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Evidence-Based Diabetes Management July 2014

Results Presented on Motivating Patients With Diabetes

Mary K. Caffrey
ADA 74th Scientific Sessions
It’s well-known that it’s hard to treat type 1 (T1DM) or type 2 diabetes mellitus (T2DM) if patients fail to take prescribed medications, stick with diets, or follow blood glucose–monitoring regimens. Motivating at-risk groups, such as teenagers with T1DM, or minority populations with T2DM, is especially challenging. The June 14, 2014, poster session at the 74th Scientific Sessions of the American Diabetes Association (ADA) meeting, held at the Moscone Center in San Francisco, California, included the track “Diabetes Self-Management Education: New Methods,” with ideas for both T1DM and T2DM populations.

Teens and Young Adults With T1DM. In an interview earlier this year with Evidence-Based Diabetes Management, Robert Kritzler, MD, a pediatric endocrinologist who is also deputy chief medical officer, John Hopkins Health Care LLC, said the transition from the early teenage years to young adulthood is a challenging time for those with T1DM.1 In short, these patients have all the normal challenges of moving from childhood to adulthood, and when one adds diabetes management to the mix, responsibility for self-care isn’t always perfect.

A pair of abstracts at the poster session looked at this population. A study led by Kathleen C. Garvey, MS,2 reported results from a survey of members of the American Association of Diabetes Educators. The 771 respondents (17% response rate) were overwhelmingly female (96%) and had typically practiced 12 to 15 years. Among the findings:

Most felt that reviewing a young adult’s pediatric records prior to the first adult visit was important (88%), but only 22% reported having time to do so. Most had access to endocrinologists (82%) or dieticians (93%), but fewer had access to mental health referrals (58%). Half reported they would prefer better access to mental health care for their young adult clients. Those without access to mental health referrals reported more problems with young adults suffering from depression, substance abuse, eating disorders, or developmental disabilities.

The educators endorsed more access to education on young adult behavior (90%), better reimbursement (52%), and young adult support groups (83%). A second study examined whether using social media as a tool for glucose management would be as effective as clinic visits in young T1DM adults.3 The authors, from Skopje, Macedonia, used Facebook and Skype with a group of 124 teens and young adults aged 16 to 23 years. They were randomized into 2 groups: the first was treated with standard clinic visits, and the second with social media platforms and Medtronic’s Carelink program. After 6 months, the groups swapped methods of care.

After 1 year, glycated hemoglobin (A1C) levels dropped as follows: from an average of 7.8% to 6.4% in the first group, and from 7.9% to 6.3% in the second group. Both groups maintained A1C levels during the 6 months after the changeover. The authors, led by Goran Petrovski, MD, PhD, concluded that both methods worked, but that the young adults preferred the social media visits to coming to the clinic.

At-Risk Populations With T2DM. Poor medication adherence is a problem across medicine, but it’s a particular problem among the demographic groups with disproportionate levels of T2DM. Patients who are poor, less educated, and lacking access to better food or knowledge of how to follow a healthy diet are also less likely to stick with a medication regimen. Several abstracts  examined efforts to improve adherence to medication and lifestyle changes among adults with T2DM—and showed just how stubborn the problem can be.

Robert M. Mayberry, PhD, MS, MPH, professor of epidemiology at Morehouse School of Medicine in Atlanta, Georgia, and his co-authors incorporated evidence-based medication use into patient self-care at a federally qualified health center (FQHC). A prior study found that 90% of African American adults with T2DM at this center did not take medication as prescribed. Mayberry’s
study engaged a community health worker and used motivational interviewing (MI) techniques to adapt an education program to these patients. A group of 460 adults were randomly assigned to a worker using MI techniques, as well as peer support, or a worker delivering general education. Patients were followed each month for a year.

The group receiving the MI intervention showed significant improvements in A1C levels right after the intervention, but there was no significant difference in A1C improvement between the 2 groups. However, the intervention group showed improvement in scores on the PACIC survey (Patient Assessment of Chronic Illness Care).4

Results from the IDEA trial (Improving Diabetes through Examining and Advising)5 examined whether patients who knew the nature of their diabetes risk would be more willing to stick with a lifestyle modification program. Low, moderate, and high-risk scores were assigned to 192 patients at baseline, and they were divided into 2 groups. In the first group, patients were told their
risk at the outset; in the other, they were not told until week 12. The groups started with similar characteristics, and at 12 weeks there was little difference in attendance or weight loss (average of 10.08 lb for intervention group vs 9.66 lb for control). At 12 weeks, both groups were given risk information, including the previously unseen baseline for the control group. At 24 weeks, the control group continued to lose weight (2.63 lb average), while the intervention group gained (0.93 lb average). Thus, the knowledge of a baseline did not affect compliance with a lifestyle intervention, but the researchers concluded that those who were given information about their prior risk, and how much they had improved, were shown to have improved adherence.
References

1. Mehr S. Managing the transition to adulthood with type 1 diabetes mellitus: an interview with Robert Kritzler, MD, pediatric endocrinologist and deputy chief medical officer, Johns Hopkins Health Care LLC. Am J Manag Care. 2014;20(SP4):SP120-SP126.

2. Garvey KC, Finkelstein JA, Forbes PW, Laffel LM. Health care transitions in young adults with type 1 diabetes: national survey of diabetes educators in the United States. Diabetes. 2014;63(suppl 1):Abstract 673-P.

3. Petrovski G, Zivkovic M, Milenkovic T, et al. One-year experience using social media as tool to improve glucose control in adolescents with type 1 diabetes: a crossover study. Diabetes. 2014;63(suppl 1):Abstract 674-P.

4. Mayberry RM, Daniels P, Willock RJ. Adaptation, education, and motivation: improving evidence-based medication adherence among adults with T2DM. Diabetes. 2014;63(suppl 1): Abstract 676-P.

5. True MW, Strickland LE, Lewi JE, et al. Impact of a diabetes risk score on lifestyle education and patient adherence (IDEA): a randomized, controlled trial. Diabetes. 2014;63(suppl 1):Abstract 679-P.
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