The Diabetes Control and Complications Trial demonstrated the importance of an ongoing, integrated approach to diabetes management. There is, however, a need for brief, low-intensity behavioral interventions to address self management issues. The present proposal will evaluate and refine such a promising approach for dietary self-management, arguably the most challenging aspect of the regimen for patients with Type II diabetes. This competing renewal application will test two key components of an intervention program based upon the investigators' conceptual model of diabetes self management. It will extend the previous research by determining the importance of follow-up telephone calls to the intervention package, and by evaluating the effectiveness of a new intervention component focused on maximizing social and community resources. The program will also be extended to be offered as a centralized resource for many different primary care practices, and will evaluate the participation rate among eligible patients. Three hundred adult patients with Type II diabetes will be randomly assigned to one of four conditions within a two (phone calls vs. no phone calls) by two (community resources vs. no community resources) design. Outcomes will be evaluated at 3, 6, and 12 month follow-ups on a variety of measures including dietary self management, physiologic (serum lipids, HbA-1-c) and quality of life variables. Process measures will include barriers to self care, awareness and use of community nutrition resources, and personal models of diabetes. At the conclusion of this trial there should be knowledge of the key components and intervention processes involved in a broadly applicable diabetes dietary self management intervention that is feasible to conduct in many outpatient settings.
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