Lifestyle Intervention For Effective Diabetes Management

NCT ID: NCT00813930

Last Updated: 2010-03-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-11-30

Study Completion Date

2010-07-31

Brief Summary

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Chronic disease management programs are shown to reduce mortality, recurrent hospitalizations, and improve indirect societal costs among specific subgroups of the population. INTERxVENT is one such individualized chronic cardiovascular and lifestyle management program, comprised of several individualized modules - diet, exercise, stress management, smoking cessation, chronic disease - prescribed algorithmically according to patient risk profile, environmental surroundings, and behavioural readiness-to-change. Nonrandomized studies assessing INTERxVENT in diabetic, pre-diabetic, and metabolic syndrome populations have demonstrated improvement in several intermediary endpoints, including reductions in fasting glucose, lipids, and blood pressure. However, no randomized controlled clinical trials in these populations have been conducted. This pilot study is a randomized clinical trial evaluating the effectiveness of INTERxVENT as compared with 'usual medical care' in improving cardiovascular risk-factor profiles among individuals with diabetes. Additionally, the extent to which such findings are generalizable to diabetic, socially vulnerable, populations is unknown, thus this will be examined also.

Detailed Description

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Diabetes is a leading cause of cardiovascular mortality and morbidity, and is more often than not a very difficult disease for individuals to manage effectively. People with diabetes have to be committed to a self-care regimen which includes, careful monitoring of blood sugar, blood pressure, cholesterol, eating healthy, exercising, foot care and regular physical and eye check-ups. This can be quite daunting and stressful for some to undertake themselves, and is largely dependent on individual self-motivation. Family physicians assist their patients in managing their diabetes but they have significant time constraints and may not always be able to deliver the high service intensity required to reduce morbidity and/or may have inadequate access to resources to help patients positively change their self-care behaviour.

Chronic disease-management programs involving home-based nursing health promotion have been shown to reduce mortality, reduce recurrent hospitalization, and improve indirect societal costs among specific subgroups of the population, including those with diabetes, however, such interventions can be costly and cumbersome to implement given the need for home-based visits.

INTERxVENT is a telephone-based, individualized, chronic cardiovascular and lifestyle management program combining a formal management plan, case-managed care (through a coach/mentor), and educational modules to teach patients to modify and sustain healthy lifestyle behaviours. It is comprised of several individualized modules (e.g., diet, exercise, stress management, smoking cessation, chronic disease), which are prescribed algorithmically in accordance to a patient's individual risk profile, environmental surroundings, and behavioural readiness to change. All recommendations are according to best-practice standards and evidence-based guidelines.

Nonrandomized intervention studies assessing INTERxVENT in diabetic, pre-diabetic, and metabolic syndrome populations have demonstrated significant reductions in biologically relevant measures, such as fasting glucose, glycosylated hemoglobin (HbA1c), lipids, and blood pressure. However, no randomized controlled clinical trials in these populations assessing the impact of INTERxVENT have been conducted.

The proposed pilot study will evaluate the efficacy of INTERxVENT as compared with 'usual medical care' in improving cardiovascular risk-factor profiles among individuals with diabetes. In addition, to what extent a chronic disease management program will yield similar effectiveness in socio-economically disadvantaged individuals is unknown. We hypothesize that chronic disease management programs, like INTERxVENT, will result in improved intermediary biological and behavioural risk profiles for all program participants randomized to this intervention, regardless of socio-economic condition.

The results of this pilot study will determine and assist in designing and ascertaining sample sizes for a larger trial, respectively, should such a trial be warranted. Additionally, such chronic disease management interventions may improve the overall health of partaking individuals and relieve strain and decrease costs within the existing health care system.

Conditions

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Diabetes Mellitus, Type 2

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Study Groups

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INTERxVENT Program

Participants in INTERxVENT will complete a 'Baseline Assessment' and 'Follow-up' questionnaire, and will have a health professional visit his/her home for an initial assessment (BP,height,weight,waist measurement) and blood collection (blood glucose and cholesterol levels). As part of the program, each participant will also complete a self-reported 'Health History Questionnaire' (HHQ); a follow-up HHQ will be completed about 12 weeks into the program to monitor progress. Each participant randomized to INTERxVENT receives educational articles which address diabetes management issues. A structured, individualized program, consisting of educational materials and 12 live mentoring/coaching telephone calls will take place over 6 months. The mentors consist of allied health professionals. The sequence by which educational content is administered will be both self-directed and guided by the mentors using an algorithmic approach according to the participant's readiness-to-change scores.

Group Type EXPERIMENTAL

INTERxVENT lifestyle modification program

Intervention Type BEHAVIORAL

It is a lifestyle behavior modification program which helps Type 2 diabetics manage diabetes better and reduce cardiovascular risk factors. The program involves up to 12 telephone mentor/coaching sessions with a certified health professional.

Usual medical care

Each participant randomized to this group will not receive any formal intervention but will receive the same care over the 6-month period as he/she usually receives from his/her health care team. Participants in this group will undergo the same baseline and outcome assessment as those in the intervention group, including blood pressure (BP) measurement, physical assessment (height, weight, waist measurement) and blood collection (blood glucose and cholesterol levels), as well as completion of the 'Baseline Assessment' and 'Follow-up' questionnaires.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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INTERxVENT lifestyle modification program

It is a lifestyle behavior modification program which helps Type 2 diabetics manage diabetes better and reduce cardiovascular risk factors. The program involves up to 12 telephone mentor/coaching sessions with a certified health professional.

