Efficacy of the Diabetes Empowerment Self-management Interactive Research (DESIRE) programme in Chinese patients with poorly controlled type 2 diabetes: a randomised controlled trial

• Published in: The Lancet (British edition) Vol. 388; p. S9
• Main Authors: Cheng, Li, Dr, Sit, Janet W H, PhD, Choi, Kaichow, Li, Xiaomei, Long, Junhong, Wu, Yuning
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.10.2016; Elsevier Limited
• Subjects: Empowerment; Internal Medicine; Intervention; Research ethics; Sensitivity analysis
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(16)31936-5

Abstract Background Interventions that specifically target patients with poorly controlled type 2 diabetes have not received much attention, despite the numerous interventional studies in patients with diabetes. This study evaluated the effectiveness of a culturally tailored, empowerment-based self-management intervention programme in Chinese patients with poorly controlled type-2 diabetes. Methods This randomised, controlled trial was conducted at two hospitals in Xi'an, China. 242 adult patients with poorly controlled type 2 diabetes (glycated haemoglobin [HbA1c] >7·5%) were randomly allocated (1:1) to receive a Diabetes Empowerment Self-management Interactive Research (DESIRE) programme or attentional control condition, by computer-generated randomisation with a block size of four. DESIRE was a nurse-led, patient-centred, empowerment-based programme consisting of six sessions on setting personally meaningful goals, making self-management action plans, and reflecting on the effect of self-management practices. HbA1c measurements, as primary outcome, were compared between the intervention and control groups at baseline and 3 months post-intervention. Data analysis adhered to intention-to-treat principles. Ethics approval was obtained from the Joint Chinese University of Hong Kong–New Territories East Clinical Research Ethics Committee. Written consent form were obtained from participants. The trial is registered at http://www.chictr.org.cn (ChiCTR-IPR-14005492). Findings The intervention (n=121) and control (n=121) participants were similar at baseline. Participants in the intervention group had significant changes in HbA1c concentration (from mean 9·94% [SD 1·81] to 9·10% [2·03] in intervention group vs 10·15% [1·81] to 9·76% [2·20] in control group; effect size 0·31, 95% CI 0·05–0·58; p=0·030). Compared with participants in the control group, more participants in the intervention group achieved HbA1c targets of less than 7% (n=27 [22·3%] vs n=15 [12·4%]; relative risk 1·80, 95% CI 1·01–3·21; p=0·042). Sensitivity analysis showed consistent results for significant changes in HbA1c in the intervention group. No adverse events were observed. Interpretation The DESIRE programme targeting patients with poorly controlled type 2 diabetes resulted in clinically significant improvement in glycaemic control. Future studies with a larger scale and longer duration are warranted to confirm the beneficial effects of such self-management programmes in this patient group. Funding None.