1. A Brief Intervention Using a Web-based Patient Self Management Assessment Tool Improves Blood Glucose Control (HbA1c)
Garry Welch, PhD1 Sofija Zagarins, PhD1 Rebecca Feinberg Shayne, MPH1 Jane Garb, MS2
1Department of Behavioral Medicine Research and 2Department of Academic Affairs, Baystate Medical Center, Springfield MA
Introduction
Background
Computerized patient diabetes self management education (DMSE) assessment tools have shown promise in office-based diabetes education research
May help the diabetes educator in busy clinical settings capture key patient self management data in a systematic, brief, and user-friendly manner
Frees diabetes educator to spend more time developing rapport with the patient and more structured, in-depth diabetes education and skills training
Offers the potential benefit of wide translation to national diabetes education network
15,000 certified diabetes educators and 15,000 diabetes educators in US
Accessible to any educator with a web browser
Research gap
These computerized assessment tools are in an early stage of development
Little research on feasibility and acceptability
Benefits for diabetes outcomes (e.g., hemoglobin A1c levels) are unclear
Current study
The Diabetes Self Care Profile (DSCP) is a web-based, computerized DSME assessment tool that has been developed by our group
$15,000 to develop
Applied within a larger clinical trial evaluating novel patient centered counseling approaches to diabetes education
We evaluated the efficacy of the DSCP) to reduce HbA1c in a population of poorly controlled (HbA1c>8%) patients with type 2 diabetes.
This tool:
Briefly assesses diet, exercise, medication, and physical activity behaviors that impact blood glucose control
Identifies one behavior selected by the patient for discussion and associated barriers to self management
Documents psychosocial problems that can impede optimal self management
Depression, diabetes distress, hypoglycemia, low social support, binge eating, alcohol abuse
Attitudes and barriers to commencing insulin therapy if on oral agents
Provides visual feedback on HbA1c control (red, yellow, or green “thermometer”)
Results
Methods
Study Design and Population
Type 2 diabetics with diagnosis >6 months were recruited from the Springfield, MA area
Prospective study with two research assessments (R1 baseline and R2 at 6 months) and four diabetes education sessions with a certified diabetes educator (CDE1 – CDE4)
DSCP assessment conducted at first of 4 education sessions
Research Assessments
Hemoglobin A1c tested at Baystate Reference Laboratory
Behavioral and psychosocial information collected using published questionnaires having satisfactory reliability and construct validity
Self-care inventory (SCI) – Measures diabetes self-care behaviors
Problem Areas in Diabetes (PAID) – Measures diabetes-related emotional distress
Center for Epidemiologic Studies Depression scale (CES-D) – Measures major depression
Diabetes Treatment Satisfaction Questionnaire (DTSQ-change version)
Patient perceptions of importance and self efficacy attitudes regarding diabetes self-care behaviors (medication, glucose self-monitoring, diet, exercise)
Figure 1. Change in SCI and PAID score
from R1 to R2
Discussion
Figure 2. Change in HbA1c from R1 to R2
Effective in terms of HbA1c change when used by Certified Diabetes Educator over a mean of 3.5 intervention sessions
Change in three of the psychosocial measures (SCI, PAID, DTSQ) explained 40% of the variation in HbA1c change
The observed 1% drop in HbA1c correlates to a 37% reduction in micro-vascular complications based on the findings from the United Kingdom Prospective Diabetes Study
Provides a tailored patient summary of key issues and barriers to optimal diabetes self management in a time-efficient (10 minute), easy-to-use format
Potentially scaleable patient self management assessment tool
Web based tool can be updated or modified easily over time
Available to any clinician if a web browser is available.
Can be incorporated into EMR or other clinical information system for nurse, educator, case manager based education and pt. tracking
Future research should explore wider testing and use of DSCP R1 +
HbA1c R2
CDE1
+ DSCP
CDE4
2 weeks
4 weeks
6 weeks
3 months
1 week
CDE3
CDE2