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Redesigning treatment strategies in type 2 diabetes by treatment intensification and patient education

Rao, Lakshmi Subrmanya (2015) Redesigning treatment strategies in type 2 diabetes by treatment intensification and patient education. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Type 2 diabetes is a complex disease that is characterized by insufficient insulin production or utilization. Type 2 diabetes is associated with complications such as diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, atherosclerosis, peripheral artery disease and coronary heart disease. Three important risk factors for complications are hyperglycemia, hypertension and dyslipidemia.
Effective diabetes care involves self-management of the disease with proper nutrition, physical exercise and pharmacological agents that can control levels of glucose, cholesterol and blood pressure. With the rise in the prevalence of diabetes and often ineffective treatment intensification it is necessary to consider new treatment strategies. Patient centered approaches along with treatment intensification and diabetes education can be one such strategy to improve diabetes care. Diabetes education can be helpful as it helps in promoting healthy behaviors and appropriate diabetes self-management.
The objective of this study was to evaluate the effectiveness of providing patient education and intensifying treatment in patients with Type 2 diabetes and determine if there were significant changes observed in HbA1c, LDLc, blood pressure and adherence. This study specifically reported changes in patients at the 3 month follow up. The study was a prospective, cluster randomized controlled trial. There were a total of 240 patients enrolled in the study: 175 were in the intervention group and 65 were in the control group. Treatment was intensified according to pre-approved protocols and diabetes education was provided to patients in the intervention group.
There was significant decrease in HbA1c and LDLc levels within the intervention group but the difference was not significant within the control group. There was no decrease in blood pressure within the intervention or the control group. HbA1c, systolic blood pressure and diastolic blood pressure was significantly different in between the groups at baseline but not during 3 month follow up. There was no statistically significant difference between the underlying distributions of the adherence scores of protocol and the adherence scores of control at baseline or 3 month follow up.
The results from the 3 month follow up strongly indicated that treatment intensification along with patient education can be an effective way to treat diabetes. These results also emphasized the importance of a patient centered approach and diabetes education. The public health significance of this study is that it can be very helpful to optimize treatment strategies in diabetes while addressing behavioral and psychological needs of a patient. This can improve self-management of diabetes, which is one of the very important aspects of diabetes care.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Rao, Lakshmi SubrmanyaLAR108@pitt.eduLAR108
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairZgibor, Janice C.edcjan@pitt.eduEDCJAN
Committee MemberGlynn, Nancy Wglynnn@edc.pitt.eduEPIDNWG
Committee MemberFrank , Linda Rosefrankie@pitt.eduFRANKIE
Date: 30 June 2015
Date Type: Publication
Defense Date: 23 April 2015
Approval Date: 30 June 2015
Submission Date: 19 May 2015
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 55
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Diabetes, Treatment intensification, Patient education
Date Deposited: 30 Jun 2015 13:23
Last Modified: 15 Nov 2016 14:28
URI: http://d-scholarship.pitt.edu/id/eprint/25244

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