JDM  Vol.2 No.3 , August 2012
Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project
Abstract: Background: Today most guidelines on the management of type 2 diabetes incorporate lifestyle intervention including patient education, physical activity and dietary modification. However, the content and organization of lifestyle intervention programs are still debatable. Aims: To compare the longer term effectiveness of a group-based rehabilitation program with an individual counseling program at improving glycemic control, cardiovascular risk factors and quality of life among type 2 diabetes patients. Methods: We randomized 143 type 2 diabetes patients to either a 6-month group-based rehabilitation program, including patient education, supervised exercise, and diet intervention, or a 6-month individual counseling program. Follow-up time was 12 months after baseline. Outcome measures were glycated hemoglobin (HbA1c), cardiovascular risk factors, quality-of-life and self-rated health. Results: In the rehabilitation group, HbA1c decreased 0.2%-point (95% confidence interval [CI] = -0.4, -0.03), systolic blood pressure decreased 6 mmHg (95% CI = -9.3, -2.5), diastolic blood pressure decreased 4 mmHg (95% CI = -6.3, -2.4), weight decreased 2.2 kg (95% CI = -3.2, -1.3), and waist circumference decreased 2.0 cm (95% CI = -2.9, -1.1). In the individual group, HbA1c decreased 0.4% (95% CI = -0.6, -0.1), systolic blood pressure decreased 3 mmHg (95% CI = -6.3, -0.7), diastolic blood pressure decreased 3 mmHg (95% CI = -4.7, -0.7), weight decreased 1.6 kg (95% CI = -2.6, -.7]), and waist circumference decreased 1.6 cm (95% CI = -2.5, -0.6). Vitality, fatigue distress, physical functioning and cardiovascular distress improved over time (P < 0.05) in the two groups combined. Repeated measurement analysis did not result in significant differences between the groups of any outcome. Conclusions: This study demonstrates that group-based rehabilitation in a primary healthcare center is a comparable alternative to individual counseling in an outpatient clinic. However, the resource use of the rehabilitation program was twice as much as the individual program.
Cite this paper: Soelberg Vadstrup, E. , Frølich, A. , Perrild, H. , Borg, E. and Røder, M. (2012) Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project. Journal of Diabetes Mellitus, 2, 308-315. doi: 10.4236/jdm.2012.23048.

[1]   Deakin, T., McShane, C.E., Cade, J.E. and Williams, R.D. (2005) Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 18, Article ID: CD003417.

[2]   Norris, S.L., Lau, J., Smith, S.J., Schmid, C.H. and Engelgau, M.M. (2002) Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care, 25, 1159-1171. doi:10.2337/diacare.25.7.1159

[3]   Gary, T.L., Genkinger, J.M., Guallar, E., Peyrot, M. and Brancati, F.L. (2003) Meta-analysis of randomized educational and behavioral interventions in type 2 diabetes. The Diabetes Educator, 29, 488-501. doi:10.1177/014572170302900313

[4]   Brown, S.A. (1990) Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. Patient Education and Counseling, 16, 189-215. doi:10.1016/0738-3991(90)90070-2

[5]   Norris, S.L., Engelgau, M.M. and Narayan, K.M. (2001) Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care, 24, 561-587. doi:10.2337/diacare.24.3.561

[6]   Zhang, X., Norris, S.L., Chowdhury, F.M., Gregg, E.W. and Zhang, P. (2007) The effects of interventions on health-related quality of life among persons with diabetes: A systematic review. Medical Care, 45, 820-834. doi:10.1097/MLR.0b013e3180618b55

[7]   Corabian, P. and Harstall, C. (2001) Patient diabetes education in the management of adult type-2 diabetes. Alberta Heritage Foundation for Medical Research, Edmonton.

[8]   Trento, M., Passera, P., Bajardi, M., Tomalino, M., Grassi, G., Borgo, E. et al. (2002) Lifestyle intervention by group care prevents deterioration of Type II diabetes: A 4-year randomized controlled clinical trial. Diabetologia, 45, 1231-1239. doi:10.1007/s00125-002-0904-8

[9]   Rickheim, P.L., Weaver, T.W., Flader, J.L. and Kendall, D.M. (2002) Assessment of group versus individual diabetes education: A randomized study. Diabetes Care, 25, 269-274. doi:10.2337/diacare.25.2.269

[10]   Vadstrup, E.S., Frolich, A., Perrild, H., Borg, E. and Roder, M. (2009) Lifestyle intervention for type 2 diabetes patients: trial protocol of The Copenhagen Type 2 Diabetes Rehabilitation Project. BMC Public Health, 9, 166. doi:10.1186/1471-2458-9-166

