Self-management education may improve blood pressure in people with type 2 diabetes. A randomized controlled clinical trial.

BACKGROUND AND AIMS: Diabetes is a suitable model to evaluate intervention programmes aimed at chronic diseases, because of its well-defined and measurable process and outcome indicators. In this study, we aimed at investigating the effects of group based self-management education on clinical and psychological variables in type 2 diabetes. METHODS AND RESULTS: Four-year randomized controlled clinical trial (ISRCTN14558376) comparing Group Care and traditional one-to-one care. Clinical and psychological variables were monitored at baseline, 2 and 4 years. Although differences between groups appear to be non-significant at univariate analysis, body weight, BMI and HbA1c, systolic and diastolic blood pressure improved in the patients followed by Group Care but not among Controls. Prescription of lipid-lowering and anti-hypertensive agents did not change among the patients on Group Care, whereas anti-hypertensives were stepped up among Controls without improving their blood pressure. Multivariable analysis suggests that blood pressure improvement among patients on Group Care was independent of BMI, duration of diabetes and antihypertensive medication, suggesting a direct effect of education, presumably by increasing adherence. The "Powerful Others" dimension of the Locus of Control worsened and fear of complications decreased among Controls. CONCLUSIONS: The results confirm that a multidisciplinary structured group educational approach improves blood pressure, presumably through better adherence to healthy lifestyle and medication, in people with type 2 diabetes. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN14558376.

Cognitive function may be a predictor of retinopathy progression in patients with type 2 diabetes.

PURPOSE: Microvascular and macrovascular complications of diabetes, such as retinopathy and nephropathy, progress over time and may be associated with cognitive decline. In this article, we aim to gain further insight into the association between cognitive function and retinopathy in type 2 diabetes. METHODS AND RESULTS: In this observational 8-year prospective study of 498 outpatients, demographic and clinical variables were monitored, along with retinopathy, depression, anxiety, and cognitive function. Baseline fundus photographs were available in 477 patients, 240 with no retinopathy, 110 with mild retinopathy, and 127 with moderate/more severe retinopathy. Of the first 2 groups, 279 patients were reevaluated after 8 years, of whom 181 still had no/mild retinopathy and 98 had progressed to more severe stages. On multivariate analysis, retinopathy progression was associated with being insulin-treated (p = 0.036), and worse cognitive function (p = 0.025) at baseline. CONCLUSIONS: Cognitive function may be an independent predictor of retinopathy progression.

Depression, anxiety and cognitive function in patients with type 2 diabetes: an 8-year prospective observational study.

AIMS: Since depression, anxiety and cognitive function may be impaired in type 2 diabetes, we investigated the relationships between clinical and socioeconomic variables and these psychological dimensions. METHODS: For an 8-year prospective observational study of 498 patients, 249 were not insulin-treated (NIT) and 249 were insulin-treated (IT). Demographic, socioeconomic and clinical data were monitored along with depression and anxiety (assessed by Zung questionnaire) and cognitive function by Mini Mental State Examination (MMSE). RESULTS: After 8 years, 131 patients remained NIT (NIT-NIT), 179 remained IT (IT-IT), 47 switched to insulin (NIT-IT), 111 were lost to follow-up and 30 were died. In all groups, HbA1c remained stable, BMI, glucose and lipid profile improved, and foot ulcers and retinopathy worsened. Mild worsening in depression and anxiety scores was observed in the IT-IT patients only. On multivariate analysis, worsening of depression was associated with female gender, disease duration and being IT-IT, and worsening of anxiety with disease duration. Decreased MMSE was associated inversely with smoking and directly with being IT-IT. CONCLUSIONS: Patients with type 2 diabetes are at relatively low risk of psycho-cognitive decline. However, being female and on long-term insulin treatment may be risk factors for psychological distress, suggesting that special attention is required for these patients.