diabetes educators (CDE) compared to usual diabetes education (DE) on glycemic level and stage of behavior change in patients with type 2 diabetes mellitus (T2D). Materials and Methods: Patients with T2D having A1C 8-12% were recruited between 2019-2020 to receive DSMES from CDE. Patients received the usual DE from healthcare professionals in 2016 were randomly selected from their medical records. Results: 76 patients were enrolled in each group. Mean±SD age was 59.4±11.5 years. After receiving DSMES and DE, A1C decreased dramatically at 3 months in both groups without significant difference between the groups (9.4±1.1% to 8.0±1.2% vs. 9.5±1.1% to 8.1±1.5%, respectively). However, the DEMES group can further decrease A1C to 7.8±1.2% while A1C in the usual DE group increased to 8.5±1.6% at 12 months (p=0.028). In the DSMES group, most patients can move to the next stage of behavior change and reported a better QOL (89.4±11.6 vs. 92.6±12.2, p=0.018). Conclusion: The receipt of DSMES from CDE significantly improved the level of A1C, the stage of behavior change, and QOL. Its benefit on the glycemic level can last at least one year.

Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Influence Self Monitoring Blood Glucose (SMBG) and Diabetes Self Management Education (DSME) on the Stability of Blood Glucose Levels

Diabetes Mellitus (DM) sufferers must do DM management behavior (self-management) to control their Blood glucose levels and prevent complications. To achieve optimal self-management behavior, one of the efforts made is SMBG and DSME. Self-Monitoring Blood Glucose (SMBG) is self-monitoring blood glucose using a glucometer. Diabetes Self-Management Education (DSME) is an ongoing process of facilitating the knowledge, skills, and abilities needed for diabetes self-care. This study contributes to analyzing the effect of Self-Monitoring Blood Glucose (SMBG) and Diabetes Self-Management Education (DSME) on the stability of Blood glucose levels. The research design used is quasi-experimental. The sample in this study amounted to 40 and was taken using the technique of simple random sampling. Stability of Blood glucose levels using a glucometer measuring instrument. Data analysis using test Wilcoxon Signed-rank. The results of statistical tests on SMBG showed a p-value (0.001), so it could be concluded that there was an effect of SMBG on the stability of Blood glucose levels. Statistical test results on DSME showed a p-value (0.000), so it can be concluded that there is an effect of DSME on the stability of Blood glucose levels. Adherence to structured SMBG allows sufferers to interpret results regarding their activity level and portion size. It motivates them to act on these results for better blood sugar results. DSME components taught to patients can increase patient knowledge and skills and improve patient care that is not correct.

Diabetes Self Management Education Assistance on The Quality of Life in Type 2 Diabetes Mellitus Patients

Patients with DM in the district. Rejang Lebong reached 382 cases, and 9 people died from this disease in 2020. Diabetes Self Management Education (DSME) is a program designed to provide understanding and skills in caring for DM sufferers daily at home. This subject of this study was to analyze the effect of DSME administration on the quality of life in type 2 DM patients in the PKM Perumnas area, Rejang Lebong district. This research is a quasi-experimental study with a pretest and posttest approach with a control group design. The sampling technique used consecutive sampling involving 30 respondents, divided into 15 respondents in the treatment group and 15 in the control group. Bivariate analysis in the form of a parametric test, namely the dependent t-test and independent t-test with ? = 0.05. Researchers use computer programs for data processing and statistical analysis. The mean quality of life for DM patients was 36.20 with a standard deviation of 10.79 and p = 0.000 &lt;0.05. This shows that after the intervention, there is an increase in the quality of life of DM patients by 36.20. There is an effect of Diabetes Self-Management Education (DSME) on the Quality of Life of Diabetes Mellitus (DM) Patients in Kab. Rejang Lebong in 2022. Education is essential for patients to change their behaviour and self-management independently to improve the quality of life of DM patients.

