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Clinical Decisionmaking

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Diabetes education programs can help patients manage their condition, especially if they are recently diagnosed

Behavioral studies show that people usually make changes in smoking, eating, or exercise behaviors after going through several stages: precontemplation (not considering making a change in the next 6 months), contemplation (seriously considering a change in the next 6 months), preparation (have decided to change their behavior and are about to do so), action (have made a change in behavior in the past 6 months), and maintenance (behavior change has been sustained for at least 6 months). A recent study demonstrated that five weekly 2-hour educational sessions were enough to advance most people with diabetes one or more stages of change for at least one of three behaviors important to lowering excessively high blood glucose levels: diet, exercise, and self-monitoring of blood glucose (SMBG).

Those who had been diagnosed with diabetes for less than 2 years were significantly more likely to advance at least one stage of change for diet and exercise than those with diabetes for more than 2 years. Furthermore, this advance was significantly associated with a decline in blood glucose levels comparable to drug therapy, says Jacqueline A. Pugh, M.D., of the University of Texas Health Sciences Center-San Antonio. Her work was supported in part by the Agency for Healthcare Research and Quality (HS07397, Minority Medical Treatment Effectiveness Research Program [MEDTEP]).

Dr. Pugh and her colleagues randomly assigned 428 adults (65.5 percent female, 75.8 percent Hispanic) with type 2 diabetes to one of two types of 2-hour diabetes education sessions once each week for 5 weeks. The researchers interviewed patients 1 to 4 weeks before and 6 months after the classes to determine stages of behavioral change.

Advancement through one or more stages of change was more common for diet (68 percent) and SMBG (43 percent) than for exercise (36 percent). This may reflect the fact that a large proportion of the diabetes class time was devoted to nutrition and blood glucose control, and exercise did not receive as much attention during the sessions. A 0.9 percent decline in hemoglobin A1C (blood-glucose) level was observed for those who advanced one stage of change or more for diet, and a 0.89 percent decline was observed for those who advanced one stage of change or more for exercise.

More details are in "Stage of change advancement for diabetes self-management behaviors and glucose control," by Michael L. Parchman, M.D., Teshia G. Arambula-Solomon, Dr.P.H., Polly Hitchcock Noel, Ph.D., and others, in the January 2003 Diabetes Educator 29(1), pp. 128-134.

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