Significant lifestyle changes are required of individuals who experience adult onset diabetes, including: self-administration of medications, dietary restrictions, exercise, self-monitoring for signs and symptoms of hyper- and hypoglycemia, self-monitoring for development of comorbid conditions secondary to diabetes, and timely notification of health care professionals when problems arise. Adherence to self-care and self-monitoring requirements is necessary for successful management of diabetes. The medical literature demonstrates that many diabetics do not adhere to their treatment regimen which, consequently results in poorer outcomes for the patient. With this study we propose to pilot test an Individualized Enhanced Adherence Intervention (IEAI), based on social cognitive theory, for elderly diabetic patients living in the Piedmont region of North Carolina. In a randomized trial, we will compare patients having gone through the Diabetes Medical Management Program (DMMP) at Wake Forest University Baptis Medical Center, followed by the IEAI with participants receiving DMMP alone. With this study we will determine the following: (1) the feasibility of recruiting and retaining study participants in the IEAI, (2) the potential effectiveness of the intervention in achieving improved levels of blood glucose control as reflected in hemoglobin A1c levels, (3) the feasibility of using various measures of adherence to diabetes self management including: use of the Nutrient Data System to assess adherence to dietary restrictions, use of the ACCU-CHECK monitor to assess adherence to capillary blood monitoring of glucose, use of a self-report physical activity survey, and use of pharmacy records to assess adherence to self-administration of insulin, (4) the impact of the intervention on various measures of self-efficacy, and (5) the sample size requirements or evaluating IEAI in a larger clinical trial conducted within a Medicare managed care plan in the Piedmon region of North Carolina.