IDF2022-1144 Effect of Diabetes Self-Management Education on Glycemic Control amongst Adolescents with Type 1 Diabetes in Gaza Strip

IDF2022-1144 Effect of Diabetes Self-Management Education on Glycemic Control amongst Adolescents with Type 1 Diabetes in Gaza Strip

Effect of Diabetes Self-Management Education on the Prevention of Diabetic Foot Injuries

Diabetics are at high risk of developing chronic disease problems such as diabetic foot injuries. Diabetic foot injuries can be prevented if diabetics have good knowledge so that they are able to carry out diabetic foot care. The provision of DSME can facilitate the knowledge and ability of diabetes mellitus clients to carry out self-care. This study aims to analyze the effect of DSME on the prevention of diabetic foot injuries. The method used is a quasi-experiment with one group pre-test post-test design. Data collection uses research instruments in the form of questionnaires. The study sample used was 55 people with a purposive sampling technique. The data analysis technique used is the marginal homoegenity test. The results showed that there was an effect of DSME on the prevention of diabetic foot injuries. It is hoped that the Center for Public Health can make DSME a regular health promotion program to improve the self-care ability of type 2 diabetes mellitus clients while preventing complications from diabetic foot injuries.

The effectiveness of social media intervention in people with diabetes: An integrative review.

This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus. DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME. An integrative review was conducted based on Whittemore and Knafl's (2005) methodology. The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used. A total of 13studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression. Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression. This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.

Application of Diabetes Self-Management Education and Support in Outpatients with Type II DM

Education through self-management and support plays an important role in providing knowledge and instilling an awareness of the importance of healthy living. The purpose of this study was to determine the effect of Diabetes Self-Management Education and Support on eating habits, body weight, nutritional status, and glycemic control. The design of this study was quasi-experimental with the experimental design of the Pre Test Post Test without a control group. The number of samples was 60 patients who were taken by purposive sampling with predefined inclusion and exclusion criteria. Interventions were conducted 2 times a month for 6 months. From this study, it is known that for 6 months there was an increase in the consumption of vegetables, fruit, and milk (p&lt;0,05), a significant decrease in the consumption of tubers and starches (p &lt;0.05), while the consumption of rice and side dishes did not experience a significant change (p&gt; 0, 05). Besides, there was a significant decrease in glycemic control (p &lt;0.05) but there was no significant reduction in body weight and nutritional status (p&gt; 0.05). The application of Diabetes Self-Management Education and Support for 6 months can influence glycemic control and change eating habits.

The Effects of Diabetes Self-Management Education on Quality of Life for Persons With Type 1 Diabetes: A Systematic Review of Randomized Controlled Trials.

It is well documented that chronic conditions, such as diabetes, impact quality of life (QoL). QoL assessment is essential when developing and evaluating diabetes self-management education support interventions. The aim of this systematic review was to evaluate the evidence and gaps in the research and the impact of diabetes self-management education (DSME) on QoL outcomes in persons with type 1 diabetes mellitus (T1DM). A systematic review of English language studies published between January 1, 2007, and March 31, 2020, was conducted using a modified Cochrane review method. Studies were included if they were randomized controlled trials (RCTs), participants had T1DM with or without caregivers, a DSME intervention alone or a component(s) of the ADCES7™ Self-Care Behaviors was described, and QoL was a primary or secondary outcome. A 3-tiered review process was utilized for selecting articles. Retained articles were assessed for risk of bias. Nineteen articles, reporting on 17 RCTs, met inclusion criteria, of which 7 studies reported QoL as the primary outcome and 10 as a secondary outcome. Seven studies detected significant impact of DMSE on QoL outcomes in either the participants or family caregivers, which varied in participant populations, selection of QoL tools (generic vs diabetes-specific), intervention type, intervention length, and type of interventionist. DSME has the potential to influence QoL outcomes in people with T1DM. Research using more standardized methods are needed to delineate impact on a broader range of factors that influence QoL for those living with T1DM across the life span and their caregivers.

Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person’s motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior.&#x0D; Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed.&#x0D; Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons.&#x0D; Conclusions: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM.

The Effect of Diabetes Self-Management Education on Glycemic Control in Minority Patients With Diabetes Mellitus.

