Diabetes: High Level of Self Care Improved Glycemic Control and Reduced Mortality

Michael Laxy Helmholtz Zentrum München German Research Center for Environmental Health Institute of Health Economics and Health Care Management Neuherberg, GermanyMedicalResearch.com Interview with:
Michael Laxy
Helmholtz Zentrum München
German Research Center for Environmental Health
Institute of Health Economics and Health Care Management
Neuherberg, Germany

MedicalResearch.com: What are the main findings of the study?

Answer: In patients with type 2 diabetes a high level of self-management behavior was associated with a better glycemic control, i.e. a lower HbA1c level, in the cross-sectional perspective and a reduced mortality over a 12-year period. This effect remained robust after controlling for socio-demographic and disease related factors, including medication.

MedicalResearch.com: Were any of the findings unexpected?

Answer: The results of this study were not unexpected. Researchers and physicians often refer that self-care and self-management behavior is a crucial element in the disease management process. RCTs have showed that diabetes education and self-management training improves patient behavior and intermediate clinical outcomes, such as glycemic control in the short run. However, the time horizon of these studies was mostly too short to study effects on cardiovascular events or mortality, and the current evidence from observational studies on the impact of self-management behavior on long term outcomes is also weak.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: The results show that in addition to physician delivered treatment according to medical guidelines, the patient’s behavior is also of great significance for the course of the disease and for the success of the treatment process. Therefore, patient-centered services such as diabetes education, self-management training and intensive patient counseling, that are expected to improve self-care, are highly important in clinical practice and should be a key element in patient care.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: Measuring an individualized construct, such as self-care or self-management behavior, is difficult and therefore data about patient behavior is scarce. In this study we combined 6 different dimensions, including self-monitoring of blood glucose, foot care and physical activity, to a ‘self-management index’. However, methodological refinements in measuring patient behavior are needed to derive further implications on how different self-management dimensions impact health outcomes. In addition, it is important to find (cost-) effective strategies to improve patient behavior on a large scale: Amongst classical one-to-one or group-based diabetes education one needs to study the potential of peer networks or web/smartphone/SMS- based support approaches.


The Association Between Patient-Reported Self-Management Behavior, Intermediate Clinical Outcomes, and Mortality in Patients With Type 2 Diabetes: Results From the KORA-A Study

Laxy M1, Mielck A, Hunger M, Schunk M, Meisinger C, Rückert IM, Rathmann W, Holle R.
Diabetes Care.
2014 Mar 25. [Epub ahead of print]