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.
| Weinger, Katie; Beverly, Elizabeth A; Smaldone, Arlene (2014) Diabetes self-care and the older adult. West J Nurs Res 36:1272-98 |
| Beverly, Elizabeth A; Fitzgerald, Shane; Sitnikov, Lilya et al. (2013) Do older adults aged 60-75 years benefit from diabetes behavioral interventions? Diabetes Care 36:1501-6 |
| Hirose, Masakazu; Beverly, Elizabeth A; Weinger, Katie (2012) Quality of life and technology: impact on children and families with diabetes. Curr Diab Rep 12:711-20 |
| Beverly, Elizabeth A; Ganda, Om P; Ritholz, Marilyn D et al. (2012) Look who's (not) talking: diabetic patients' willingness to discuss self-care with physicians. Diabetes Care 35:1466-72 |
| Beverly, Elizabeth A; Brooks, Kelly M; Ritholz, Marilyn D et al. (2012) Assessment of emotional struggles in type 2 diabetes: patient perspectives. Diabetes Care 35:e62 |
| Beverly, Elizabeth A; Ritholz, Marilyn D; Brooks, Kelly M et al. (2012) A qualitative study of perceived responsibility and self-blame in type 2 diabetes: reflections of physicians and patients. J Gen Intern Med 27:1180-7 |
| Ritholz, Marilyn D; Beverly, Elizabeth A; Abrahamson, Martin J et al. (2011) Physicians' perceptions of the type 2 diabetes multi-disciplinary treatment team: a qualitative study. Diabetes Educ 37:794-800 |
| Goebel-Fabbri, Ann E; Anderson, Barbara J; Fikkan, Janna et al. (2011) Improvement and emergence of insulin restriction in women with type 1 diabetes. Diabetes Care 34:545-50 |
| Munshi, Medha N; Segal, Alissa R; Suhl, Emmy et al. (2011) Frequent hypoglycemia among elderly patients with poor glycemic control. Arch Intern Med 171:362-4 |
| Weinger, Katie; Beverly, Elizabeth A; Lee, Yishan et al. (2011) The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Arch Intern Med 171:1990-9 |
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