Effectiveness of lifestyle counseling by certified expert nurse of Japan for non-insulin-treated diabetic outpatients: A 1-year randomized controlled trial

We examine whether one-to-one lifestyle counseling for non-insulin-treated diabetic outpatients by a Certified Expert Nurse (CEN) can improve patients’ health outcomes. Participants were randomly assigned to a 1-year lifestyle intervention (n = 67) or to a usual care group (n = 67). Main outcome measures were changes from baseline in: HbA1C and score of health related quality of life scales (SF-36 and Problem Areas in Diabetes Scale). Cognitive/behavioral modification for 1 year and satisfaction in CEN counseling was also measured by self-produced items. We found no significant differences in HbA1C, BMI, blood pressure, serum lipids, or health related quality of life over 1 year between the two groups. Patients in the intervention group, however, showed modest but more favorable modification of cognition (p = 0.004) and behavior (p < 0.001) than subjects in usual care group. The low attrition rate (9%), more frequent hospital visit (12 ± 2 times versus 11 ± 3 times; p = 0.03) and high degree of satisfaction (95%) in the intervention group indicate feasibility of the monthly CEN counseling in the outpatient settings of Japanese hospitals. Future research should confirm the long-term effectiveness of the CEN counseling on clinical outcomes and the cost effectiveness of a possibly time-consuming intervention.