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Can autonomy support have an effect on type 2 diabetes glycemic control? Results of a cluster randomized controlled trial
  1. Qingping Yun,
  2. Ying Ji,
  3. Shenglan Liu,
  4. Yang Shen,
  5. Xuewen Jiang,
  6. Xinyi Fan,
  7. Jingnan Liu,
  8. Chun Chang
  1. School of Public Health, Peking University, Beijing, China
  1. Correspondence to Dr Chun Chang; changchunpku{at}


Objectives To assess whether social support or autonomy support intervention for patients with type 2 diabetes can achieve glycemic control at the end of intervention, and to test whether the glycemic control effect can be maintained for a long time.

Research design and methods In this cluster randomized controlled trial, 18 community healthcare stations (CHSs) were randomized to the following: (1) usual care group (UCG) offering regular public health management services, (2) social support group (SSG) providing 3-month social support intervention based on problem solving principles, and (3) autonomy support group (ASG) offering 3-month autonomy support intervention based on self-determination theory. A total of 364 patients registered in the CHSs were enrolled into either of the three groups. The primary outcome was hemoglobin A1c (HbA1c), and secondary outcomes were diabetes self-management (DSM) behaviors. Assessment was conducted at baseline and at 3 and 6 months.

Results Patients in ASG achieved better HbA1c reduction at the end of intervention (0.53% or 7.23 mmol/mol, p<0.001) than those in the UCG and successfully maintained it up to 6 months (0.42% or 5.41 mmol/mol, p<0.001). However, patients in SSG did not experience significant change in HbA1c at 3 or 6 months when compared with patients in UCG. Besides, patients in both the SSG (0.12, p<0.05) and ASG (0.22, p<0.001) experienced improvement in exercise at 3 months. Patients in ASG sustained improvement in exercise up to 6 months (0.21, p<0.001), but those in the SSG did not.

Conclusions Autonomy support for patients with type 2 diabetes could help achieve glycemic control at the end of intervention and successfully maintain it up to 6 months. These findings indicate that autonomy support has positive long-term effects on DSM behaviors and glycemic control and can be recommended in future diabetes intervention programs.

Trial registration number ChiCTR1900024354.

  • patient self-management
  • community-based research/intervention
  • glycemic control
  • behavior change

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  • Contributors SL and CC conceived of the study concept and design. QY, YJ and YS analyzed data. QY wrote the manuscript, and YJ contributed to the discussion. XJ and XF reviewed the manuscript. XJ, XF and JL took responsibility for collecting the data and quality control of the data. CC and QY are the guarantors for this study, had full access to all the data and took the responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval (IRB00001052-17017) was obtained from the institutional review board of Peking University Health Science Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The raw data of the current study cannot be shared at this time because the data is part of an ongoing study, but the data are available from the corresponding author on reasonable request.

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