Success
in a Diabetes Educational Program Tied to
Readiness to Change
Readiness
to change will determine the patients success in a diabetes program.
A
study to determine whether a simple tool characterizing readiness to
change among patients before participating in a diabetes educational
intervention successfully screens for patients who will achieve
satisfactory clinical improvement.
The study took fifty patients referred to a diabetes educational
center with hemoglobin A1c
levels of more than 9.0% were asked four questions before
participation in a diabetes educational program. Patients were
categorized into precontemplation-contemplation, preparation, and
action stages of readiness to change. Intensive diabetes education was
offered to all participants. Hemoglobin A1c
levels were measured for 24 months after the educational program.
What
the results showed was that patients in preparation and actions stages
achieved a significantly larger reduction in hemoglobin A1c
levels in a shorter time than patients in the combined
precontemplation-contemplation stage. Average change in hemoglobin A1c
levels at 12 months was -1.06 ± 1.80 (P = .17) for the
precontemplation-contemplation stage, -1.82 ± 1.84 (P = .006)
for the preparation stage, and -2.56 ± 2.12 (P = .0006) for
the action stage. Patients had significantly more hemoglobin A1c
measurements in the preparation stage (4.63 ± 2.42, P = .036)
and the action stage (4.94 ± 2.38, P = .013) than patients in
the precontemplation-contemplation stage (3.00 ± 1.22) during the
24-month study.
From
the results it was concluded that in this small population, stage of
change as determined by a simple clinical tool was significantly
associated with clinical improvement in hemoglobin A1c
levels at 3 months after an educational intervention. Significant
differences in clinical improvement between groups persisted for at
least 12 months. This tool could be used to tailor the most effective
clinical diabetes interventions for patients and to address the needs
of patients in a more targeted manner.
This
small pilot study suggests that a patient's readiness to change
diabetes self-management as measured by four simple questions was
significantly associated with the likelihood of a successful clinical
outcome in this educational intervention. Patients who stated that
they were ready to begin to change their diabetes-related behavior now
(action stage) or within 1 month (preparation stage) reduced their
baseline hemoglobin A1c
levels more quickly and to a greater degree than patients who were
willing to change their diabetes management in 6 months (contemplation
stage) or who did not want to change their diabetes management (precontemplation
stage). Large clinical trials indicate that a 1% reduction in
hemoglobin A1c
levels is associated with a 38% reduction in eye disease and a 22%
reduction in kidney disease in 6.5 years.[2]
Those in the preparation and action stages reduced their hemoglobin A1c
levels by an average of approximately 2.5%, which would be expected to
result in substantial clinical benefit. In addition, patients in the
action and preparation groups were likely to have their hemoglobin A1c
measured more often than patients in the precontemplationcontemplation
group. This finding might reflect a more concerted effort to follow up
with their health care provider and receive or request the recommended
testing.
