A structured goal-setting approach can improve care outcomes for patients with type 2 diabetes
Self-management skills are critical to reducing morbidity and use of health services for older patients with both diabetes mellitus and other diseases. Delivery of effective self-management education and support can be difficult in traditional primary care. But a new study shows that structured goal-setting approaches to diabetes self-management can significantly reduce hemoglobin A1 (HbA1c, an indicator of blood-glucose levels). The researchers tested two alternative diabetes clinic approaches in 87 older veterans with treated, but uncontrolled diabetes (HbA1c 7 percent or higher).
Patients who participated in the structured goal-setting approach known as "Empowering Patients in Care" (EPIC), had significantly greater improvements in HbA1c immediately following the active intervention (HbA1c declined from 8.86 to 8.04 percent) in the EPIC intervention group, whereas it declined from 8.74 to 8.70 in the education-usual care group), and these differences persisted at the 1 year follow-up.
The EPIC approach trained patients to integrate their health care providers' treatment plans into collaborative self-management goals and action plans. The other approach consisted of diabetes group education plus routine primary care. The EPIC intervention consisted of four group sessions every 3 weeks over a 3-month period. Each session consisted of 1 hour of group interaction led by a study clinician trained in goal setting and action planning methods, and 10 minutes of individual interaction with the study clinician.
The group education approach consisted of two group sessions led by a diabetes nurse educator and a certified dietician, and individual sessions with the nurse educator and the primary care provider. This study was supported by the Agency for Healthcare Research and Quality (HS16093).
See "Comparative effectiveness of goal setting in diabetes mellitus group clinics," by Aanand D. Naik, M.D., Nynikka Palmer, Dr.P.H., Nancy J. Petersen, Ph.D., and others in the March 14, 2011, Archives of Internal Medicine 171(5), pp. 453-459.
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