Evaluating the effectiveness of an empowerment program for self-care in type 2 diabetes: a cluster randomized trial

Daniel Nogueira Cortez, Maísa Mara Lopes Macedo, Débora Aparecida Silva Souza, Jéssica Caroline Dos Santos, Gesana Sousa Afonso, Ilka Afonso Reis, Heloísa de Carvalho Torres, Daniel Nogueira Cortez, Maísa Mara Lopes Macedo, Débora Aparecida Silva Souza, Jéssica Caroline Dos Santos, Gesana Sousa Afonso, Ilka Afonso Reis, Heloísa de Carvalho Torres

Abstract

Background: The prevalence of type 2 diabetes mellitus is increasing substantially worldwide, leading to serious economic effects, complications and deaths. This study evaluated the effectiveness of an empowerment program providing support for psychosocial, behavioral, and clinical aspects of diabetes to help Brazilian users of public health services obtain metabolic control of this condition.

Methods: In this cluster randomized trial, participants aged 30-80 diagnosed with type 2 diabetes were recruited from ten Brazilian public health units in 2014 and 2015. Five units were randomly assigned to receive the empowerment program based on a behavior change protocol, and five continued to receive only conventional treatment. The primary outcome was the biochemical and anthropometric parameters, and the secondary outcomes were self-care, attitude, knowledge and empowerment related to diabetes. The effect of the experiment was defined as the percentage variation between the values at the initial and final periods. To evaluate this effect and to compare it in the two groups, tests were used for paired and independent samples, respectively.

Results: There were 238 participants: 127 and 111 in the intervention and control group, respectively. For glycated hemoglobin, the mean effect in the control and intervention groups was 3.93 and -5.13, respectively (p < 0.001). Levels of glycated hemoglobin and other metabolic indicators, as well as the most part of the secondary outcomes showed a significant difference in the experimental group compared to the control group.

Conclusions: The empowerment program improved metabolic control of type 2 diabetes in Brazilian users.

Trial registration: NCT02132338 - April 22, 2014.

Keywords: Diabetes type 2; Health education; Primary health care; Randomized controlled trial; Self care.

Figures

Fig. 1
Fig. 1
Model of the empowerment program for self-care in diabetes mellitus
Fig. 2
Fig. 2
Diagram of the progress of clusters and individuals in the phases of the randomized trial
Fig. 3
Fig. 3
Percentual variations (∆-delta symbol) in measurements between Tf and Ti fir IG and CG. Statistically significant differences between means for IG and CG are marked with * (p <0.05). DG: control group; IG: intervention group; HbA1c: glycated hemoglobin; DBP: diastolic blood pressure; SLC: self-care for type 2 diabetes; KNW; knowledge for type 2 diabetes; ATT: attitude for type 2 diabetes; EPW: empowerment for type 2 diabetes; TC; total cholesterol; LDL: low density lipoprotien; HDL: high density lipoprotein

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Source: PubMed

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