Self-management diabetes program feasible for adults with intellectual disability
medwireNews: A pilot randomized study shows that an adapted structured self-management program can be successfully delivered to diabetes patients with mild or moderate intellectual disabilities.
The researchers adapted the DESMOND program, which is used in the UK to support adults with type 2 diabetes to manage their condition. As well as its delivery being modified to meet the needs of the patients, the adapted program also included an additional introductory session aimed specifically at family members and carers.
In addition, the two instruments used to assess patients’ understanding of their diabetes (the Illness Perception Questionnaire-Revised [IPQ-R] and Diabetes Illness Representation Questionnaire) were adapted to simplify the wording and include pictorial cues with the rating scales.
The adapted program (DESMOND-ID) was delivered in six sessions, once a week, to 19 patients from Scotland, Wales, and Northern Ireland. Attendance was good, with 90% of patients attending at least four of six sessions and 94% of carers attending six of a possible seven.
Feedback identified positive factors such as improved understanding, and making friends by attending group sessions, although some patients reported difficulties understanding the significance of carbohydrates and fats.
At follow-up 6 weeks after the end of the DESMOND-IR intervention, the patients had significantly improved coherence scores on the IPQ, compared with a further 20 control patients who were assigned to receive usual care. They also had significantly improved physical quality of life and a “shift in a desirable direction” for psychological quality of life.
Furthermore, there was a significant improvement in glycated hemoglobin levels over time in the patients who attended the program versus controls, although the confidence intervals were wide.
“This was a pilot feasibility study and no power calculation was undertaken prior to recruitment,” note Laurence Taggart (Ulster University, Belfast, UK) and colleagues, nonetheless describing the result as “very promising.”
The researchers note that around two-thirds of the patients had carers, and that it will be hard to determine whether the intervention works equally well for those with and without carers, citing practical and ethical issues with trying to study either group separately.
“In real life, education must be provided to both those with an intellectual disability who attend on their own and those who are accompanied: the evidence base for both is urgently required,” they write in Diabetic Medicine.
The team also observes that delivering an educational program to patients with intellectual disabilities “poses challenges for the educators thereby requiring greater creativity” in their delivery and potentially affecting the fidelity of the program’s core principles. “We accept the issue of fidelity needs to be more fully addressed in future studies,” they say.
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