Issue 122 Item 12 Success in a Diabetes Educational Program Tied to Readiness to

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.