Impact of reinforcement of diabetes self-care on poorly controlled diabetes: a randomized controlled trial

Diabetes Educ. Jul-Aug 2013;39(4):504-14. doi: 10.1177/0145721713486837. Epub 2013 May 2.


Purpose: The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education.

Methods: In this randomized controlled trial, 134 participants (75% white, 51% female, 59 ± 9 years old, 13 ± 8 years with diabetes, A1C = 8.4% ± 1.2%) were randomized to either a group map-based program (intervention) or group education on cholesterol and blood pressure (control). Participants were assessed for A1C levels, diabetes self-care behaviors (3-day pedometer readings, 6-minute walk test, blood glucose checks, frequency of self-care), and psychosocial factors (distress, frustration, quality of life) at baseline, 3, 6, and 12 months post intervention and health literacy at baseline.

Results: Groups did not differ on baseline characteristics including A1C levels, health literacy, or self-care; however, the intervention group had more years of education than controls. Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up. Importantly, frequency of self-reported self-care, diabetes quality of life, diabetes-related distress, and frustration with diabetes self-care improved in both groups over time.

Conclusions: Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care. The best method to accomplish reinforcement needs to be established.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / psychology*
  • Diabetes Mellitus, Type 2 / therapy
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism
  • Health Behavior*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Patient Compliance / psychology*
  • Patient Education as Topic / methods*
  • Psychotherapy, Group / methods*
  • Quality of Life
  • Reinforcement, Psychology
  • Self Care / psychology*
  • Treatment Outcome


  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human