Graduation Year

2006

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Public Health

Major Professor

Robert J. McDermott, Ph.D.

Keywords

Health belief model, Glycosylated hemoglobin, Diabetes patient care assessment, Diabetes outcomes, Outpatient program

Abstract

The purpose of this study was to determine whether adults with type 2 diabetes participating in American Diabetes Association (ADA) diabetes self-management education (DSME) randomly assigned to an intensive follow-up group (IFG), utilizing continuous glucose monitoring system (CGMS), or a standard follow-up group (SFG) have any significant differences in mean HgbA1c values and health belief scores over time. Baseline HgbA1c values and health beliefs were measured using the revised Expanded Health Belief Model (HBM) questionnaire. The questionnaire measured the 8 HBM domains: perceived susceptibility; severity; treatment benefit; cues to action; motivation; barriers; self-efficacy and structural elements. Twelve weeks after DSME, patients returned for follow-up based on random assignment. The SFG received routine follow-up care: HgbA1c measurements; behavioral goals and education assessments. The IFG received routine follow-up and CGMS.

Patients wore the CSMS for 72 hours and recorded their daily food, blood glucose values, medications and physical activities. Results were analyzed and reviewed with patients. Both groups returned in 24 weeks for HgbA1c measurements and to complete the HBM questionnaire. A repeated measure ANOVA analysis showed a statistically significant reduction in mean HgbA1c at each time period (F=86.75. p>.0001 ) from week 1 to week 12 (SFG 8.6-7.1; IFG 8.5 --7.1,) and from week 12 to week 24 ( SFG 7.1 to 6.9; IFG 7.1 --

7.0). There were no significant differences found between the groups. (F = 0.17 p > 0.87). Following DMSE and follow-up intervention some health belief scores improved but no significant differences were found between groups except for severity scores. (SFG 27.05, IFG 25.00, p=0.03). The power of the study to detect small differences between the groups was affected by the higher than anticipated attrition and the significant lowering of HgbA1c in the education arm of the study. Both groups achieved a high success rate (58% IFG; 55% SFG) to lower the HgbA1c to the ADA goal of less than 7. DSME and follow-up care (both standard follow-up and more intensive follow-up) achieved a significant lowering of HgbA1c (1.6%), which has been shown to reduce diabetes related morbidity and health costs.

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