- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01425866
Two Years Maintenance of Structured Group Self-management Education in Type 2 Diabetes : a Randomized Controlled Trial (ERMIES)
January 4, 2024 updated by: Centre Hospitalier Universitaire de la Réunion
Multicenter Randomized Trial of Structured Educational Intervention at the Community Level in Insufficiently Controlled Patients With Type 2 Diabetes in Reunion Island
Type 2 diabetes has a growing impact on populations and public health worldwide.
Clinical trials have clearly demonstrated that a better control of blood glucose level and of other risk factors is efficient in preventing or retarding the complications of the disease.
On Reunion island, Type 2 diabetes is present in 18% of population aged 30 or older with a high level of socio-economic deprivation.
The hypothesis of the ERMIES study is that a structured group self-management education maintained at the community level for 2 years in patients with insufficiently controlled type 2 diabetes has better metabolic results (as attested by improvement in HbA1c level) at 2 yrs, compared to an initial short term (< 3 months) self-management program, based on the same theoretical basis and framework (learning nests empowerment).
A total of 240 adults living in Reunion Island, with type 2 diabetes mellitus with HbA1c ≥ 7.5% on a stable treatment for at least 3 months will be randomly allocated to 2 intervention arms: either a short term (< 3 months) program (1 to 7 thematic 2-hr long sessions depending on individual assessment), or a long term program including the same initial program as 1st arm, but with group self management education sessions, maintained for 2 years (4-monthly assessment, empowerment, and contextual action planning; facultative additional specific thematic sessions being delivered if needed).
Medical visits will be held quarterly for the recording of outcome measures (HbA1c, blood pressure, anthropometrics, tobacco consumption, diabetes complications) and yearly for blood glucose, lipids, micro-albuminuria or proteinuria, creatinine clearance, diet and exercise (questionnaires), treatment recording, quality of life, self-efficacy, anxiety and depression scales, and social support.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Randomised clinical trial comparing 2 parallel arms of educational intervention with the hypothesis of the superiority of a 2-year maintenance of a structured, theoretically-based, educational follow-up.
All subjects of both arms will beneficiate from an initial structured educational program (< 3-months).
Subjects, educators, and investigators will be unaware of the group allocation during this initial round.
Then the intervention arm will undergo a 2 years self management educational follow-up program.
Randomisation will be stratified on 2 factors : centres (5 strata) and anti diabetic treatment (2 strata: insulin-treated or not).
All group sessions (3-10 subjects, 2 hr-long, one assessment group session and 6 facultative additional specific sessions for each round [initial in both arms or follow-up in the intervention arm], as needed and planned during the first) will be held at the community level, as closer as possible to the subjects' residence.
Educators are specifically trained and the educational sessions are structured and coordinated in the framing and organisational supervision of the health management network "ReuCARE" in Reunion island.
Subjects of both arms will continue quarterly to attend at the outpatient clinic of the centre.
This trial is associated to a qualitative ethno-sociological study on a sample of 30-40 subjects, with in-depth interviews and ethnographic observation of group sessions, with the specific aim of describing the learning processes, coping, health and functional literacy, social and contextual issues.
Study Type
Interventional
Enrollment (Actual)
132
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Saint Denis De La Réunion, France, 97405
- Department of endocrinology, University Hospital Reunion Island - Felix Guyon Site
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La Réunion
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Saint Benoît, La Réunion, France, 97470
- Groupe Hopitalier Est Réunion
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Saint Paul, La Réunion, France, 97863
- Centre Hospitalier Gabriel Martin
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Saint Pierre, La Réunion, France, 97448
- Diabetolgy - UNiversity Hospital Sud Réunion
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Type 2 diabetes
- HbA1c ≥ 7,5% more than 3 months
- Adults
- ≥ 1 year ADO and/or insulin and/or GLP-1 analog
- antidiabetic treatment unchanged since 3 months (no change of treatment in the last 3 months, except for insulin dosage)
- Living in Reunion Island
- Affiliated to French national health insurance
- Signed informed consent
Exclusion Criteria:
- Treatment or associated conditions that would influence glycemic control, such as corticotherapy, cancer, inflammatory chronic diseases
- Hospitalisation linked to diabetes < 3 months
- Structured patient education in the past 3 months
- Severe diabetes complications (e.g. ischemic or proliferative retinopathy, severe renal failure (clearance < 15 ml/min), acute ischemic heart disease (< 6 months, foot lesion)
- Pregnancy (on-going or planned during the study)
- Evolutive cancer
- Physical or cognitive heavy handicap
- Concomitant participation to a therapeutic trial
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 2 years self management education
Long-term program including initial self-management education program (1 to 7 sessions, based on individual assessment), and follow-up group sessions maintained for 2 years (4-monthly assessment, empowerment, and contextual action planning; facultative additional specific thematic sessions being delivered if needed).
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After an initial intensive group education, four-monthly follow-up self-management group education sessions for 2 years.
