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Randomized Controlled Trial
. 2013 Jun;31(2):119-27.
doi: 10.3109/02813432.2013.797178.

No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial

Renate Jansink  1 , Jozé Braspenning, Ellen Keizer, Trudy van der Weijden, Glyn Elwyn, Richard Grol
Affiliations
Randomized Controlled Trial

No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial

Renate Jansink et al. Scand J Prim Health Care. 2013 Jun.

Abstract

Objective: To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices.

Intervention: Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting.

Subjects: Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m². Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires).

Results: Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI 20.8-0.35) and diet (fat (difference between groups = 0.19; CI 20.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = 20.02; CI 20.26-0.22)), and physical activity (difference between groups = 21.15; CI 212.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life.

Conclusion: A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.

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Figures

Figure 1.
Figure 1.
The interventions in the comprehensive programme.
Figure 2.
Figure 2.
Flow diagram of general practices and patients at different stages (enrolment, allocation, baseline measurement, follow-up, and analysis) of the trial.
See this image and copyright information in PMC

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