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Behavioral change stage might moderate the impact of multifaceted interventions on nonâattendance from medical care among patients with typeâ2 diabetes: The Japan Diabetes Outcome Intervention Trialâ2 LargeâScale Trial 007 (JâDOIT2âLT007)
Abstract Aims/Introduction Nonâattendance from regular medical care is a major problem in diabetes patients. This study aimed to examine the impact of a multifaceted lifestyle intervention by faceâtoâface approach (FFA) on nonâattendance from regular medical care in comparison with that by telephone from the technical support center (TSC). Materials and Methods This was secondary analysis from a 1âyear, prospective, cluster randomized, intervention study. Patients with typeâ2 diabetes, who were regularly visiting primary care physicians clusterârandomized into the control or intervention (TSC or FFA according to resource availability of the district medical associations) groups, were consecutively recruited. The primary endâpoint was nonâattendance from regular medical care. The interaction between the type of intervention (TSC vs FFA) and behavioral change stage (preâ vs postâaction stage) in diet and exercise for the dropout rate was assessed. Results Among the 1,915 participants (mean age 56â±â6âyears; 36% women) enrolled, 828, 564 and 264 patients belonged to the control, TSC and FFA groups, respectively. We found evidence suggestive of an interaction between the intervention type and behavioral change stage in diet (Pâ=â0.042) and exercise (Pâ=â0.038) after adjusting for covariates. The hazard ratios (95% confidence interval) of FFA to TSC were 0.21 (0.05â0.93) and 7.69 (0.50â117.78) in the preâaction and postâaction stages for diet, respectively, whereas they were 0.20 (0.05â0.92) and 4.75 (0.29â73.70) in the preâaction and postâaction stages for exercise. Conclusions Among diabetes patients, the impact of multifaceted intervention on nonâattendance from medical care might differ by the behavioral change stage