Title Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study)
Authors Represas-Carrera, Francisco , Couso-Viana, Sabela , Mendez-Lopez, Fatima , Masluk, Barbara , Magallon-Botaya, Rosa , Recio-Rodriguez, Jose I. , Pombo, Haizea , Leiva-Rus, Alfonso , Gil-Girbau, Montserrat , MOTRICO MARTINEZ, EMMA, Marti-Lluch, Ruth , Gude, Francisco , Claveria, Ana
External publication No
Means Int. J. Environ. Res. Public Health
Scope Article
Nature Científica
JCR Quartile 1
SJR Quartile 2
Area International
Web https://www.scopus.com/inward/record.uri?eid=2-s2.0-85106601110&doi=10.3390%2fijerph18115788&partnerID=40&md5=f1f533163ca0403630e07a01e50210ef
Publication date 01/06/2021
ISI 000660024200001
Scopus Id 2-s2.0-85106601110
DOI 10.3390/ijerph18115788
Abstract Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions\' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking >= 1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.
Keywords health promotion; diabetes mellitus; exercise; Mediterranean diet; tobacco use disorder; primary health care
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