The results, published online in the Journal of general internal medicine, offer doctors a new tool to help change the lifestyles of poorly controlled diabetes to improve their health, researchers said. They pointed out that many educational programs for people with diabetes have little impact and benefits and use after the end of programs.
"We know that people need information to control the disease, but a knowledge of the facts is not sufficient for that behaviour change," said Felicia Hill-Briggs, Ph.d., associate professor in the Division of general medicine, internal to the Johns Hopkins University School of Medicine and senior author of the study. "With this new approach, we found a way to give people the skills required to resolve the problems in all areas of their lives so that they may have diabetes held back and begin to take care of their health."
In the small study, 56 participants were distributed randomly to one of the two groups. One is the intensive course, nine sessions in all, which had problems that cover not only the standard diabetes self-management and attention, but also teaches problems such as the ability to help manage the resources financial, social and interpersonal problems that are often of their management of their diabetes. The other group received a condensed version of two sessions of the program.
Three months after the end of the program, the participants in the intensive group saw the fall of Hemoglobin A1C levels - a measure long term sugar in the blood - by an average de.7 from their levels from before the beginning of the program. 5.7 Lower levels are considered normal, while the fate of people with diabetes is less than 7.0. A participant stopped needing insulin after the completion of the program, says Hill-Briggs. The condensed program participants have not seen any improvement in their HbA1c.
Many of those who participated in the saw intensive program, saw the high rate of cholesterol and high blood pressure fall also. What struck Hill-Briggs the most of his research, was he improved HbA1c of only three months after the program. This is in contrast to the many interventions of diabetes, particularly with the socio-economic groups below poverty line. "When the program is stopped and the support stops , the behavior stops and so do the benefits"
Hill-Briggs says that he believes that one of the reasons for the improvement of his study is that if the solution of the problems as a skill for life has taught successfully, see these skills improve they use most.
More than 25 million Americans have type 2 diabetes, and the number of diagnoses increased by 1.9 million new cases diagnosed in 2010. Like many chronic diseases, diabetes disproportionately affects the elderly, and its prevalence is higher among racial and ethnic minorities. The annual economic burden of diabetes is 132 million and rising, mainly due to the expensive complications of the disease.
Hill-Briggs, said the intensive programme - as many other diabetes education programs - focused firstly on how improving the management of the disease and prevent further dangerous complications such as disease of the kidney, foot requiring a poor circulation and amputations and blindness. Animators, explained the importance of healthy eating, exercise, medication and self control. Did for materials designed to ensure that a fifth reading level turn at best to this group, including one of the three participants to each had very low level of literacy.
But the program did not stop there. He was to ask why the participants had difficulties to make changes in the way of life and adherence to care. Some said that they did not have access to healthy food near their home. Others said that it was too expensive to eat healthy. Some said that they do not take their medication because they could not. Many had family problems, requests for care and even neighbourhood violence that affect their ability to care for his diabetes.
In response, the problems of the participants has taught the program as a way to manage these challenges. Participants apply their skills to solve problems on an individual basis only to resolve their own life situations. Some, for example, began to see their budgets of mosto-ricos and wishes. Often, he said, participants considered rent and electricity debe-ricos and not diabetes, his chronic disease because drugs do strives nor their sufficiently to be considered as an urgent need. With a good understanding of the role of drugs, participants described to move them to the list of the essential and something more that one wants to take off.
For those who thought drugs did not work, options that have emerged including constantly taking prescribed for a week and then checking the sugar in the blood to see what had happened. When the results were good, he encouraged the themes and results reinforce the need for consistent personal care.
Participants are also taught how to make the best options when having no foods such as fruits and fresh vegetables. Often, canneries are available only in areas with little access to large grocery stores. Two of the participants, on their own, convinced of their local varieties of small grocery stores of vegetables little sodium, enabling them to make healthier choices.
"We have helped people with diabetes take care of everything what was going on in their lives and in the context of how these things affect their health", said Hill-Briggs. "The fight, is that these other things seem to be more immediate, because if today will be a crisis, it is the focal point of Diabetes is still there. They understand that diabetes can be a priority, and problem solving to respond when help is needed . "We helped improve their personal care of diabetes by reliable capacity to address the problems that arise every day that have their game plan."
This study was funded by grants from the national heart, lung and Blood Institute, the American Diabetes Association, Centre for the national health research resources national institutes and the National Institute of Diabetes and digestive diseases, and kidney.
The other authors of the study, of Johns Hopkins University, are Mariana bond, MD, PhD.; Mark Peyrot, PhD.; Angela Doswell, B.A.; Yi-Ting Chang, Sc.M.; Martha n. Hill, PhD.; David Levine, M.D., SCD. NTS - Yuh Wang, PhD.; and Frederick l. Brancati, M.D., m.h.s.
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