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Articles by C. Fox
Total Records ( 2 ) for C. Fox
  J. A. Sturt , S. Whitlock , C. Fox , H. Hearnshaw , A. J. Farmer , M. Wakelin , S. Eldridge , F. Griffiths and J. Dale

Aims To determine the effects of the Diabetes Manual on glycaemic control, diabetes-related distress and confidence to self-care of patients with Type 2 diabetes.

Methods A cluster randomized, controlled trial of an intervention group vs. a 6-month delayed-intervention control group with a nested qualitative study. Participants were 48 urban general practices in the West Midlands, UK, with high population deprivation levels and 245 adults with Type 2 diabetes with a mean age of 62 years recruited pre-randomization. The Diabetes Manual is 1:1 structured education designed for delivery by practice nurses. Measured outcomes were HbA1c, cardiovascular risk factors, diabetes-related distress measured by the Problem Areas in Diabetes Scale and confidence to self-care measured by the Diabetes Management Self-Efficacy Scale. Outcomes were assessed at baseline and 26 weeks.

Results There was no significant difference in HbA1c between the intervention group and the control group [difference − 0.08%, 95% confidence interval (CI) − 0.28, 0.11]. Diabetes-related distress scores were lower in the intervention group compared with the control group (difference −4.5, 95% CI −8.1, −1.0). Confidence to self-care Scores were 11.2 points higher (95% CI 4.4, 18.0) in the intervention group compared with the control group. The patient response rate was 18.5%.

Conclusions In this population, the Diabetes Manual achieved a small improvement in patient diabetes-related distress and confidence to self-care over 26 weeks, without a change in glycaemic control. Further study is needed to optimize the intervention and characterize those for whom it is more clinically and psychologically effective to support its use in primary care.

  K. G. Asimakopoulou , C. Fox , J. Spimpolo , S. Marsh and T. C. Skinner
  Aims  We examined the impact of communicating risk of coronary heart disease (CHD) and stroke, using three time frames (1, 5 or 10 years), on Type 2 diabetic (T2D) patients' understanding of risk of CHD/stroke and their memory for these risks.

Methods  Patients (N = 95) estimated their risk of developing CHD/having a stroke as a result of diabetes, in one of three time frames. Using the United Kingdom Prospective Diabetes Study Risk Engine and the same time frame, patients were then given individualized, objective risk estimates of developing CHD/stroke. Following explanation of these risks, patients' risk understanding was examined by asking them to report again their risk of developing CHD/stroke. Six weeks later we assessed patient memory for these risks by asking them to recall their actual risk estimates for CHD/stroke.

Results  In all time frames, we successfully reduced participants' originally inflated risk perceptions of CHD (F1,92 = 73.01, P < 0.001) and stroke (F1,91 = 119.05, P < 0.001), although the 10-year risk group was the most resistant to correction for both CHD (F1,90 = 9.32, P < 0.001) and stroke (F2,88 = 3.97, P < 0.02). Participants' recall of their stroke risk at 6 weeks regressed towards original, inflated risk perceptions for the 10-year group only (F4,176 = 4.73, P < 0.001).

Conclusion  Patients' inflated perceptions of CHD/stroke risk can be easily corrected using shorter (1- or 5-year) risk communication time frames.

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