Manage Your Own High Blood Pressure and Diabetes

Summarized by Robert W. Griffith, MD
November 21, 2005

Introduction

Some chronic diseases that plague older people can be treated, but not cured. It seems obvious that those who know more about their conditions can often do better than those who rely on just taking what the doctor prescribes. And, of course, if they follow a healthy lifestyle (eat a healthy diet, control weight, and exercise) they'll do even better. suggests that they have a slightly reduced risk of developing cancer. Here's a summary of the research findings.

Formal programs have been developed to teach patients with such chronic diseases what they need to know - and do - to make the most of their health options. These programs are called self-management programs; the name is pretty self-explanatory.

Scientists from the University of California and the US Veterans Administration have conducted a meta-analysis - that's an analysis of selected results from separate but combined relevant studies - on self-management programs for high blood pressure, type 2 diabetes, and osteoarthritis. Their findings have been published in the Annals of Internal Medicine, and are summarized here.

What was done

The researchers searched medical literature to find published reports of self-management programs for the three conditions. They looked for studies that had randomly allocated patients to receive self-management programs or to receive routine health care only. They defined self-management programs as those that helped patients actively participate in monitoring their conditions or in decisions related to managing them. As an example, the range of such a program in diabetes is described in the footnote ¹.

The primary criteria for effectiveness used were:

• Hypertension: blood pressure readings, body weight (13 studies)
• Diabetes: hemoglobin A1c level, fasting blood sugar (26 studies)
• Osteoarthritis: pain, physical function (14 studies)

The analysis assessed the effectiveness of self-management programs in each condition, and tried to determine whether certain elements of the programs were associated with better outcomes.

What were the findings?

Out of 780 studies screened, the researchers found 53 studies that effectively assessed the effect of self-management programs on chronic disease. Compared with usual care, self-management programs improved blood pressure and glucose control in older adults with high blood pressure and diabetes. However, self-management programs offered only slight improvement of pain and physical function in older adults with arthritis.

In high blood pressure patients, the systolic pressure was lowered by an average of 5mm Hg, and the diastolic pressure by 4.3 mm Hg, by self-management programs.

In the diabetics, self management achieved an average reduction in HbA1c of 0.36%, which is equivalent to a reduction in the level of about 80%.

Both these effects are considered useful improvements for the conditions concerned.

The researchers could not identify particular elements of programs that were consistently associated with success. They found evidence that some research may not have been published, which might make self-management programs look better than they really are.

What does this analysis mean?

It's clear that self-management programs can improve blood pressure and glucose control in older patients, but they don't help patients with osteoarthritis. Before such programs can be widely recommended, however, one needs to find out which parts of the programs are most effective, and which are not helpful. Then more efficient programs can be designed.

This somewhat cautious approval of such programs shouldn't discourage older patients with any condition working closely with their physicians, so that they can help monitor their progress - or lack thereof - and react accordingly. Depending on their rapport with their healthcare professional, they can participate in modifying their treatment accordingly. And, of course, a well-educated patient is likely to be doing as much as possible for their general good health already.

Source

• Chodash J, Morton SC, Mojica W, et al. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med 2005;143:427-438, and patient page I-24

Footnotes
1. Self-management in diabetes, the ongoing process of managing diabetes, Includes meal planning, planned physical activity, blood glucose monitoring, taking diabetes medicines, handling episodes of illness and of low and high blood glucose, managing diabetes when traveling, and more. The person with diabetes designs his or her own self-management treatment plan in consultation with a variety of health care professionals such as doctors, nurses, dietitians, pharmacists, and others.

Related Links
Reining In High Blood Pressure
Patient Self-management Program for Diabetes
National Diabetes Training Programs

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