Each session is based on empowerment, socio-constructivism, social learning theory: personalized assessment (BG and risk factors, actions: realized, planned, achieved (or not), cognitive work, analysis of individual and social context and environment (facilitators, obstacles) then action planning.
Specific additional sessions can be scheduled (food management, diabetes treatment and hypoglycemia, exercise, self monitoring of BG, insulin dosage, foot care).
Sessions are framed, and structured, with patient booklet support.
Sessions are delivered at the community level, by trained registered nurses, under the coordination of the health management network Reucare.
|
Active Comparator: Initial self-management education
Initial self-management group education: 1 to 7 sessions (< 3 months), based on individual assessment.
|
After an initial intensive group education, four-monthly follow-up self-management group education sessions for 2 years.
Each session is based on empowerment, socio-constructivism, social learning theory: personalized assessment (BG and risk factors, actions: realized, planned, achieved (or not), cognitive work, analysis of individual and social context and environment (facilitators, obstacles) then action planning.
Specific additional sessions can be scheduled (food management, diabetes treatment and hypoglycemia, exercise, self monitoring of BG, insulin dosage, foot care).
Sessions are framed, and structured, with patient booklet support.
Sessions are delivered at the community level, by trained registered nurses, under the coordination of the health management network Reucare.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Mean change in glycated haemoglobin (GlyHb)
Time Frame: 0 and 2 years
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0 and 2 years
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean change in glycated haemoglobin (GlyHb)
Time Frame: 0 and 1 year
|
0 and 1 year
|
|
change in GlyHb
Time Frame: quarterly up to 2 yrs
|
quarterly up to 2 yrs
|
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Blood sugar and lipids
Time Frame: 1 and 2 yrs
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Blood sugar Total, HDL and LDL cholesterol, triglycerides
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1 and 2 yrs
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diabetes complications
Time Frame: 1 and 2 yrs
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retinopathy stages, micro-albuminuria or proteinuria, creatinine clearance, foot risk grade, ischemic heart or cerebral disease
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1 and 2 yrs
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health behaviours
Time Frame: 1 and 2 yrs
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physical activity and diet (Baecke and food frequency questionnaires)
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1 and 2 yrs
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anti-diabetic therapy
Time Frame: 1 and 2 yrs
|
type, dosage
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1 and 2 yrs
|
health care process
Time Frame: 1 and 2 yrs
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medical follow-up and appointments, compliance (questionnaire)
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1 and 2 yrs
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Psychometric scales
Time Frame: 1 and 2 yrs
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self-efficacy, social support, HAD (anxiety and depression)
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1 and 2 yrs
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Quality of Life
Time Frame: 1 and 2 yrs
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short DQOL adapted and validated for Reunion
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1 and 2 yrs
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Change in tobacco consumption
Time Frame: quarterly up to 2 yrs
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quarterly up to 2 yrs
|
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Change in fasting blood glucose
Time Frame: quarterly up to 2 yrs
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quarterly up to 2 yrs
|
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Change in body mass index
Time Frame: quarterly up to 2 yrs
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quarterly up to 2 yrs
|
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Change in waist circumference
Time Frame: quarterly up to 2 yrs
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quarterly up to 2 yrs
|
|
Change in blood pressure
Time Frame: quarterly up to 2 yrs
|
quarterly up to 2 yrs
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Xavier Debussche, MD, Diabetology - University Hospital Reunion Island - Felix Guyon Site
- Principal Investigator: Jean Luc YVIN, MD, Department of Internal Medicine - University Hospital Reunion Island - Felix Guyon Site
- Principal Investigator: Stéphane SCHNEEBELI, MD, Diabetology - University Hospital Reunion Island - GHSR
- Principal Investigator: Jean Hugues GATINA, MD, Centre Hospitalier Gabriel Martin
- Principal Investigator: Yogananda THIRAPATHIAPPADU, MD, Groupe Hospitalier Est Réunion
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Debussche X, Balcou-Debussche M, Ballet D, Caroupin-Soupoutevin J. Health literacy in context: struggling to self-manage diabetes - a longitudinal qualitative study. BMJ Open. 2022 Jun 14;12(6):e046759. doi: 10.1136/bmjopen-2020-046759.
- Debussche X, Collin F, Fianu A, Balcou-Debussche M, Fouet-Rosiers I, Koleck M, Favier F. Structured self-management education maintained over two years in insufficiently controlled type 2 diabetes patients: the ERMIES randomised trial in Reunion Island. Cardiovasc Diabetol. 2012 Aug 2;11:91. doi: 10.1186/1475-2840-11-91.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 1, 2011
Primary Completion (Actual)
September 1, 2016
Study Completion (Actual)
September 1, 2016
Study Registration Dates
First Submitted
August 26, 2011
First Submitted That Met QC Criteria
August 29, 2011
First Posted (Estimated)
August 30, 2011
Study Record Updates
Last Update Posted (Actual)
January 5, 2024
Last Update Submitted That Met QC Criteria
January 4, 2024
Last Verified
January 1, 2024
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2010/CHR/03
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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