Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus

Miguel A Salinero-Fort, Enrique Carrillo-de Santa Pau, Francisco J Arrieta-Blanco, Juan C Abanades-Herranz, Carmen Martín-Madrazo, Berta Rodés-Soldevila, Carmen de Burgos-Lunar, Miguel A Salinero-Fort, Enrique Carrillo-de Santa Pau, Francisco J Arrieta-Blanco, Juan C Abanades-Herranz, Carmen Martín-Madrazo, Berta Rodés-Soldevila, Carmen de Burgos-Lunar

Abstract

Background: Individual health education is considered to be essential in the overall care of patients with type 2 diabetes (DM2), although there is some uncertainty regarding its metabolic control benefits. There have been very few randomized studies on the effects of individual education on normal care in DM2 patients with a control group, and none of these have assessed the long-term results. Therefore, this study aims to use this design to assess the effectiveness of the PRECEDE (Predisposing, Reinforcing, Enabling, Causes in Educational Diagnosis, and Evaluation) education model in the metabolic control and the reduction of cardiovascular risk factors, in patients with type 2 diabetes.

Methods: An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area (Spain). Six hundred patients with DM2 were randomized in two groups: PRECEDE or conventional model for health promotion education. The main outcome measures were glycated hemoglobin A1c, body mass index (BMI), blood pressure, lipids and control criteria during the 2-year follow-up period.

Results: Glycated hemoglobin A1c and systolic blood pressure (SBP) levels decreased significantly in the PRECEDE group (multivariate analysis of covariance, with baseline glycated hemoglobin A1c, SBP, and variables showing statistically significant differences between groups at baseline visits). The decrease levels in diastolic blood pressure (DBP), triglycerides and LDL cholesterol were nonsignificant. PRECEDE increased compliance in all control criteria, except for LDL cholesterol. BMI did not change during the study in either of the two models analyzed.

Conclusions: PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes, which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria, except for LDL cholesterol.

Trial registration number: ClinicalTrials.gov NCT01316367.

Figures

Figure 1
Figure 1
Flow Diagram of participants. HPE: Health Promotion Education.
Figure 2
Figure 2
Contents of the PRECEDE health promotion education model.

References

    1. González EL, Johansson S, Wallander MA, Rodríguez LA. Trends in the prevalence and incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health. 2009;63:332–6. doi: 10.1136/jech.2008.080382.
    1. Valdés S, Rojo-Martínez G, Soriguer F. Evolution of prevalence of type 2 diabetes in adult Spanish population. Med Clin (Barc) 2007;129:352–5. doi: 10.1157/13109554.
    1. Roper NA, Bilous RW, Kelly WF, Unwin NC, Connoly VM. Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ. 2001;11:122–39.
    1. Bianchi C, Miccoli R, Penno G, Del Prato S. Primary prevention of cardiovascular disease in people with dysglycemia. Diabetes Care. 2008;31(suppl 2):S208–14.
    1. American Diabetes Association. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008;31:596–615.
    1. Green LW, Kreuter MW. Health Program Planning: An Educational and Ecological Approach. 4. New York: McGraw-Hill Higher Education; 2005.
    1. Chiang LC, Huang JL, Lu CM. Educational diagnosis of self-management behaviours of parents with asthmatic children by triangulation based on PRECEDE-PROCEED model in Taiwan. Patient Education and Counselling. 2003;49:19–25. doi: 10.1016/S0738-3991(02)00037-X.
    1. Sjöström M, Karlsson AB, Kaati G, Yngve A, Green LW, Bygren LO. A four week residential program for primary health care patients to control obesity and related heart risk factors: effective application of principles of learning and lifestyle change. Eur J Clin Nutr. 1999;53(Suppl 2):S72–7.
    1. Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009. p. CD005268.
    1. Conferencia Nacional de Diabetes Mellitus. Ministerio de Sanidad y Consumo Madrid. 1994.
    1. Haynes RB, Sackett DL, Snow JC, Sackett DL. In: Compliance in health care. Haynes RB, Taylor DW, Sackett DL, editor. Baltimore (MD): Johns Hopkins University Press; 1979. Annotated and indexed bibliography on compliance with therapeutic and preventive regimens; pp. 337–42.
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. the National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52. doi: 10.1161/01.HYP.0000107251.49515.c2.
    1. Vickers AJ, Altman DG. Analysing controlled trials with baseline and follow up measurements. BMJ. 2001;323:1123–24. doi: 10.1136/bmj.323.7321.1123.
    1. Samaras K, Ashwell S, Mackintosh AM, Fleury AC, Campbell LV, Chisholm DJ. Will older sedentary people with non-insulin-dependent diabetes mellitus start exercising? A health promotion model. Diabetes Res Clin Pract. 1997;37:121–8. doi: 10.1016/S0168-8227(97)00061-2.
    1. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25:1159–71. doi: 10.2337/diacare.25.7.1159.
    1. Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, Dallosso HM, Daly H, Doherty Y, Eaton S, Fox C, Oliver L, Rantell K, Rayman G, Khunti K. Diabetes Education and Self Management for Ongoing and Newly Diagnosed Collaborative. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336:491–5. doi: 10.1136/.
    1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet. 1998;352:837–53.
    1. The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.
    1. Hiss RG, Gillard ML, Armbruster BA, McClure LA. Comprehensive evaluation of community-based diabetic patients: effect of feedback to patients and their physicians: a randomized controlled trial. Diabetes Care. 2001;24:690–4. doi: 10.2337/diacare.24.4.690.
    1. Ko GT, Li JK, Kan EC, Lo MK. Effects of a structured health education programme by a diabetic education nurse on cardiovascular risk factors in Chinese Type 2 diabetic patients: a 1-year prospective randomized study. Diabet Med. 2004;21:1274–9. doi: 10.1111/j.1464-5491.2004.01329.x.
    1. Shibayama T, Kobayashi K, Takano A, Kadowaki T, Kazuma K. Effectiveness of lifestyle counseling by certified expert nurse of Japan for non-insulin-treated diabetic outpatients: a 1-year randomized controlled trial. Diabetes Res Clin Pract. 2007;76:265–8. doi: 10.1016/j.diabres.2006.09.017.
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. 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.
    1. Gary TL, Bone LR, Hill MN, Levine DM, McGuire M, Saudek C, Brancati FL. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med. 2003;37:23–32. doi: 10.1016/S0091-7435(03)00040-9.
    1. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286:1218–27. doi: 10.1001/jama.286.10.1218.
    1. Scain SF, Friedman R, Gross JL. A structured educational program improves metabolic control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Educ. 2009;35:603–11. doi: 10.1177/0145721709336299.
    1. Spann SJ, Nutting PA, Galliher JM, Peterson KA, Pavlik VN, Dickinson LM, Volk RJ. Management of type 2 diabetes in the primary care setting: a practice-based research network study. Ann Fam Med. 2006;4:23–31. doi: 10.1370/afm.420.
    1. Jackson GL, Edelman D, Weinberger M. Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients. J Gen Intern Med. 2006;21:1050–6. doi: 10.1111/j.1525-1497.2006.00519.x.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir