Self-empowerment and health outcomes in obese adults with type 2 diabetes following completion of a multi-disciplinary metabolic rehabilitation program

Introduction: Type 2 diabetes mellitus (T2DM) is a worldwide epidemic yet; self-empowerment remains an important yet under-utilised aspect of daily self-care in patients with T2DM. Methods: We retrospectively administered the validated Diabetes Empowerment Scale (DES) to evaluate self-empowerment in 42 obese, adult patients with T2DM who completed a minimum 1-year participation in an intensive multi-disciplinary metabolic rehabilitation program. We sought to determine correlations with clinical outcomes in nine cardiometabolic parameters collected at baseline and subsequently 6-monthly till 30-months. Results: Over 87% of patients attended > 3 sessions/week, with 95% enrolled up to 30-months. Patients indicated a moderately high level of empowerment both globally and in all three DES domains. Subscale III (setting and achieving diabetes goals) was significantly and inversely correlated with % change in waist circumference (WCC) at 12-months (R = -0.337, P = 0.03) and % reduction in diastolic blood pressure at 24-months (r = -0.381, P = 0.01). Subscale II (assessing dissatisfaction and readiness to change) was positively correlated with duration of diagnosis (R = 0.354, P = 0.02). Furthermore, the number of exercise sessions attended was correlated with decreased 12-month % change in weight (r = -0.320, P = 0.04) and glycosylated haemoglobin (HbA1c) (r = -0.344, P = 0.03). Significant reduction was achieved in as early as 6-months for weight (-4.2 + 0.9%, P < 0.001), BMI (-3.9 + 0.9%, P = 0.002) and WCC (-2.8 + 0.7%, P = 0.004) and continued to decrease at 30 months (-8.6 + 1.4%, P < 0.001; -8.4 + 1.5%, P < 0.001; -5.0 + 1.3%, P < 0.001, respectively). Concurrent with weight reduction, significant improvement in HbA1c was also observed early at 6-months (-8.5 + 1.6%, P < 0.001) with maximum benefit at 24-months (-10.1 + 2.2%, P < 0.001). High-density lipoprotein cholesterol also reached a maximal increase at 24 months (10.6 + 4.3%, P = 0.049). Conclusion: Setting and achieving goals was associated with reductions in waist circumference and blood pressure. The role of empowerment-based intervention in conjunction with intensive multi-disciplinary rehabilitation on health outcomes in these patients remains under-researched and under-utilised in clinical practice.