[11]   Vadstrup, E.S., Fr?lich, A., Perrild, H., Borg, E. and R?der, M. (2011) Effect of a group-based rehabilitation programme on glycaemic control and cardiovascular risk factors in type 2 diabetes patients: The Copenhagen Type 2 Diabetes Rehabilitation Project. Patient Education and Counseling, 84, 185-190. doi:10.1016/j.pec.2010.06.031

[12]   Vadstrup, E.S., Fr?lich, A., Perrild, H., Borg, E. and R?der, M. (2011) Health-related quality of life and self-related health in patients with type 2 diabetes: Effects of group-based rehabilitation versus individual counselling. Health and Quality of Life Outcomes, 9, 110. doi:10.1186/1477-7525-9-110

[13]   R?jen, D., Vibe-Petersen, J. and Perrild, H. (2005) Education of patients with type 2 diabetes. Handbook for healthcare providers. Novo Nordisk A/S, Bagsvaerd.

[14]   Funnell, M.M., Anderson, R.M., Arnold, M.S., Barr, P.A., Donnelly, M., Johnson, P.D., et al. (1991) Empowerment: an idea whose time has come in diabetes education. The Diabetes Educator, 17, 37-41. doi:10.1177/014572179101700108

[15]   Miller, W.R. and Rollnick, S. (2002) Motivational interviewing: Preparing people for change. 2nd Edition, Guilford Press, New York.

[16]   Ware, J.E., Jr. and Sherbourne, C.D. (1992) The MOS 36-item short-form health survey (SF-36). I. conceptual framework and item selection. Medical Care, 30, 473-483. doi:10.1097/00005650-199206000-00002

[17]   Grootenhuis, P.A., Snoek, F.J., Heine, R.J. and Bouter, L.M. (1994) Development of a type 2 diabetes symptom checklist: A measure of symptom severity. Diabetic Medicine, 11, 253-261. doi:10.1111/j.1464-5491.1994.tb00268.x

[18]   McHorney, C.A., Ware, J.E., Jr., Lu, J.F. and Sherbourne, C.D. (1994) The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40-66. doi:10.1097/00005650-199401000-00004

[19]   Arbuckle, R.A., Humphrey, L., Vardeva, K., Arondekar, B., Danten-Viala, M.M., Scott, J.A., et al. (2009) Psychometric evaluation of the diabetes symptom checklist-revised (DSC-R)—A measure of symptom distress. Value in Health, 12, 1168-1178.

[20]   Littell, R.C., Milliken, G.A., Stroup, W.W. and Wolfinger, R.D. (1996) SAS system for mixed models. SAS Institue Inc., Cary.

[21]   Thomas, D.E., Elliott, E.J. and Naughton, G.A. (2006) Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, 3, Article ID: CD002968.

[22]   Collins, R., Peto, R., MacMahon, S., Hebert, P., Fiebach, N.H., Eberlein, K.A., et al. (1990) Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: Overview of randomised drug trials in their epidemiological context. Lancet, 335, 827-838. doi:10.1016/0140-6736(90)90944-Z

[23]   Lewington, S., Clarke, R., Qizilbash, N., Peto, R. and Collins, R. (2002) Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 360, 1903-1913. doi:10.1016/S0140-6736(02)11911-8

[24]   Jeffery, R.W., Drewnowski, A., Epstein, L.H., Stunkard, A.J., Wilson, G.T., Wing, R.R., et al. (2000) Long-term maintenance of weight loss: Current status. Health Psychology, 19, 5-16. doi:10.1037/0278-6133.19.Suppl1.5

[25]   Goddijn, P.P., Bilo, H.J., Feskens, E.J., Groeniert, K.H., van der Zee, K.I. and Meyboom-de, J.B. (1999) Longitudinal study on glycaemic control and quality of life in patients with Type 2 diabetes mellitus referred for intensified control. Diabetic Medicine, 16, 23-30. doi:10.1046/j.1464-5491.1999.00002.x

[26]   Vinik, A.I. and Zhang, Q. (2007) Adding insulin glargine versus rosiglitazone: Health-related quality-of-life impact in type 2 diabetes. Diabetes Care, 30, 795-800. doi:10.2337/dc06-1712

[27]   Steed, L., Cooke, D. and Newman, S. (2003) A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Education and Counseling, 51, 5-15. doi:10.1016/S0738-3991(02)00213-6