Guided self-determination improves life skills with type 1 diabetes and A1C in randomized controlled trial

OBJECTIVE: To report 1-year results of newly developed method, guided self-determination (GSD), applied in group training (GSD-GT) for Type 1 diabetes patients with persistent poor glycaemic control.

METHODS: GSD was designed on the basis of qualitative research to help patients develop life skills with diabetes using worksheets filled in at home and coached by nurses in mutual reflection. We randomized 18-49-year-old adults at a Danish university hospital to either 16 h GSD-GT in 2001 or to similar training 1 year later.

INCLUSION CRITERIA: mean A1C> or =8.0% for at least 2 years, disease onset < or =40 years and insulin treatment from onset.

RESULTS: Thirty GSD-GT patients and 20 controls completed the study. GSD-GT patients did better than control patients in terms of (a) increased autonomy support perceived from health professionals (p<0.01); (b) higher frequency of self-monitored blood glucoses (p<0.001); (c) increased perceived competence in managing diabetes (p<0.01); (d) fewer diabetes-related problems (p<0.05); and (e) improved glycaemic control (p<0.01).

CONCLUSION: GSD was effective in improving life skills with diabetes, including A1C, over a period of 1 year.

PRACTICE IMPLICATIONS: GSD is a worthy candidate for further research. We consider it adjustable to people with type 2 diabetes and other chronic conditions.