Breaking Down Barriers to Diabetes Self-Care

Joslin Diabetes Center, Boston MA

Investigators

Linked publications & trials

Abstract

Performance of self-care recommendations is key to the successful treatment of diabetes. However, many patients have difficulty adhering to diabetes self-care recommendations. Recent results from our own studies and others have identified specific barriers to diabetes self-care. To evaluate the efficacy of a diabetes educator-led group intervention, the Breaking Down Barriers Program, that addresses barriers and therefore leads to improved adherence to diabetes self-care recommendations, we propose to randomize 222 (111 type 1 and 111 type 2) diabetes patients to one of three conditions: 1) the Breaking Down Barriers Program, 2) a cholesterol attention control condition, or 3) a `usual care' control condition. The first two arms include a group diabetes education program while the usual care arm includes individual appointments with diabetes educators. To maintain the integrity of interventions, each will be taught by a separate team of RN and RD educators. Diabetes educators teaching the Breaking Down Barriers Program will receive special behavioral training that is based on their clinical expertise and education in nursing and nutrition. Patients will be assessed immediately prior to randomization, immediately after completion of the intervention and at 3, 6, and 12 months follow-up. The primary outcomes will be adherence behaviors (e.g. frequency of glucose monitoring, frequency of following medication prescription as ordered) and physiologic outcomes (e.g. HbA[1c], weight, fitness level). Secondary outcomes include health- related quality of life and diabetes-related emotional distress. We will also examine mechanisms linking the intervention's effectiveness to improved adherence. For example, whether use of emotion-based coping styles mediate the effect of the Breaking Down Barriers Program on self-care behaviors. If we find that the Breaking Down Barriers Program is effective in terms of improving self-care behaviors and ultimately physiologic outcomes, we plan to develop training materials to allow the intervention to be used by diabetes educators.