Beyond Good Intentions: The effectiveness of a proactive self-management intervention in patients with screen-detected type 2 diabetes

This prospective randomized controlled trial evaluated a theory-driven group-based self-management course for patients with screen-detected type 2 diabetes. 227 patients receiving either intensive pharmacological or usual-care treatment since diagnosis (3-33 months previously) agreed to participate and were subsequently randomized to a control or intervention condition (3-month, nurse-lead, self-management course). Based on self-regulation theory and proactive coping, the course incorporated elements of anticipation, goal-setting and planning in a proactive 5-step plan to help patients translate their good intentions into sustained self-management behaviors. A 2x2 factorial design evaluated the behavioral intervention (self-management course versus control) nested within the medical treatment (intensive versus usual-care) and included a baseline psychological assessment, a preliminary assessment of psychological outcomes at 3-months, and changes in self-management behaviors and cardiovascular outcomes (BMI, blood pressure, Hba1c and lipid profiles) from 0-12 months. At baseline, most patients experienced little emotional distress but also generally underestimated their condition and reported low self-management behavior. At 3-months, course completers evaluated the course and the 5-step plan very positively and showed significant improvements in their proactive coping, self-efficacy and goal-attainment. 12-month evaluations revealed that the intervention group experienced significant and sustained improvements in their self-management behaviors, BMI (-0.77 kg/m2) and systolic blood pressure (-6.2 mmHg). In all aspects, the self-management course was effective independent of medical treatment; however, those patients receiving both intensive pharmacological treatment and the course showed greatest reduction in their cardiovascular risk, suggesting that a combination of medical and behavioral treatments may be particularly effective in newly diagnosed type 2 diabetes

Beyond good intentions: the role of proactive coping in achieving sustained behavioural change in the context of diabetes management.

This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions. (aut. ref.