BackgroundDiabetes self-management education (DSME) plays a vital role in diabetes control yet is highly underutilized, especially in the minority population. The efficacy of DSME on glycemic control among the Hispanic and non-Hispanic black population is not as well established as it is compared to the non-Hispanic White population.MethodologyIn this retrospective cohort study, patients who participated in both group and one-to-one DSME classes at Saint Francis Medical Center, Trenton, New Jersey, from 2017 to 2019 were identified. Mean hemoglobin A1c levels before DSME and after DSME were compared using paired t-test.ResultsA total of 344 patients were included in the study. Out of 344 patients, 200 (58%) patients were Hispanic and 97 (28%) were non-Hispanic black, 42 (12%) were Caucasian, and five (2%) were from other races. The mean hemoglobin A1c was reduced by an average of 1.08% among patients who participated in group DSME (DSME done in group settings) and by an average of 1.95% among patients who participated in one-to-one DSME (DSME done in individualized settings).Conclusion DSME is effective in reducing hemoglobin A1c levels in Hispanic and non-Hispanic black majority patients. One-to-one DSME is more effective than group DSME in reducing hemoglobin A1c in this patient population.

The Effects of Diabetes Self-Management Education and Support Program in Thailand: A Systematic Review and Meta-Analysis

Background: Diabetes is a growing health problem worldwide. Diabetes self-management education and support (DSMES) program is a crucial component in promoting self-care in all people with diabetes. However, the practice in certain countries, including Thailand, is not yet standardized, thus the effectiveness of such program is unknown. Objective: To evaluate the effectiveness of DSMES in Thailand. The outcomes were glycemic control, lipid levels, body mass index (BMI), quality of life (QoL), and diabetes knowledge. Materials and Methods: The authors searched PubMed, Scopus, and ProQuest databases since their inception until March 2019 for randomized controlled trials conducted in Thailand that evaluated outcomes of DSMES programs. Meta-analyses were performed to pool mean differences (MD) of the outcomes. Results: Seven studies, with 1,523 participants, were included. DSMES programs were conducted in different healthcare settings by health professionals from multiple disciplines. The results revealed that participants receiving DSMES had significantly lower hemoglobin A1c, MD –0.66% (95% CI –0.90 to –0.42), and FBG levels, MD –15.88 mg/dL (95% CI –20.95 to –10.79), than those who did not. Lipid levels, BMI, QoL, and diabetes knowledge, however, did not significantly differ. Conclusion: Meta-analysis results showed that DSEMS is effective in improving glycemic control and should be promoted to combat the burden of this important health problem in Thailand. Keywords: Diabetes self-management education and support; DSMES; Glycemic control; Meta-analysis; Thailand

The Effect of Diabetes Self-Management Education (DSME) on Improving Self-Management and Quality of Life in Millitus Type 2 Diabetes

Self-management is a form of self-regulation. The purpose of this study was to determine the effect of Diabetes Self-Management Education (DSME) on the Improvement of Self-Management and Quality of Life in Type II Diabetes Millitus Patients. This research method is True-Experiment Pre-Test and Post-Test design. DSMQ and WHOQOL instruments. Independent Variable (DSME) Dependent variable Self-management and quality of life. The subjects of the control group were 55 people and the intervention group was 55 people. Wilcoxon data analysis, Maan-Whitney and Path Analysis. The results of the comparison of self-management between the intervention group and the control group, a significance value of 0.000 less than 0.05 (p &lt;0.05), indicating that the group given effective intervention significantly improved self-management compared to the group that was not given the intervention. The results of the comparison of the quality of life of the intervention group and the control group, the significance value of 0.000 less than 0.05 (p &lt;0.05) indicates that the group given the intervention was more effective in improving the quality of life significantly than the group that was not given the intervention. There is an effect of Diabetes Self-Management Education (DSME) on the Improvement of Self-Management and Quality of Life for Type II Diabetes Millitus Patients in the Work Area of the Kempo Health Center, Kempo District. DSME is a process to facilitate knowledge, skills and abilities in self-care (Self-Management) and quality of life

Examining elevated blood pressure and the effects of diabetes self-management education on blood pressure among a sample of Marshallese with type 2 diabetes in Arkansas.

IntroductionHypertension is a leading risk factor for heart attack and stroke. Undiagnosed hypertension increases the risk of heart attack and stroke. The risk of hypertension is increased for those with type 2 diabetes mellitus (T2DM). Diabetes self-management education (DSME) has been shown to be effective at improving clinical outcomes, including reducing blood pressure, but few studies have evaluated the effects of DSME for Native Hawaiians and Pacific Islanders.MethodsThis study examined the baseline prevalence of diagnosed hypertension and undiagnosed high blood pressure and differences in health care access between those with diagnosed hypertension versus undiagnosed high blood pressure. The sample consisted of 221 Marshallese adults with T2DM participating in a DSME randomized controlled trial in northwest Arkansas. The study also examined the effects of DSME interventions on participants’ blood pressure, comparing an Adapted-Family DSME with a Standard DSME.ResultsNearly two-thirds of participants had blood pressure readings indicative of hypertension, and of those, over one-third were previously undiagnosed. The frequency of doctor visits was significantly lower for those with undiagnosed high blood pressure. There were no differences in health insurance coverage or forgone medical care between those with undiagnosed high blood pressure versus diagnosed hypertension. Across all participants, a significant reduction in systolic blood pressure occurred between baseline and post intervention, and a significant reduction in diastolic blood pressure occurred between baseline and post-intervention, 6 months, and 12 months post-intervention. No differences were observed by study arm.ConclusionThis study is the first to document the prevalence of diagnosed hypertension and undiagnosed high blood pressure, as well as the effects of DSME on blood pressure among a sample of Marshallese adults with T2DM.

Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review.

Background Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals. Methods Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity. Results The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed. Conclusion Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.

Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand.

The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand. The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients. A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand. Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05). The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.

THE INFLUENCE OF DIABETES SELF MANAGEMENT EDUCATION AND SUPPORT FOR SELF EFFICACY AND SELF CARE BEHAVIOUR IN CLIENT WITH TYPE 2 DIABETES MELLITUS

Independent diabetes care management is needed for health maintenance. Low self-care is caused by low self-efficacy. The purpose of this study was to analyze the effects of diabetes self-management education and support for self-efficacy and independent behavior in clients with type 2 diabetes mellitus. This observational research used a cross sectional approach. Sample which used clusster sampling method consisted of of 200 people. Independent variable was education and support for independent diabetes management, and dependent variable was self-efficacy and independence. Research analysis techniques used bivariate statistical logistic regression test. The results of Binary Logistic Regression test showed that education and independent management support for diabetes significantly influence self-efficacy with a result of sig 0.001 &lt;α 0.05. Education and support for independent diabetes management significantly influence self-care with sig 0,000 &lt;α 0,05. Self-efficacy affects self-care significantly with sig 0,000 &lt;α 0,05. Self-management education and diabetes support are beneficial for people with type 2 diabetes in increasing self-confidence to control and manage the disease they experience.&#x0D; Keywords: Self-management education, self-efficacy and self-reliance behavior

Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review.

AimThis review study aimed to determine the effectiveness and factors affecting the success of DSME programs in T2DM patients living in ME countries.MethodsAn extensive manual literature search was conducted using PubMed and Google Scholar for clinical trials assessing the effect of diabetes self-management education (DSME) for type 2 diabetes mellitus patients in Middle East countries. Information from the included studies was summarized in relation to study population, sample size, duration of follow-up, characteristics of DSME program, and follow-up time, besides in addition to parameters used in assessment, results, and conclusions. The risk of bias in the included studies was assessed using the Cochrane risk of bias tool. The effect of DSME on clinical and patient-reported outcomes was measured by calculation of the percentage of DSME studies that produce a significant improvement in these outcomes for patients in intervention group as compared to those in control group. Additionally, the effect of DSME on each clinical outcome was assessed by calculating the mean for the absolute effect of DSME on that outcome.ResultsTwelve studies were included in this review. Heterogeneity was found among included studies in terms of DSME program characteristics, the enrolled patients, duration of follow-up, assessment methods, and obtained outcomes. All clinical glycemic outcomes (glycosylated hemoglobin, fasting, and non-fasting blood glucose), lipid profile (total cholesterol and triglycerides), and body mass index were significantly improved for patients in intervention group as compared to those in control group in at least 60% of the included studies. All patients' reported outcomes (medication adherence, self-management behavior, knowledge, self-efficacy, health belief and quality of life) were significantly improved by the DSME program.ConclusionDSME programs are highly effective in improving glycemic control, lipid profile and BMI, and modestly effective in improving BP. Thus, they can reduce the risks of developing diabetes complications. Patient diabetes knowledge, DSM behaviors, adherence to medications, self-efficacy, and quality of life can also be significantly improved by DSME.

Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: results of a randomized controlled trial (TRIGGER study)

ObjectiveTo investigate the effect of diabetes self-management education and support via a smartphone app in individuals with type 2 diabetes on insulin therapy.Research design and methodsOpen two-arm multicenter parallel randomized...