Intervention Type BEHAVIORAL

Other Intervention Names

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INTERxVENT

Eligibility Criteria

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Inclusion Criteria

* Type 2 Diabetes
* Age 18 years or older

Exclusion Criteria

* Documented history of myocardial infarction, stroke, angina, angioplasty, or bypass surgery
* Unable to understand written and spoken English
* Presence of cognitive impairment (e.g., dementia) or significant psychological problems (e.g., schizophrenia, schizoaffective disorders) that, in the investigators' opinion, may prohibit the participant from following study protocols
* Unavailable to participate (e.g., incarceration, no access to a telephone)
* HIV / AIDS
* Estimated life expectancy less than one year in the opinion of the clinician
* Participation in any other clinical study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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St. Joseph's Health Centre Toronto

OTHER

Sponsor Role collaborator

University Health Network, Toronto

OTHER

Sponsor Role collaborator

Unity Health Toronto

OTHER

Sponsor Role lead

Responsible Party

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St. Michael's Hospital, Toronto

Principal Investigators

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Gillian L. Booth, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Li Ka Shing Knowledge Institute, St. Michael's Hospital

Locations

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St. Michael's Hospital

Toronto, Ontario, Canada

Site Status

University Health Network, Toronto Western Hospital

Toronto, Ontario, Canada

Site Status

St. Joseph's Health Centre

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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Booth GL, Kapral MK, Fung K, Tu JV. Recent trends in cardiovascular complications among men and women with and without diabetes. Diabetes Care. 2006 Jan;29(1):32-7. doi: 10.2337/diacare.29.01.06.dc05-0776.

Reference Type BACKGROUND
PMID: 16373892 (View on PubMed)

Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006 Jul 1;368(9529):29-36. doi: 10.1016/S0140-6736(06)68967-8.

Reference Type BACKGROUND
PMID: 16815377 (View on PubMed)

Simpson SH, Corabian P, Jacobs P, Johnson JA. The cost of major comorbidity in people with diabetes mellitus. CMAJ. 2003 Jun 24;168(13):1661-7.

Reference Type BACKGROUND
PMID: 12821619 (View on PubMed)

Bonow RO, Gheorghiade M. The diabetes epidemic: a national and global crisis. Am J Med. 2004 Mar 8;116 Suppl 5A:2S-10S. doi: 10.1016/j.amjmed.2003.10.014.

Reference Type BACKGROUND
PMID: 15019858 (View on PubMed)

Buhrmann R, Asaad D, Hux JE, Tang M, Sykora K: Diabetes and the Eye. In Diabetes in Ontario: an ICES practice atlas. Hux JE, Booth GL, Slaughter P, Laupacis A, Eds. Toronto, Institute for Clinical Evaluative Sciences, 2003.

Reference Type BACKGROUND

Shah BR, Mamdani M, Kopp A: Drug Use in Older People with Diabetes. In Diabetes in Ontario: an ICES practice atlas. Hux JE, Booth GL, Slaughter P, Laupacis A, Eds. Toronto, Insitute for Clinical Evaluative Sciences, 2003.

Reference Type BACKGROUND

Markle-Reid M, Weir R, Browne G, Roberts J, Gafni A, Henderson S. Health promotion for frail older home care clients. J Adv Nurs. 2006 May;54(3):381-95. doi: 10.1111/j.1365-2648.2006.03817.x.

Reference Type BACKGROUND
PMID: 16629922 (View on PubMed)

Markle-Reid M, Browne G, Weir R, Gafni A, Roberts J, Henderson SR. The effectiveness and efficiency of home-based nursing health promotion for older people: a review of the literature. Med Care Res Rev. 2006 Oct;63(5):531-69. doi: 10.1177/1077558706290941.

Reference Type BACKGROUND
PMID: 16954307 (View on PubMed)

Gordon NF, Salmon RD, Mitchell BS, Faircloth GC, Levinrad LI, Salmon S, Saxon WE, Reid KS. Innovative approaches to comprehensive cardiovascular disease risk reduction in clinical and community-based settings. Curr Atheroscler Rep. 2001 Nov;3(6):498-506. doi: 10.1007/s11883-001-0040-9.

Reference Type BACKGROUND
PMID: 11602070 (View on PubMed)

Gordon NF, English CD, Contractor AS, Salmon RD, Leighton RF, Franklin BA, Haskell WL. Effectiveness of three models for comprehensive cardiovascular disease risk reduction. Am J Cardiol. 2002 Jun 1;89(11):1263-8. doi: 10.1016/s0002-9149(02)02323-8.

Reference Type BACKGROUND
PMID: 12031725 (View on PubMed)

Gordon NF, Salmon RD, Franklin BA, Sperling LS, Hall L, Leighton RF, Haskell WL. Effectiveness of therapeutic lifestyle changes in patients with hypertension, hyperlipidemia, and/or hyperglycemia. Am J Cardiol. 2004 Dec 15;94(12):1558-61. doi: 10.1016/j.amjcard.2004.08.039.

Reference Type BACKGROUND
PMID: 15589017 (View on PubMed)

Stevens RJ, Kothari V, Adler AI, Stratton IM; United Kingdom Prospective Diabetes Study (UKPDS) Group. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Clin Sci (Lond). 2001 Dec;101(6):671-9.

Reference Type BACKGROUND
PMID: 11724655 (View on PubMed)

Other Identifiers

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SMH-LKSKI

Identifier Type: -

Identifier Source: org_study_id

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