Improving Self-Management of Type 2 Diabetes in Overweight and Inactive Patients Through an Educational and Motivational Intervention Addressing Diet and Physical Activity: A Prospective Study in Naples, South Italy

• Published in: Diabetes therapy Vol. 8; no. 4; pp. 875 - 886
• Main Authors: Gallé, Francesca, Di Onofrio, Valeria, Cirella, Assunta, Di Dio, Mirella, Miele, Alessandra, Spinosa, Tiziana, Liguori, Giorgio
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-08-2017; Springer; Springer Nature B.V
• Subjects: Cardiology; Diabetes; Diabetes therapy; Diabetics; Diet therapy; Disease management; Endocrinology; Exercise; Glucose monitoring; Glycosylated hemoglobin; Health aspects; Health surveys; Hypoglycemia; Internal Medicine; Intervention; Medicine; Medicine & Public Health; Obesity; Original Research; Overweight; Physical fitness; Prevention; Self-care, Health; Training; Type 2 diabetes; Weight control; Type 2 diabetes; Exercise; Healthy lifestyles; Self-management education
• ISSN: 1869-6953; 1869-6961
• DOI: 10.1007/s13300-017-0283-2

Introduction
Nutrition and physical activity are key elements in the prevention and management of type 2 diabetes. A community-based, multidisciplinary educational intervention aimed to improve quality of life and disease self-management in sedentary, overweight/obese type 2 diabetic patients was implemented in Naples, South Italy.
Methods
The 9-month intervention included a motivational program, a nutrition program, and an exercise program. Satisfaction, worry, and embarrassment regarding their condition, together with disease-related behaviors and propensity towards physical activity, were evaluated through a validated questionnaire before and after the intervention; health status perception was evaluated through the short-form 12 questionnaire. Changes in HbA1c level and weight were also checked.
Results
A significant improvement (
p
 < 0.05) was registered in behaviors related to the management of hypoglycemic crisis and food choice; in nearly all the items related to living with the disease (
p
 < 0.01); and in health status perception (
p
 < 0.01). The adoption of healthy behavior was more common among women (OR 2.17, 95% CI 1.09, 3.02) and persons with higher educational levels (OR 1.26, 95% CI 0.83, 2.17; OR 1.54, 95% CI 0.56, 2.27). About 30% of participants did not modify their emotional status after the intervention. Although not significantly (
p
 = 0.18), the trust of patients towards physical activity increased at the end of the study, together with their active lifestyle (
p
 < 0.01) and with the decrease of perceived barriers (
p
 < 0.01). A significant improvement was registered in glycemic control and weight status (
p
 < 0.01).
Conclusions
The intervention was feasible and effective in addressing diet and physical activity among participants, giving consequent improvements in health status. Similar educational interventions including a training program for people with diabetes should be standardized and adopted by the Italian National Health System.