Effectiveness of a training course for general practice nurses in motivation support in type 2 diabetes care: a cluster-randomised trial

Abstract

Background: Type 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population.

Methods: Forty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory-based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40-74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed.

Results: The differences between the intervention- and the control practices' mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: -0.02%-points (95% CI: -0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: -0.12%-points (-0.23 to -0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01.

Conclusions: Offering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention.

Trial registration: ClinicalTrials.gov (Identifier NCT01187069).

Figure 1. Flowchart.

The inclusion of general practices and the associated diabetes populations in a trial evaluating the effectiveness of a training course for general practice nurses in applying Self-determination theory in current type 2 diabetes care, DK 2011.

Figure 2. Timeframe of the trial.

The trial evaluated the effectiveness of a training course for general practice nurses in applying Self-determination theory in current type 2 diabetes care, DK.

Figure 3. Subgroup analyses.

Differences in mean HbA_1c adjusted for baseline values and cluster effect in subgroups in intervention practices compared with usual practices 18 months after the core intervention, DK 2011.

Figure 4. Evaluation of the training course on the nurses’ self-perceived autonomy supportive competences.

The number of nurses distributed on their scores from 1–10 (1 = rarely, 10 = always) before (below the line) and 11 months after (above the line) the training course for each autonomy supportive competence, DK 2011.