{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T14:07:08Z","timestamp":1789222028000,"version":"build-2803163510"},"reference-count":60,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,11,27]],"date-time":"2017-11-27T00:00:00Z","timestamp":1511740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","award":["06669"],"award-info":[{"award-number":["06669"]}],"id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2018,2]]},"abstract":"\n Objectives<\/jats:title>\n \n To compare the effect of a 6\u2010month community\u2010based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self\u2010efficacy, self\u2010management, and healthcare costs in older adults with type 2 diabetes mellitus (T2\n DM<\/jats:styled-content>\n ) and 2 or more comorbidities.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Multisite, single\u2010blind, parallel, pragmatic, randomized controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Four communities in Ontario, Canada.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n Community\u2010dwelling older adults (\u226565) with T2\n DM<\/jats:styled-content>\n and 2 or more comorbidities randomized into intervention (n\u00a0=\u00a080) and control (n\u00a0=\u00a079) groups (N\u00a0=\u00a0159).\n <\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Client\u2010driven, customized self\u2010management program with up to 3 in\u2010home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation.<\/jats:p>\n <\/jats:sec>\n \n Measurements<\/jats:title>\n \n Quality\u2010of\u2010life measures included the Physical Component Summary (\n PCS<\/jats:styled-content>\n , primary outcome) and Mental Component Summary (\n MCS<\/jats:styled-content>\n , secondary outcome) scores of the Medical Outcomes Study 12\u2010item Short\u2010Form Health Survey (\n SF<\/jats:styled-content>\n \u201012). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (\n CES<\/jats:styled-content>\n \u2010D\u201010), Summary of Diabetes Self\u2010Care Activities (\n SDSCA<\/jats:styled-content>\n ), Self\u2010Efficacy for Managing Chronic Disease, and healthcare costs.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Morbidity burden was high (average of eight comorbidities). Intention\u2010to\u2010treat analyses using analysis of covariance showed a group difference favoring the intervention for the\n MCS<\/jats:styled-content>\n (mean difference\u00a0=\u00a02.68, 95% confidence interval (\n CI<\/jats:styled-content>\n )\u00a0=\u00a00.28\u20135.09,\n P<\/jats:italic>\n \u00a0=\u00a0.03),\n SDSCA<\/jats:styled-content>\n (mean difference\u00a0=\u00a03.79, 95%\n CI<\/jats:styled-content>\n \u00a0=\u00a01.02\u20136.56,\n P<\/jats:italic>\n \u00a0=\u00a0.01), and\n CES<\/jats:styled-content>\n \u2010D\u201010 (mean difference\u00a0=\u00a0\u22121.45, 95%\n CI<\/jats:styled-content>\n \u00a0=\u00a0\u22120.13 to \u22122.76,\n P<\/jats:italic>\n \u00a0=\u00a0.03). No group differences were seen in\n PCS<\/jats:styled-content>\n score, anxiety, self\u2010efficacy, or total healthcare costs.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Participation in a 6\u2010month community\u2010based intervention improved quality of life and self\u2010management and reduced depressive symptoms in older adults with T2\n DM<\/jats:styled-content>\n and comorbidity without increasing total healthcare costs.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.15173","type":"journal-article","created":{"date-parts":[[2017,11,27]],"date-time":"2017-11-27T09:04:57Z","timestamp":1511773497000},"page":"263-273","source":"Crossref","is-referenced-by-count":146,"title":["Community Program Improves Quality of Life and Self\u2010Management in Older Adults with Diabetes Mellitus and Comorbidity"],"prefix":"10.1111","volume":"66","author":[{"given":"Maureen","family":"Markle\u2010Reid","sequence":"first","affiliation":[{"name":"Aging Community and Health Research Unit School of Nursing McMaster University Hamilton Ontario Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Ploeg","sequence":"additional","affiliation":[{"name":"Aging Community and Health Research Unit School of Nursing McMaster University Hamilton Ontario Canada"},{"name":"Department of Health, Aging and Society McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly D.","family":"Fraser","sequence":"additional","affiliation":[{"name":"Faculty of Nursing University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Aging Community and Health Research Unit School of Nursing McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Bartholomew","sequence":"additional","affiliation":[{"name":"Aging Community and Health Research Unit School of Nursing McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"Griffith","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Miklavcic","sequence":"additional","affiliation":[{"name":"Faculty of Nursing University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amiram","family":"Gafni","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada"},{"name":"Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lehana","family":"Thabane","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Upshur","sequence":"additional","affiliation":[{"name":"Division of Clinical Public Health Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,27]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Diabetes Fact Sheet.World Health Organization Media Centre [on\u2010line]. 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