Lifestyle self-management intervention in patients with type 2 diabetes.

The studies reported in this thesis sought to explore two major areas of concern in the care of the obese patient with type 2 diabetes: 1) the development and evaluation of a brief, effective intervention to improve lifestyle self-management in patients with type 2 diabetes and 2) differences in diabetes-related attitudes and beliefs of health care professionals and patients with type 2 diabetes that may have a negative impact on diabetes-related outcomes and intervention implementation and effectiveness. To address these issues, two studies were conducted. The first was a randomised controlled trial of a brief intervention to improve lifestyle self-management in patients with type 2 diabetes. One hundred patients aged between 40-70 years were recruited at a Diabetes Centre. Participants completed full questionnaire and physiological assessments at four time points, baseline, 3 months, 6 months and 1 year. A personalised self-management plan was developed with participants in the intervention group who also received follow-up telephone calls at 1 week, 3 weeks and 7 weeks post initial assessment. The second study was a comparison of patients' and health care professionals' diabetes beliefs and attitudes. One hundred and four health care professionals and 100 of their patients completed questionnaires assessing diabetes-related beliefs and attitudes. In addition, the 100 patients in the lifestyle intervention study also participated in this study, in order to test the hypothesis that patients with type 2 diabetes will regard their own diabetes as less serious compared to diabetes in general. Key findings from the randomised controlled trial suggest that the intervention was successful in helping patients in the intervention group to reduce their fat intake and increase their lifestyle physical activity levels. These self-reported changes in behaviour were reflected in the objective data with weight maintenance in the intervention group compared to the control group, together with a reduction in waist circumference but did not translate into improvements in the other physiological measures. A striking finding from the comparison of patients' and health care professionals' diabetes beliefs and attitudes study was that health care professionals viewed type 2 diabetes as more serious than their patients, and participants in the intervention study viewed their own diabetes as a less serious condition compared to the seriousness of type 2 diabetes in general. A majority of the health care professionals considered diabetes harder to treat compared with other chronic conditions and felt that they did not have adequate time and resources to treat their patients with diabetes effectively. The implications of the above for future research and practice were discussed