Effectiveness of an intervention to improve diabetes self-management on clinical outcomes in patients with low educational level.

OBJECTIVE: To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. METHODS: 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. RESULTS: The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. CONCLUSIONS: In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.

[Psychosocial nature of chronic illnesses in the dependent elderly]. / Tipología psicosocial de las enfermedades crónicas en los mayores dependientes.

OBJECTIVE: To find the psychosocial nature of chronic diseases in elderly dependent persons. DESIGN: Transversal, observational study. SETTING: Two urban health districts in Granada and Jaén, Spain. PARTICIPANTS: One hundred five patients included in the Family and Home Care programme for elderly dependent persons. MAIN MEASUREMENTS: The type of chronic illness was analysed through the modified Rolland classification. Types of incapacity, demographic variables and the presence of multi-pathologies were recorded. RESULTS: 47.6% of the 105 participants were between 70 and 79 years old. On their psychosocial nature, 94.2% had some kind of disability, 78% had a gradual start, 61% had a progressive course of disease, and 63.8% had a possibly fatal prognosis. Psychosocial type B -- incapacitating, gradual start, progressive and possibly fatal -- was the most common (44.7%). CONCLUSION: The study of psychosocial type in elderly dependent persons is an important instrument for the analysis of families with chronic illnesses within them. Questions relating to its progressive course and the fatal prognosis may have a more determining prognostic weight.