LISA WHITEHEAD reports on a Christchurch-based randomised control trial into improving diabetes self-management.
Recruiting people with poor diabetes management into a Christchurch-based trial proved to be challenging for researchers. However, once committed to the randomised control trial, very few people dropped out, despite the earthquakes bringing more challenges.
The two-year study on enhancing the self-management of diabetes is now nearing completion. The study, lead by the University of Otago’s Centre for Postgraduate Nursing Studies, explored whether self-management of glycaemic control was improved through interventions designed to support and enhance self-management. It focused on people who struggle to maintain glycaemic control (HbA1c ≥ 7 per cent), as the majority of intervention studies have worked with people who already have optimal glycaemic control. We knew that recruiting people to the trial would be difficult.
Recruitment began in early 2010, with people contacted through a wide variety of mediums, including through GP practices. Over 1500 letters were sent out and we received 300 responses; 100 respondents were eligible to take part in the study.
Participants were randomised into three groups: one group was offered a day of education on diabetes; another group a day combining education with acceptance and commitment therapy (ACT – a form of cognitive behavioural therapy); and the final control group received usual care. The last intervention group was completed in August 2011 and the results are currently being analysed, though several key issues were raised as the study unfolded.
Both interventions were run in a group setting and this proved to be very powerful. We are exploring the impact of group participation, as this would appear to be an active ingredient in the process. We need to better understand what inhibits people from participating in research in the first instance and we are conducting interviews to explore this area further.
The education intervention, which started with the basics on diabetes and its management, was well received and participants spoke positively about the importance of going back to basics to understand their condition. The group that undertook the education and ACT therapy intervention also gave positive feedback on the experience. ACT therapy involved participants recognising difficult thoughts and feelings about diabetes and explored their personal values related to diabetes. This approach has been used in one study in the US before, but not specifically with those who find glycaemic control particularly challenging. Again, this was conducted in a group setting, and participants reported the value of being able to share their difficulties living with diabetes and managing their blood sugar.
The data collected during the study includes questionnaires on health and wellbeing, illness perception and self-management as well as HbA1c at baseline; three and six months. Interviews are also being conducted with a sample of participants to explore their perceptions of self-management and the impact of the intervention.
The interviews have also given us an insight into the impact of the earthquakes on diabetes self-management with the changes in diet, exercise and stress levels that have resulted for many. It has not been the best of times to undertake a randomised, controlled trial, but we are grateful to the participants for the commitment and goodwill they showed in sticking with the study despite challenging circumstances. ✚
Dr Whitehead is director of the University of Otago’s Centre for Postgraduate Nursing Studies, and was lead investigator of the study, which was one of the research projects funded under the $2.7m STAR (Strategy to Advance Research) fund designed to build research capability in nursing and allied health disciplines.
