The Use of Motivational Interviewing by Healthcare Providers to Improve Glycemic Control in Patients with Type 2 Diabetes

摘要

Background: Type 2 diabetes mellitus (T2DM) is a multi-factorial disease which requires significant patient self-management in order to maintain glycemic control. Patients with T2DM must be vigilant in maintaining a good diet and consistent exercise while also monitoring blood glucose levels. Many patients are ambivalent about making these necessary lifestyle changes. Motivational interviewing (MI) is a patient centered counseling technique which focuses on allowing patients to explore ambivalence to lifestyle changes.This review examines the efficacy of training healthcare providers in motivational interviewing in an effort to improve clinical outcomes of Hemoglobin A1c, BMI, blood pressure and total cholesterol.Method: An exhaustive search of available medical literature was conducted using Medline, CINAHL, Web of Science and EBMR Multifile to identify studies that incorporated MI training of healthcare providers to effect lifestyle changes in patients with T2DM and thus decrease hemoglobin A1c (HbA1c) blood pressure, body mass index (BMI) and total cholesterol. The logistics of MI training and its ability to be incorporated into usual care were also examined. Two studies met the inclusion criteria and one additional study was used for discussion purposes.Results: The two RCTs reviewed showed there was no enduring improvement in HbA1c, blood pressure, BMI or total cholesterol when comparing motivational interviewing was added to usual care.Conclusion: Although health care providers could successfully demonstrate the tenets of MI, motivational interviewing showed lackluster results in improving clinical outcomes in patients with type 2 diabetes. Any improvements in glycemic control are short lived. Training in MI and applying its tenets in practice is time consuming and requires a significant commitment on the part of healthcare providers.