An intensive programme that taught low-income, poorly educated diabetics to better manage their disease resulted in significantly improved long-term blood sugar control, according to university researchers.

The findings from Baltimore-based Johns Hopkins researchers, who designed and implemented the programme, offer clinicians a proven new tool to help those with poorly controlled diabetes make lifestyle changes to improve their health.

The researchers noted in the findings published online in the Journal of General Internal Medicine that many educational programmes for people with diabetes typically have little impact and the benefits wear off after the programmes end.

"We know that people need information to manage their disease, but having knowledge of the facts is not enough for behavioral change," said Felicia Hill-Briggs, PhD, an associate professor in the division of general internal medicine at the Johns Hopkins University School of Medicine and the study's lead author.

"With this novel approach, we have found a way to give people the skills to solve problems in all areas of their lives so that they can take diabetes off the back burner and start caring for their health."

In the small study, 56 participants were randomized into one of two groups. One got the intensive, nine-session, problem-solving course that covered not only standard diabetes self-management  and care, but taught problem-solving as a skill to help manage the financial, social, resource, and interpersonal issues that often stand in the way of  their managing their diabetes.

The other group got a condensed two-session version of the programme.

Three months after the end of the programme, participants in the intensive group saw their hemoglobin A1C levels - a long-term measure of blood sugar - fall by an average of .7 as compared with their levels before the start of the programme.

Levels below 5.7 are considered normal, while the target for people with diabetes is below 7.0. One participant stopped needing insulin after the completion of the programme, Hill-Briggs says. The participants in the condensed programme saw no improvement in their A1C levels. 

Many who took part in the intensive programme saw high cholesterol and high blood pressure drop as well. What struck Hill-Briggs most about her research was that A1C levels improved three months after the programme was over. This is in contrast to many diabetes interventions, particularly with lower socioeconomic groups.

"When the programme stops and support is taken away, the behaviour stops and the benefits stop," she said.

Hill-Briggs added that she thinks one of the reasons for the sustained improvement in her study is that if problem solving as a life skill has been taught successfully, people see those skills improve as they use them more.

Hill-Briggs says the intensive programme - like many other diabetes education programmes - first focused on how to better manage the disease and prevent further dangerous complications such as kidney disease, poor circulation requiring foot and other amputations, and blindness.

Facilitators explained the importance of a healthy diet, exercise, adherence to medication and self-monitoring. They did so using materials designed for a fifth-grade reading level to better reach this group, in which one in three participants had very low literacy skills.

The programme taught participants problem solving as a way to manage challenges to healthful eating. Participants applied their problem-solving skills in individual ways to address their own unique life situations.

Participants were also taught about making the best choices when foods such as fresh fruits and vegetables were not available.

"We helped people integrate diabetes care into everything else that was going on in their lives and in the context of how those things affected their health," Hill-Briggs said.

"The struggle is these other things seem more immediate, because if today they're having a crisis, that is the focus. The diabetes is always there.”

“We helped them understand that their diabetes can be a priority, and problem solving lets us meet them where they are.  We help them improve their diabetes self-care by using a reliable skill to tackle the problems that come up every day that used to throw them off their game plan,” she added. – TradeArabia News Service