PMID- 29178317
OWN - NLM
STAT- MEDLINE
DCOM- 20190830
LR  - 20240316
IS  - 1532-5415 (Electronic)
IS  - 0002-8614 (Print)
IS  - 0002-8614 (Linking)
VI  - 66
IP  - 2
DP  - 2018 Feb
TI  - Community Program Improves Quality of Life and Self-Management in Older Adults 
      with Diabetes Mellitus and Comorbidity.
PG  - 263-273
LID - 10.1111/jgs.15173 [doi]
AB  - OBJECTIVES: To compare the effect of a 6-month community-based intervention with 
      that of usual care on quality of life, depressive symptoms, anxiety, 
      self-efficacy, self-management, and healthcare costs in older adults with type 2 
      diabetes mellitus (T2DM) and 2 or more comorbidities. DESIGN: Multisite, 
      single-blind, parallel, pragmatic, randomized controlled trial. SETTING: Four 
      communities in Ontario, Canada. PARTICIPANTS: Community-dwelling older adults 
      (>/=65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) 
      and control (n = 79) groups (N = 159). INTERVENTION: Client-driven, customized 
      self-management program with up to 3 in-home visits from a registered nurse or 
      registered dietitian, a monthly group wellness program, monthly provider team 
      case conferences, and care coordination and system navigation. MEASUREMENTS: 
      Quality-of-life measures included the Physical Component Summary (PCS, primary 
      outcome) and Mental Component Summary (MCS, secondary outcome) scores of the 
      Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Other secondary 
      outcome measures were the Generalized Anxiety Disorder Scale, Center for 
      Epidemiologic Studies Depression Scale (CES-D-10), Summary of Diabetes Self-Care 
      Activities (SDSCA), Self-Efficacy for Managing Chronic Disease, and healthcare 
      costs. RESULTS: Morbidity burden was high (average of eight comorbidities). 
      Intention-to-treat analyses using analysis of covariance showed a group 
      difference favoring the intervention for the MCS (mean difference = 2.68, 95% 
      confidence interval (CI) = 0.28-5.09, P = .03), SDSCA (mean difference = 3.79, 
      95% CI = 1.02-6.56, P = .01), and CES-D-10 (mean difference = -1.45, 95% 
      CI = -0.13 to -2.76, P = .03). No group differences were seen in PCS score, 
      anxiety, self-efficacy, or total healthcare costs. CONCLUSION: Participation in a 
      6-month community-based intervention improved quality of life and self-management 
      and reduced depressive symptoms in older adults with T2DM and comorbidity without 
      increasing total healthcare costs.
CI  - (c) 2017 The Authors. The Journal of the American Geriatrics Society published by 
      Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
FAU - Markle-Reid, Maureen
AU  - Markle-Reid M
AD  - Aging Community and Health Research Unit, School of Nursing, McMaster University, 
      Hamilton, Ontario, Canada.
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Ploeg, Jenny
AU  - Ploeg J
AD  - Aging Community and Health Research Unit, School of Nursing, McMaster University, 
      Hamilton, Ontario, Canada.
AD  - Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Fraser, Kimberly D
AU  - Fraser KD
AD  - Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
FAU - Fisher, Kathryn A
AU  - Fisher KA
AD  - Aging Community and Health Research Unit, School of Nursing, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Bartholomew, Amy
AU  - Bartholomew A
AD  - Aging Community and Health Research Unit, School of Nursing, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Griffith, Lauren E
AU  - Griffith LE
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Miklavcic, John
AU  - Miklavcic J
AD  - Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
FAU - Gafni, Amiram
AU  - Gafni A
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, Ontario, Canada.
AD  - Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, 
      Ontario, Canada.
FAU - Thabane, Lehana
AU  - Thabane L
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Upshur, Ross
AU  - Upshur R
AD  - Division of Clinical Public Health, Dalla Lana School of Public Health, 
      University of Toronto, Toronto, Ontario, Canada.
LA  - eng
PT  - Journal Article
PT  - Pragmatic Clinical Trial
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20171127
PL  - United States
TA  - J Am Geriatr Soc
JT  - Journal of the American Geriatrics Society
JID - 7503062
SB  - IM
MH  - Aged
MH  - *Comorbidity
MH  - Diabetes Mellitus, Type 2/psychology/*therapy
MH  - Female
MH  - Health Care Costs
MH  - Humans
MH  - Male
MH  - Ontario
MH  - *Quality of Life
MH  - Self-Management/*methods
MH  - Single-Blind Method
PMC - PMC5836873
OTO - NOTNLM
OT  - community-based program
OT  - comorbidity
OT  - older adults
OT  - self-management
OT  - type 2 diabetes mellitus
EDAT- 2017/11/28 06:00
MHDA- 2019/08/31 06:00
PMCR- 2018/03/05
CRDT- 2017/11/28 06:00
PHST- 2017/11/28 06:00 [pubmed]
PHST- 2019/08/31 06:00 [medline]
PHST- 2017/11/28 06:00 [entrez]
PHST- 2018/03/05 00:00 [pmc-release]
AID - JGS15173 [pii]
AID - 10.1111/jgs.15173 [doi]
PST - ppublish
SO  - J Am Geriatr Soc. 2018 Feb;66(2):263-273. doi: 10.1111/jgs.15173. Epub 2017 Nov 
      27.