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Cited by 58Diabetes Management and EducationDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

Management of type 2 diabetes in China: the Happy Life Club, a pragmatic cluster randomised controlled trial using health coaches

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Browning, Colette, Chapman, Anna, Yang, Hui, Liu, Shuo, Zhang, Tuohong, Enticott, Joanne C, Thomas, Shane A·2016·BMJ Open
DOI 10.1136/bmjopen-2015-009319PMC PMC4785304
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Abstract

Objective: To assess the effectiveness of a coach-led motivational interviewing (MI) intervention in improving glycaemic control, as well as clinical, psychosocial and self-care outcomes of individuals with type 2 diabetes mellitus (T2DM) compared with usual care. Design: Pragmatic cluster randomised controlled trial (RCT). Setting: Community Health Stations (CHSs) in Fengtai district, Beijing, China. Participants: Of the 41 randomised CHSs (21 intervention and 20 control), 21 intervention CHSs (372 participants) and 18 control CHSs (296 participants) started participation. Intervention: Intervention participants received telephone and face-to-face MI health coaching in addition to usual care from their CHS. Control participants received usual care only. Medical fees were waived for both groups. Outcome measures: Outcomes were assessed at baseline, 6 and 12 months. Primary outcome measure was glycated haemoglobin (HbA1c). Secondary outcomes included a suite of anthropometric, blood pressure (BP), fasting blood, psychosocial and self-care measures. Results: At 12 months, no differential treatment effect was found for HbA1c (adjusted difference 0.02, 95% CI −0.40 to 0.44, p=0.929), with both treatment and control groups showing significant improvements. However, two secondary outcomes: psychological distress (adjusted difference −2.38, 95% CI −4.64 to −0.12, p=0.039) and systolic BP (adjusted difference −3.57, 95% CI −6.08 to −1.05, p=0.005) were robust outcomes consistent with significant differential treatment effects, as supported in sensitivity analyses. Interestingly, in addition to HbA1c, both groups displayed significant improvements in triglycerides, LDL cholesterol and HDL cholesterol. Conclusions: In line with the current Chinese primary healthcare reform, this study is the first large-scale cluster RCT to be implemented within real-world CHSs in China, specifically addressing T2DM. Although a differential treatment effect was not observed for HbA1c, numerous outcomes (including HbA1c) improved in both groups, supporting the establishment of regular, free clinical health checks for people with T2DM in China. Trial registration number: ISRCTN01010526; Pre-results.

