<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03008395</url>
  </required_header>
  <id_info>
    <org_study_id>NSHABCIEMMA</org_study_id>
    <nct_id>NCT03008395</nct_id>
  </id_info>
  <brief_title>Empowerment, Motivation and Medical Adherence (EMMA).</brief_title>
  <acronym>EMMA</acronym>
  <official_title>Empowerment, Motivation and Medical Adherence (EMMA). Dialogue Tools for Consultations With Patients With Type 2 Diabetes</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Nova Scotia Health Authority</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Nova Scotia Health Authority</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Outcomes in type 2 diabetes are largely achieved by self-management efforts by individuals&#xD;
      living with diabetes. Diabetes self-management is typically provided using the principles of&#xD;
      adult education. Current evidence suggests that standard educational interventions are&#xD;
      suboptimal. This study evaluates a novel approach to diabetes self-management using dialogue&#xD;
      tools based on empowerment and motivational communication methods. The approach evaluated in&#xD;
      this study is called EMMA: empowerment, motivation and medical adherence. Participants will&#xD;
      be randomized to EMMA and treatment as usual, treated for a period of 4 months and evaluated&#xD;
      over a period of 12 months.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      The management of type 2 diabetes (T2D) is experienced by many patients as being very&#xD;
      complex. This is especially true when diabetes management includes multiple medical&#xD;
      interventions such as oral agents and injectable medication (insulin, GLP-1; DPP-4s) in&#xD;
      combination with diabetes specific behaviours such as blood glucose monitoring and foot care&#xD;
      as well as healthy lifestyle behaviours such as physical activity and healthy eating. Studies&#xD;
      show that 40-50 % of patients with T2D have suboptimal adherence to self-management&#xD;
      recommendations. In general, it is estimated that about half of patients with chronic&#xD;
      diseases do not take their medications as prescribed. Suboptimal medical adherence drives&#xD;
      poor glycemic control as well as poor quality of life for an individual patient not to&#xD;
      mention increased health care costs due to comorbidities, reduced work function and hospital&#xD;
      admissions.&#xD;
&#xD;
      Suboptimal adherence may be driven by numerous factors, including lack of symptoms of TD2&#xD;
      (perceived nonseriousness of the disease), side-effects of treatments (GI distress associated&#xD;
      with metformin, weight gain associated with insulin) in conjunction with a complex dosing&#xD;
      regimen, lack of knowledge or belief in the efficiency of the medication, lack of motivation,&#xD;
      cultural factors as well as poor instruction and judgmental communication between the&#xD;
      healthcare professional and patient.&#xD;
&#xD;
      There is a need for new methods to understand the drivers of nonadherence and support the&#xD;
      patient to proactively self-manage their TD2. There is also a need for new tools (i.e.,&#xD;
      knowledge translation methods) to support healthcare professionals to engage patients based&#xD;
      on dialogue (collaboration) and active patient involvement (self-management), to overcome the&#xD;
      barriers to adherence and thereby improve their ability to obtain good glycemic control. The&#xD;
      purpose of this study is to evaluate a self-management support intervention called EMMA:&#xD;
      Empowerment, motivation &amp; medical adherence.&#xD;
&#xD;
      EMMA is a concept consisting of a number of dialogue tools for use in diabetes consultations&#xD;
      (see below). The concept was, in its original form tested, in a feasibility study (N = 19&#xD;
      T2D) in 2011-12. The study showed significant reduction in HbA1c (EMMA: median decrease of&#xD;
      2.0 mmol / mol (-1.0 to 3.0) versus control: median increase 2.5 mmol / mol (-2.0 to -4.5) p&#xD;
      = 0.05) (Varming 2012; Andrésdóttir 2014). The investigators have been collaborating with the&#xD;
      Danish group who have developed the EMMA protocol and have developed training programs to&#xD;
      support the diabetes educator in the delivery of the intervention. The use of the EMMA method&#xD;
      is very consistent with motivational communication and behaviour change counselling. The&#xD;
      investigators plan to conduct a small scale randomized comparison trial of the EMMA method&#xD;
      with diabetes services at the NSHA Central Zone.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Withdrawn</overall_status>
  <why_stopped>
    Unable to secure clinic support for conducting research&#xD;
  </why_stopped>
  <start_date type="Anticipated">October 2017</start_date>
  <completion_date type="Anticipated">August 2018</completion_date>
  <primary_completion_date type="Anticipated">August 2018</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Supportive Care</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Hemoglobin A1c</measure>
    <time_frame>12 months</time_frame>
