BOSTON – A family-focused diabetes self-management education program was feasible, well received, and more effective in African American patients with type 2 diabetes who brought along a household family member than among those who participated alone, according to findings from a randomized study.
In 21 participants who were randomized to attend the diabetes self-management education (DSME) program with a household family member or companion (HFMC), and who completed the study, significant reductions were seen at 3 months in body mass index, blood pressure, and cholesterol levels, but the same was not true among 27 participants who attended alone, Natasha Greene, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.
BMI among those who brought an HFMC was reduced from 37.4 to 36.6, while those who attended alone experienced a reduction from 36 to 35.7. Mean systolic blood pressure was reduced from 154.2 mm Hg to 139.5 mm Hg, and from 146.3 mm Hg to 140.2 mm Hg in the groups, respectively. Mean diastolic blood pressure was reduced from 75 mm Hg to 69 mm Hg, and increased from 72.2 mm Hg to 73.5 mm Hg in the groups, respectively, said Dr. Greene of North Carolina Central University, Durham.
Mean total cholesterol was reduced from 175.7 mg/dL to 164.1 mg/dL, and increased from 167.2 mg/dL to 171.3 mg/dL and low density lipoprotein cholesterol was reduced from 106 mg/dL to 96.3 mg/dL, and increased from 95 mg/dL to 99 mg/dL in the groups, respectively, she said, noting that hemoglobin A1c levels improved, but not significantly, in either group.
“DSME interventions have drastically increased over the last 10 years. Most interventions have been successful, but statistically significant outcomes either weakened after 6-12 months or completely disappeared,” Dr. Greene said, adding that it is “therefore essential to develop some interventions that have sustainable outcomes, especially in African Americans.”
African Americans continue to experience higher rates of diabetes prevalence, complications, and premature age-adjusted deaths, compared with non-Hispanic European Americans, she explained.
“Moreover, African Americans report difficulty following recommendations because the regimens interfere with work, family life, beliefs, family food preferences, and the socialization of the African Americans within their environment,” she said.
The DSME program developed for this study thus focused on family interactions within the African American family in the context of health and nutrition. The curriculum was conceptually based on the family interaction theory, “loose adaptation” of a number of published curricula, and the clinical experiences of the investigators, including a family nurse practitioner, a family psychologist, and a licensed dietitian, Dr. Greene noted.
Four community lay persons and two dietitians were trained to implement the intervention, which included three classes related to diabetes, one on exercise, and four related to nutrition; all classes addressed family interactions, including communication, problem solving, and negotiation skills that would encourage a goal of health behaviors for the entire family.
Patients who participated were over age 40 years (mean of 58.9 years), and had been diagnosed at least 1 year prior to the program. Those in the experimental group were encouraged to select an HFMC who influenced the household diet and other health-related behaviors, and the experimental and control group participants did not differ significantly with respect to any baseline variables.
Classes lasted 1.5 hours each week for 8 weeks, and were held at local community churches; 70% of those in the experimental group and 81% in the control group attended at least six of the eight classes.
The trainers had high “intervention fidelity,” completing the class objectives 90% of the time, and they reported high satisfaction and ease with program implementation. Participants thought the intervention was fun, Dr. Greene said. “Their retention and attendance showed it,” she said, noting that 92% of those enrolled completed the study.
Further, participants consistently rated the program as highly acceptable, either agreeing or strongly agreeing that each class had content that was understandable, useful, and informative, and that the trainer was knowledgeable and the class was interactive.
The program was successful and unique in that it taught participants to think about healthy behaviors and improve communication and negotiation at home, Dr. Greene said.
“We incorporated the family and their interpersonal interactions into the intervention by asking them to think about it and work it out in favor of a healthy change for all,” she said, noting that future studies should investigate sustainability of the program in a larger sample and the possibility of increasing the intervention strength through goal-setting and numerous other measures at the end of each class.