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Randomized Controlled Trial
. 2017 Sep 1;68(9):883-890.
doi: 10.1176/appi.ps.201600377. Epub 2017 May 15.

A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus

Martha Sajatovic  1 , Douglas D Gunzler  1 , Stephanie W Kanuch  1 , Kristin A Cassidy  1 , Curtis Tatsuoka  1 , Richard McCormick  1 , Carol E Blixen  1 , Adam T Perzynski  1 , Douglas Einstadter  1 , Charles L Thomas  1 , Mary E Lawless  1 , Siobhan Martin  1 , Corinna Falck-Ytter  1 , Eileen L Seeholzer  1 , Christine L McKibben  1 , Mark S Bauer  1 , Neal V Dawson  1
Affiliations
Randomized Controlled Trial

A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus

Martha Sajatovic et al. Psychiatr Serv. .

Abstract

Objectives: A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus.

Methods: The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control.

Results: Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group.

Conclusions: TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.

Keywords: Psychoeducation; Schizoaffective disorders; Schizophrenia; bipolar disorder; depression; diabetes; self-management; serious mental illness.

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Figures

Figure 1
Figure 1
Flow of study screening, enrollment, randomization assignment, retention and completion
See this image and copyright information in PMC

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