Institute of Nursing and Health Research, Ulster University, Belfast, UK.
Edinburgh Napier University, Edinburgh, UK.
Diabet Med. 2018 Jan;35(1):137-146. doi: 10.1111/dme.13539. Epub 2017 Nov 21.
To report on the outcomes of a pilot feasibility study of a structured self-management diabetes education programme targeting HbA .
We conducted a two-arm, individually randomized, pilot superiority trial for adults with intellectual disability and Type 2 diabetes mellitus. A total of 66 adults with disabilities across the UK met the eligibility criteria. Of these, 39 agreed to participate and were randomly assigned to either the DESMOND-ID programme (n = 19) or a control group (n = 20). The programme consisted of seven weekly educational sessions. The primary outcome was HbA level, and secondary outcomes included BMI, diabetes illness perceptions, severity of diabetes, quality of life, and attendance rates.
This study found that the DESMOND-ID programme was feasible to deliver. With reasonable adjustments, the participants could be recruited successfully, and could provide consent, complete the outcome measures, be randomized to the groups and attend most of the sessions, with minimal loss to follow-up. The fixed-effects model, the interaction between occasion (time) and condition, showed statistically significant results (0.05 level) for HbA ; however, the CI was large.
This is the first published study to adapt and pilot a national structured self-management diabetes education programme for adults with intellectual disability. This study shows it is possible to identify, recruit, consent and randomize adults with intellectual disabilities to an intervention or control group. Internationally, the results of this pilot are promising, demonstrating that a multi-session education programme is acceptable and feasible to deliver. Its effectiveness should be further tested in an adequately powered trial.
报告一项针对糖化血红蛋白的结构化自我管理糖尿病教育计划的初步可行性研究结果。
我们进行了一项两臂、个体随机、初步优势试验,对象为患有 2 型糖尿病和智力障碍的成年人。英国共有 66 名残疾成年人符合入选标准。其中,39 人同意参加,并随机分为 DESMOND-ID 计划组(n=19)或对照组(n=20)。该计划包括每周 7 次教育课程。主要结局指标为糖化血红蛋白水平,次要结局指标包括 BMI、糖尿病疾病认知、糖尿病严重程度、生活质量和出席率。
本研究发现 DESMOND-ID 计划具有可行性。经过合理调整,参与者可以成功招募,并可以提供同意、完成结局指标、随机分组并参加大部分课程,随访损失最小。固定效应模型显示,在糖化血红蛋白方面,时机(时间)和条件之间的交互作用具有统计学意义(0.05 水平);然而,置信区间较大。
这是第一项发表的关于为智力障碍成年人改编和试行国家结构化自我管理糖尿病教育计划的研究。本研究表明,有可能确定、招募、同意和将智力障碍成年人随机分配到干预组或对照组。在国际上,该试点的结果很有希望,表明多节教育计划是可以接受和可行的。其有效性应在一项充分有力的试验中进一步检验。