Comparative Effectiveness of Goal Setting in Diabetes Mellitus Group Clinics: Randomized Clinical Trial
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BACKGROUND: Diabetes mellitus (DM) group clinics can effectively control hypertension, but data to support glycemic control are equivocal. This study evaluated the comparative effectiveness of 2 DM group clinic interventions on glycosylated hemoglobin (HbA(1c)) levels in primary care. METHODS: Eighty-seven participants were recruited from a DM registry of a single regional Veterans Affairs medical center to participate in an open, randomized comparative effectiveness study. Two primary care-based DM group interventions of 3 months' duration were compared. Empowering Patients in Care (EPIC) was a clinician-led, patient-centered group clinic consisting of 4 sessions on setting self-management action plans (diet, exercise, home monitoring, medications, etc) and communicating about progress with action plans. The comparison intervention consisted of group education sessions with a DM educator and dietician followed by an additional visit with one's primary care provider. Hemoglobin A(1c) levels were compared after intervention and at the 1-year follow-up. RESULTS: Participants in the EPIC intervention had significantly greater improvements in HbA(1c) levels immediately following the active intervention (8.86%-8.04% vs 8.74%-8.70% of total hemoglobin; mean [SD] between-group difference 0.67% [1.3%]; P=.03), and these differences persisted at the 1 year follow-up (0.59% [1.4%], P=.05). A repeated-measures analysis using all study time points found a significant time-by-treatment interaction effect on HbA(1c) levels favoring the EPIC intervention (F(2,85)=3.55; P=.03). The effect of the time-by-treatment interaction seems to be partially mediated by DM self-efficacy (F(1,85)=10.39; P=.002). CONCLUSION: Primary care-based DM group clinics that include structured goal-setting approaches to self-management can significantly improve HbA(1c) levels after intervention and maintain improvements for 1 year. Trial Registration clinicaltrials.gov Identifier: NCT00481286.
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A personalized educational approach leveraging a multidisciplinary team leads to greater self-management skills.
“A personalized educational approach to persons with DM, leveraging members of a multidisciplinary team, will lead to greater self-management skills.1459–1463”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1462]
The Methods (Interventions; page not available) describe personalized goals and action plans in the EPIC intervention, and the Results (Outcome Measures; page not available) report greater diabetes self-efficacy at three months than with traditional education. But the EPIC sessions were directed by primary care physicians; the nurse educator and dietician led the traditional-education comparator. The paper therefore does not establish that a personalized approach leveraging a multidisciplinary team led to greater self-management skills, and the self-efficacy difference was not significant at one year. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDiabetes self-management education and support interventions incorporating behavioral strategies were associated with better outcomes.
“Better outcomes were reported for DSMES interventions that were more than 10 h over the course of 6-12 months (20), included ongoing support (14,32), were culturally (33)(34)(35) and age appropriate (36,37), were tailored to individual needs and preferences, addressed psychosocial issues, and incorporated behavioral strategies (15,26,38,39).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [39]
Diabetes self-management education and support interventions tailored to individual needs and preferences were associated with better outcomes.
“Better outcomes were reported for DSMES interventions that were more than 10 h over the course of 6-12 months (20), included ongoing support (14,32), were culturally (33)(34)(35) and age appropriate (36,37), were tailored to individual needs and preferences, addressed psychosocial issues, and incorporated behavioral strategies (15,26,38,39).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [39]
Diabetes self-management education and support interventions addressing psychosocial issues were associated with better outcomes.
“Better outcomes were reported for DSMES interventions that were more than 10 h over the course of 6-12 months (20), included ongoing support (14,32), were culturally (33)(34)(35) and age appropriate (36,37), were tailored to individual needs and preferences, addressed psychosocial issues, and incorporated behavioral strategies (15,26,38,39).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [39]
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- Authors
- Naik, A. D., Palmer, N., Petersen, N. J., Street, R. L., Rao, R., Suarez-Almazor, M., & Haidet, P.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- Pennsylvania State University (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2011-03-14
- Volume
- 171
- Issue
- 5
- Pages
- 453-9
- ISSN
- 0003-9926 (ISSN-L)
- PMC
- PMC3132209
- OpenAlex
- W2063557707
- Cited by
- 176
- References
- 33
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 7 · 2023: 4 · 2022: 6 · 2021: 10 · 2020: 10 · 2019: 14 · 2018: 14 · 2017: 18 · 2016: 15 · 2015: 14 · 2014: 17 · 2013: 17 · 2012: 18
- FWCI
- 15.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (U18HS016093)
- National Institute on Aging (K23AG027144)
- National Cancer Institute (R25CA057712, R25CA122061)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, goal setting, HbA1c, glycemic control, diabetes self-efficacy, patient-centered care, primary care, veterans, diabetes education
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Patient Care Planning, Primary Health Care, Treatment Outcome
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