Effectiveness of a training course for general practice nurses in motivation support in type 2 diabetes care: a cluster-randomised trial

PLoS One. 2014 May 5;9(5):e96683. doi: 10.1371/journal.pone.0096683. eCollection 2014.

Abstract

Background: Type 2 diabetes is a common metabolic disease with the potential for prevention of complications. The prevention requires a high level of lasting actions from the patients, which may be burdensome. The aim of this trial was to evaluate the effectiveness of a training course for general practice nurses in motivation support at 18 months follow-up in the affiliated type 2 diabetes population.

Methods: Forty general practices with nurse-led diabetes consultations from the area of Aarhus, Denmark were randomised 1∶1 to either intervention or usual practice. Intervention practices were offered a 16-hour Self-determination theory-based course including communication training for general practice nurses delivered over 10 months. The affiliated diabetes populations (aged 40-74 years) were identified from registers (intervention n = 2,005; usual n = 2,029). Primary outcomes were register-based glycated haemoglobin (HbA1c) -, total cholesterol levels, and well-being measured by the Problem Areas In Diabetes scale (PAID) and the mental component summary score, SF12 (SF12, mcs). Intention-to-treat analyses were performed. Predefined subgroups analyses were performed.

Results: The differences between the intervention- and the control practices' mean HbA1c and total cholesterol at follow-up adjusted for baseline values and clustering were respectively: -0.02%-points (95% CI: -0.11 to 0.07; p: 0.67); 0.08 mmol/l (95% CI: 0.01 to 0.15; p: 0.02). Differences in median scores adjusted for clustering were for PAID: 1.25; p = 0.31 and SF12, mcs: 0.99; p = 0.15. Women in intervention practices differed from women in usual practices on mean HbA1c: -0.12%-points (-0.23 to -0.02; p = 0.02) and SF12, mcs: 2.6; p = 0.01.

Conclusions: Offering a training course for general practice nurses in applying the Self-determination theory in current type 2 diabetes care had no effect compared with usual practice measured by HbA1c and total cholesterol levels and the well-being at 18 months of follow-up in a comprehensive register-based diabetes population. Subgroup analyses suggested a possible effect in women, which deserves further attention.

Trial registration: ClinicalTrials.gov (Identifier NCT01187069).

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cholesterol / blood
  • Cluster Analysis
  • Denmark
  • Diabetes Mellitus, Type 2 / nursing*
  • Diabetes Mellitus, Type 2 / therapy*
  • Education, Nursing*
  • Female
  • Follow-Up Studies
  • General Practice / methods
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Middle Aged
  • Motivation
  • Motivational Interviewing / methods
  • Nursing / methods*
  • Outcome Assessment, Health Care
  • Program Evaluation
  • Registries
  • Surveys and Questionnaires
  • Time Factors

Substances

  • Glycated Hemoglobin A
  • Cholesterol

Associated data

  • ClinicalTrials.gov/NCT01187069

Grant support

The study was financially supported by The Tryg Foundation (J.no.7597-08), UCSF Lundbeck Foundation (J.no.FP47/2009), The Health Insurance Foundation (J.no.2009B068), The Danish Nurses’ Organisation (J.no.10/38412) and Aase and Ejnar Danielsens Foundation (J.no.10-000408). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.