A nurse-led education and cognitive behaviour therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial

Abstract

Rationale, aims and objectives: Diabetes mellitus is associated with significant morbidity, mortality and escalating healthcare costs. Research has consistently demonstrated the importance of glycaemic control in delaying the onset, and decreasing the incidence, of both the short- and long-term complications of diabetes. Although glycaemic control is difficult to achieve and challenging to maintain, it is key to reducing negative disease outcomes.  The aim of this study was to determine whether a nurse-led educational intervention alone or a nurse-led intervention using education and acceptance and commitment therapy (ACT) were effective in reducing HbA1c in people living with uncontrolled type 2 diabetes compared to usual care.  Methods: Adults over the age of 18 years, with a confirmed diagnosis of type 2 diabetes and HbA1c outside of the recommended range (4-7%, 20-53 mmol/mol) for 12 months or more were eligible to participate.  Participants were randomised to either a nurse-led education intervention, a nurse-led education plus ACT intervention or usual care. One hundred and eighteen participants completed baseline data collection (N=34 education group, N=39 education plus ACT, N=45 control group). An intention to treat analysis was employed.  Results: A statistically significant reduction in HbA1c in the education intervention group was found (p=.011 [7.48, 8.14]). At 6 months, HbA1c was reduced in both intervention groups (Education group -0.21, education and ACT group -0.04) and increased in the control group (+0.32). A positive change in HbA1c (HbA1c reduced) was noted in 50 participants overall. Twice as many participants in the intervention groups demonstrated an improvement as compared to the control group (56% of the education group, 51% education plus ACT, and 24% control group.  Conclusions: At 6 months post intervention, HbA1c was reduced in both intervention groups with a greater reduction noted in the nurse-led education intervention.