Authors (including presenting author) :
Wong MK, Cheng SYR, Chu TK, Lai SK, Lam FY, Wong CKC, Liang J
Affiliation :
Department of Family Medicine and Primary Health Care, New Territories West Cluster
Introduction :
The non-pharmacological interventions in patients with diabetes mellitus (DM) is based on the focus of a healthy diet, physical activity and self-management. Many theories have been developed and applied in prevention campaigns including brief advice and counseling services. Motivational Interviewing (MI) has been proven effective in changing health behaviors in specific cases. However, stronger evidence is needed for chronic pathologies like DM.
Objectives :
To obtain preliminary data on the impact of a nurse-led MI intervention in improving glycaemic control, as well as clinical, psychosocial and self-care outcomes of individuals with type 2 DM compared with usual care.
Methodology :
An open, two-arm parallel, randomised controlled, pilot exploratory trial involving two Government Out-patient Clinics in New Territories West Cluster was performed from 10/2018 to 9/2019. Participants criteria included age 18-65 with type 2 DM diagnosed > one year and HbA1C>= 8, excluding pregnancy, severe debilitating disease and cognitive deficit. 20-25 participants have been invited in each arm and attended up to five individual counselling sessions. Intervention participants received face-to-face MI intervention plus usual care. Control participants received usual care only. Outcomes were assessed at baseline, 6 and 12 months. Primary outcome measure was HbA1c. Secondary outcomes included blood pressure, body mass index, hip/ waist circumference, fasting blood (fasting glucose and lipid profile), psychosocial and self-care measures.
Result & Outcome :
At 12 months, no differential treatment effect was found for HbA1c (adjusted difference 0.221, 95% CI -0.790 to 1.231, p=0.66), with both intervention and control groups showing improvements (Intervention: mean change −0.30, 95% CI −0.75 to 0.16; Control: mean change −0.47, 95% CI −1.32 to 0.38). One secondary outcome: hip circumference in women (adjusted difference -7.428, 95% CI -11.439 to -3.417, p=0.001) was consistent with significant differential treatment effect. Interestingly, a significant improvement was observed among intervention participants for DM self-efficacy (mean change 12.94, 95% CI -15.94 to 41.83).
Conclusion: MI skills constitute the primary strategies primary care nurses deploy to enhance patient-centered care. From this studies, MI may have a role in improving patients’ self-care. Therefore a larger, longer term randomised controlled study is indicated to clarify the mechanisms and extent of these benefits.
