Guided self-determination improves life skills with Type 1 diabetes and A1C in randomized controlled trial |
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| Institution: | 1. Institute of Public health, Department of Nursing Science, University of Aarhus, Denmark, Hoegh Guldbergsgade 6a. 8000 Aarhus C, Denmark;2. Institute of Public Health, Department of General Practice, University of Aarhus, Denmark;1. University of Padova, Department of Medicine (DIMED), Padova, Italy;2. University of Padova, Department of Information Engineering (DEI), Padova, Italy;1. Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany;2. Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62–66, 12101 Berlin, Germany;1. Division of Community Internal Medicine, Mayo Clinic, Jacksonville, USA;2. Department of Family Medicine, Mayo Clinic, Jacksonville, USA;3. Department of Biostatistics, Vanderbilt University, Nashville, USA;4. School of Nursing, Vanderbilt University Medical Center, Nashville, USA;5. Department of Medicine, Vanderbilt University Medical Center, Nashville, USA;6. Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA;2. School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D’Olier Street, Trinity College Dublin, Dublin 2, Ireland;3. Department of Endocrinology and Diabetes, Children’s Health Ireland, Tallaght, Dublin 24, Ireland;4. Department of Diabetes and Endocrinology, Children’s Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland;5. School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland;6. University of North Carolina at Chapel Hill, Chapel Hill, NC, United States;1. Department of Endocrinology and Diabetes, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia;2. Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia;3. Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia;4. Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia;5. Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia;6. School of Medicine, Flinders University, Adelaide, South Australia, Australia;7. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia;8. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia;9. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia;10. Department of Paediatrics, University of Otago, Christchurch, New Zealand;11. Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia;12. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia;13. NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia;14. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia;15. Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Tasmania, Australia;p. Cairnmillar Institute, Melbourne, Victoria, Australia;q. Department of Pathology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia;r. Department of Public Health, La Trobe University, Australia;s. Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia;t. Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia;u. School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia;1. Juliane Marie Centre, Research Unit Women''s and Children''s Health Dept. 7821, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;2. Juliane Marie Centre, Dept. 4074, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;3. Juliane Marie Centre, Gynaecology Dept. 4232, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;4. Finsencenter, Oncology Dept. 5074, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark |
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| Abstract: | ObjectiveTo report 1-year results of newly developed method, guided self-determination (GSD), applied in group training (GSD-GT) for Type 1 diabetes patients with persistent poor glycaemic control.MethodsGSD was designed on the basis of qualitative research to help patients develop life skills with diabetes using worksheets filled in at home and coached by nurses in mutual reflection. We randomized 18–49-year-old adults at a Danish university hospital to either 16 h GSD-GT in 2001 or to similar training 1 year later. Inclusion criteria: mean A1C ≥ 8.0% for at least 2 years, disease onset ≤40 years and insulin treatment from onset.ResultsThirty GSD-GT patients and 20 controls completed the study. GSD-GT patients did better than control patients in terms of (a) increased autonomy support perceived from health professionals (p < 0.01); (b) higher frequency of self-monitored blood glucoses (p < 0.001); (c) increased perceived competence in managing diabetes (p < 0.01); (d) fewer diabetes-related problems (p < 0.05); and (e) improved glycaemic control (p < 0.01).ConclusionGSD was effective in improving life skills with diabetes, including A1C, over a period of 1 year.Practice implicationsGSD is a worthy candidate for further research. We consider it adjustable to people with type 2 diabetes and other chronic conditions. |
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