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References 32 · Cited by 58

Research works printed but not linked: 27

  1. [2]Xu Y, Wang L, He J Prevalence and control of diabetes in Chinese adults. JAMA 2013; 310: 948– 59. 10.1001/jama.2013.168118 24002281 · DOI
  2. [4]Chen Z Launch of the health-care reform plan in China. Lancet 2009; 373: 1322– 4. 10.1016/S0140-6736(09)60753-4 19376436 · DOI
  3. [5]Pan C Diabetes care in China: meeting the challenge. Diabetes Voice 2005; 50: 9– 12. 16300163
  4. [7]Chinese Diabetes Society. China's prevention and treatment guideline for type 2 diabetes Mellitus (2013 edition). Chin J Diab Mellitus 2014; 6: 447– 98.
  5. [9]Zhu X, Gong Y, Yao S [The effect of biofeedback assisted relaxation training on cytokines in patients with type II diabetes: a follow up study]. Chin J Clin Psychol 2001; 9: 5– 10.
  6. [10]Huang X, Song L, Li T [The effect of social support on type II diabetes with depression]. Chin J Clin Psychol 2001; 9: 187– 9.
  7. [11]Fu M, Dong Y [Effect of psychological intervention on depression symptoms and blood glucose level of patients with diabetes mellitus in China: a meta-analysis]. J Chin Gen Pract 2013; 16: 436– 9.
  8. [12]Browning CJ, Thomas SA Behavioural change: an evidence-based handbook for social and public health. Elsevier/Churchill Livingstone, 2005.
  9. [13]Miller WR, Rollnick S Motivational interviewing: helping people change. 3rd edn New York, NY: Guilford Press, 2012.
  10. [14]Browning C, Chapman A, Cowlishaw S The Happy Life ClubTM study protocol: a cluster randomised controlled trial of a type 2 diabetes health coach intervention. BMC Public Health 2011; 11: 90 10.1186/1471-2458-11-90 21303564 PMC3041664 · DOI
  11. [15]Browning CJ, Yang H, Zhang T Implementing a chronic disease self-management program into China: Happy Life Club™. Front Public Health 2015; 2: 181 10.3389/fpubh.2014.00181 25964910 PMC4410613 · DOI · Paper page
  12. [17]Loudon K, Treweek S, Sullivan F The PRECIS-2 tool: designing trials that are fit for purpose. BMJ 2015; 350: h2147 10.1136/bmj.h2147 25956159 · DOI · Paper page
  13. [19]Campbell MK, Mollison J, Steen N Analysis of cluster randomized trials in primary care: a practical approach. Fam Pract 2000; 17: 192– 6. 10.1093/fampra/17.2.192 10758085 · DOI · Paper page
  14. [20]Kessler RC, Andrews G, Colpe LJ Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32: 959– 76. 10.1017/S0033291702006074 12214795 · DOI · Paper page
  15. [23]Vivienne Wu SF, Courtney M, Edwards H Development and validation of the Chinese version of the Diabetes Management Self-efficacy Scale. Int J Nurs Stud 2008; 45: 534– 42. 10.1016/j.ijnurstu.2006.08.020 17055509 · DOI
  16. [24]Perera R, Heneghan C, Yudkin P Graphical method for depicting randomised trials of complex interventions. BMJ 2007; 334: 127– 9. 10.1136/bmj.39045.396817.68 17235093 PMC1779898 · DOI
  17. [26]Meng Q, Fang H, Liu X Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet 2015; 386: 1484– 92. 10.1016/S0140-6736(15)00342-6 26466052 · DOI
  18. [28]Lewington S, Clarke R, Qizilbash N Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903– 13. 10.1016/S0140-6736(02)11911-8 12493255 · DOI · Paper page
  19. [29]Xu Y, Toobert D, Savage C Factors influencing diabetes self-management in Chinese people with type 2 diabetes. Res Nurs Health 2008; 31: 613– 25. 10.1002/nur.20293 18613066 · DOI
  20. [30]Patsopoulos NA A pragmatic view on pragmatic trials. Dialogues Clin Neurosci 2011; 13: 217– 24. 21842619 PMC3181997
  21. [31]MacPherson H Pragmatic clinical trials. Complement Ther Med 2004; 12: 136– 40. 10.1016/j.ctim.2004.07.043 15561524 · DOI
  22. [32]Browning CJ, Yang H, Zhang T Implementing a chronic disease self-management program into China: the Happy Life ClubTM. Front Public Health 2015; 2: 181. 25964910 PMC4410613
  23. [34]Jansink R, Braspenning J, Keizer E No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial. Scand J Prim Health Care 2013; 31: 119– 27. 10.3109/02813432.2013.797178 23659710 PMC3656395 · DOI
  24. [35]Song D, Xu TZ, Sun QH Effect of motivational interviewing on self-management in patients with type 2 diabetes mellitus: a meta-analysis. Int J Nurs Sci 2014; 1: 291– 7.
  25. [36]Rubak S, Sandbæk A, Lauritzen T Effect of “motivational interviewing” on quality of care measures in screen detected type 2 diabetes patients: a one-year follow-up of an RCT, ADDITION Denmark. Scand J Prim Health Care 2011; 29: 92– 8. 10.3109/02813432.2011.554271 21306296 PMC3347945 · DOI
  26. [37]Heinrich E, Candel MJJM, Schaper NC Effect evaluation of a Motivational Interviewing based counselling strategy in diabetes care. Diabetes Res Clin Pract 2010; 90: 270– 8. 10.1016/j.diabres.2010.09.012 20950883 · DOI
  27. [38]Rosenbek Minet LK, Wagner L, Lønvig EM The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial. Diabetologia 2011; 54: 1620– 9. 10.1007/s00125-011-2120-x 21455729 · DOI · Paper page

Authors
Browning, C., Chapman, A., Yang, H., Liu, S., Zhang, T., Enticott, J. C., & Thomas, S. A.
Affiliations
  • Monash University (AU)
  • Peking University Cancer Hospital (CN)
  • Peking University (CN)
Corresponding author
Chapman, Anna
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2016-03
Volume
6
Issue
3
Pages
e009319
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2015-009319
PMC
PMC4785304
OpenAlex
W2292805247
Cited by
58
References
32
Citations by year
2026: 4 · 2025: 5 · 2024: 2 · 2023: 6 · 2022: 7 · 2021: 8 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 4
FWCI
6.03
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Monash University Research Portal (Monash University) (submittedVersion, cc-by-nc)
  • FedUni ResearchOnline (Federation University Australia) (submittedVersion)
  • Figshare (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Monash University
  • Peking University
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, health coaching, motivational interviewing, glycemic control, HbA1c, community health stations, primary care reform, psychological distress, blood pressure, lipid profile, self-care, China, usual care comparison, differential treatment effects, psychosocial outcomes, anthropometric outcomes, triglycerides, LDL cholesterol
MeSH terms
Aged, Blood Glucose, Blood Pressure, China, Communication, Counseling, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Cholesterol, LDL, Male, Middle Aged, Quality of Life, Regression Analysis, Self Care, Telephone, Multivariate Analysis, Treatment Outcome, Disease Management

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