Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity

ObjectivesTo compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. DesignMultisite, single-blind, parallel, pragmatic, randomized controlled trial. SettingFour communities in Ontario, Canada. ParticipantsCommunity-dwelling older adults (65) with T2DM and 2 or more comorbidities randomized into intervention (n=80) and control (n=79) groups (N=159). InterventionClient-driven, customized self-management program with up to 3 in-home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation. MeasurementsQuality-of-life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES-D-10), Summary of Diabetes Self-Care Activities (SDSCA), Self-Efficacy for Managing Chronic Disease, and healthcare costs. ResultsMorbidity burden was high (average of eight comorbidities). Intention-to-treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference=2.68, 95% confidence interval (CI)=0.28-5.09, P=.03), SDSCA (mean difference=3.79, 95% CI=1.02-6.56, P=.01), and CES-D-10 (mean difference=-1.45, 95% CI=-0.13 to -2.76, P=.03). No group differences were seen in PCS score, anxiety, self-efficacy, or total healthcare costs. ConclusionParticipation in a 6-month community-based intervention improved quality of life and self-management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs.