Study Results
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Basic Information
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WITHDRAWN
NA
INTERVENTIONAL
2017-10-31
2018-08-31
Brief Summary
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Detailed Description
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Suboptimal adherence may be driven by numerous factors, including lack of symptoms of TD2 (perceived nonseriousness of the disease), side-effects of treatments (GI distress associated with metformin, weight gain associated with insulin) in conjunction with a complex dosing regimen, lack of knowledge or belief in the efficiency of the medication, lack of motivation, cultural factors as well as poor instruction and judgmental communication between the healthcare professional and patient.
There is a need for new methods to understand the drivers of nonadherence and support the patient to proactively self-manage their TD2. There is also a need for new tools (i.e., knowledge translation methods) to support healthcare professionals to engage patients based on dialogue (collaboration) and active patient involvement (self-management), to overcome the barriers to adherence and thereby improve their ability to obtain good glycemic control. The purpose of this study is to evaluate a self-management support intervention called EMMA: Empowerment, motivation \& medical adherence.
EMMA is a concept consisting of a number of dialogue tools for use in diabetes consultations (see below). The concept was, in its original form tested, in a feasibility study (N = 19 T2D) in 2011-12. The study showed significant reduction in HbA1c (EMMA: median decrease of 2.0 mmol / mol (-1.0 to 3.0) versus control: median increase 2.5 mmol / mol (-2.0 to -4.5) p = 0.05) (Varming 2012; Andrésdóttir 2014). The investigators have been collaborating with the Danish group who have developed the EMMA protocol and have developed training programs to support the diabetes educator in the delivery of the intervention. The use of the EMMA method is very consistent with motivational communication and behaviour change counselling. The investigators plan to conduct a small scale randomized comparison trial of the EMMA method with diabetes services at the NSHA Central Zone.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
SUPPORTIVE_CARE
NONE
Study Groups
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EMMA
These participants will receive diabetes self-management education using the dialogue tools, which emphasize empowerment and use the principles of motivational communication and behaviour modification. There will be a series of four visits using the dialogue tools to guide the patient toward meaningful self-management tasks. This is not the typical approach, where providers tell the patient the behaviours they, not the patient, consider priorities. This intervention will evaluate if medical outcomes (A1c) and adherence are improved using a patient-centered not a clinician-cantered approach in individuals with poor diabetes control.
EMMA
Dialogue tools will be used to develop personally relevant behavioural goals consistent with diabetes self-management
Treatment as Usual
The participants will receive standard diabetes education via group and individual sessions with certified diabetes educators. In this method the patient is provided structured education in which there is an emphasis on covering clinician-determined aspects of diabetes knowledge and self-management. The emphasis vis on diabetes educator recommendations.
Treatment as Usual
Participants randomized to this intervention will receive standard diabetes education sessions. These include group education session and follow up session based on clinician-generated recommendations.
Interventions
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EMMA
Dialogue tools will be used to develop personally relevant behavioural goals consistent with diabetes self-management
Treatment as Usual
Participants randomized to this intervention will receive standard diabetes education sessions. These include group education session and follow up session based on clinician-generated recommendations.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Type 2 diabetes ≥ 1 years
* HbA1c ≥ 8 % at the last three visits before randomization
* On oral or injectable medications (insulin, GLP-1; DPP-4)
* Can speak, read and understand English
Exclusion Criteria
* Receiving psychological or psychiatric treatment for a mental health disorder
* Severely impaired vision or blindness
18 Years
65 Years
ALL
Yes
Sponsors
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Nova Scotia Health Authority
OTHER
Responsible Party
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Michael Vallis
Lead, Behaviour Change Institute and Associate Professor, Family Medicine, Dalhousie University
Principal Investigators
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Michael Vallis, PhD
Role: PRINCIPAL_INVESTIGATOR
Lead, Behaviour Change Institute, NSHA and Associate Professor, Family Medicine, Dalhousie University
References
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Anderson RM, Funnell MM, Aikens JE, Krein SL, Fitzgerald JT, Nwankwo R, Tannas CL, Tang TS. Evaluating the Efficacy of an Empowerment-Based Self-Management Consultant Intervention: Results of a Two-Year Randomized Controlled Trial. Ther Patient Educ. 2009 Jun 1;1(1):3-11. doi: 10.1051/tpe/2009002.
Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in Type 2 diabetes. Diabet Med. 2013 Mar;30(3):338-44. doi: 10.1111/dme.12046.
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Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93. doi: 10.1056/NEJMoa021778.
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Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, Gallina DL, Barnes C, Phillips LS. Patient adherence improves glycemic control. Diabetes Educ. 2005 Mar-Apr;31(2):240-50. doi: 10.1177/0145721705274927.
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Teasdale, T & Svendsen, H. Psykologiske & pædagogiske metoder. Kvalitative og kvantitative forskningsmetoder I praksis. Jensen T.B. and Christensen G (eds.). 2005. Frederiksberg:Roskilde Universitetsforla
van Dulmen S. The value of tailored communication for person-centred outcomes. J Eval Clin Pract. 2011 Apr;17(2):381-3. doi: 10.1111/j.1365-2753.2010.01586.x. Epub 2010 Nov 18.
Vallis M. Behaviour change counselling--how do I know if I am doing it well? The development of the Behaviour Change Counselling Scale (BCCS). Can J Diabetes. 2013 Feb;37(1):18-26. doi: 10.1016/j.jcjd.2013.01.005. Epub 2013 Mar 14.
Varming, A. Development and usability of a participatory adherence programme aimed at patients with type 2 diabetes in poor glycemic control. 2012. Master thesis (Master of Drug Management), University of Copenhagen
Varming, A., Andrésdóttir, G., Engelund, G., Jelstrup, L., Persson, F. I. EMMA: Empowerment, Motivation & Medical Adherence. Dialogue tools for diabetes consultations. ISBN 978-87-92759-07-8. Steno Diabetes Center. 2013 Gentofte.
Williams A, Manias E, Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs. 2008 Jul;63(2):132-43. doi: 10.1111/j.1365-2648.2008.04656.x.
World Health Organization. Adherence to long-term therapies: evidence for action. 2003
Other Identifiers
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NSHABCIEMMA
Identifier Type: -
Identifier Source: org_study_id
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