    <description>Hemoglobin A1c is a blood test that is considered to be the gold standard of diabetes control</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>WHO-QoL Scale</measure>
    <time_frame>12 months</time_frame>
    <description>The validated WHO quality of life self-report index will be used to assess quality of life</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Support for autonomous control over diabetes</measure>
    <time_frame>12 months</time_frame>
    <description>The validated Healthcare Climate Questionnaire (HCCQ), measures the support for autonomy from healthcare professionals experienced by the patient</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Self-management of diabetes</measure>
    <time_frame>12 Months</time_frame>
    <description>The validated self-report scale, Treatment Self-Regulation Questionnaire (TSRQ), measures the patient's motivation for health behaviour change</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Self-Efficacy at diabetes self-management</measure>
    <time_frame>12 Months</time_frame>
    <description>The validated self-report scale, the Perceived Competence in Diabetes (PCD), measures the patient's experience of competence in diabetes self-management</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Diabetes Distress</measure>
    <time_frame>12 Months</time_frame>
    <description>The validated scale, the Diabetes Distress Scale (DDS) measures the experience of the burden of diabetes in everyday life</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">0</enrollment>
  <condition>Type2 Diabetes Mellitus</condition>
  <arm_group>
    <arm_group_label>EMMA</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>These participants will receive diabetes self-management education using the dialogue tools, which emphasize empowerment and use the principles of motivational communication and behaviour modification. There will be a series of four visits using the dialogue tools to guide the patient toward meaningful self-management tasks. This is not the typical approach, where providers tell the patient the behaviours they, not the patient, consider priorities. This intervention will evaluate if medical outcomes (A1c) and adherence are improved using a patient-centered not a clinician-cantered approach in individuals with poor diabetes control.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Treatment as Usual</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>The participants will receive standard diabetes education via group and individual sessions with certified diabetes educators. In this method the patient is provided structured education in which there is an emphasis on covering clinician-determined aspects of diabetes knowledge and self-management. The emphasis vis on diabetes educator recommendations.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>EMMA</intervention_name>
    <description>Dialogue tools will be used to develop personally relevant behavioural goals consistent with diabetes self-management</description>
    <arm_group_label>EMMA</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Treatment as Usual</intervention_name>
    <description>Participants randomized to this intervention will receive standard diabetes education sessions. These include group education session and follow up session based on clinician-generated recommendations.</description>
    <arm_group_label>Treatment as Usual</arm_group_label>
    <other_name>Standard Diabetes Education</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Adults with type 2 diabetes ≥ 18 years&#xD;
&#xD;
          -  Type 2 diabetes ≥ 1 years&#xD;
&#xD;
          -  HbA1c ≥ 8 % at the last three visits before randomization&#xD;
&#xD;
          -  On oral or injectable medications (insulin, GLP-1; DPP-4)&#xD;
&#xD;
          -  Can speak, read and understand English&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Participation in other clinical intervention studies during the trial period&#xD;
&#xD;
          -  Receiving psychological or psychiatric treatment for a mental health disorder&#xD;
&#xD;
          -  Severely impaired vision or blindness&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>65 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Michael Vallis, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Lead, Behaviour Change Institute, NSHA and Associate Professor, Family Medicine, Dalhousie University</affiliation>
  </overall_official>
  <reference>
    <citation>Anderson RM, Funnell MM, Aikens JE, Krein SL, Fitzgerald JT, Nwankwo R, Tannas CL, Tang TS. Evaluating the Efficacy of an Empowerment-Based Self-Management Consultant Intervention: Results of a Two-Year Randomized Controlled Trial. Ther Patient Educ. 2009 Jun 1;1(1):3-11. doi: 10.1051/tpe/2009002.</citation>
    <PMID>20076768</PMID>
  </reference>
  <reference>
    <citation>Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in Type 2 diabetes. Diabet Med. 2013 Mar;30(3):338-44. doi: 10.1111/dme.12046.</citation>
    <PMID>23075262</PMID>
  </reference>
  <reference>
    <citation>Cushing A, Metcalfe R. Optimizing medicines management: From compliance to concordance. Ther Clin Risk Manag. 2007 Dec;3(6):1047-58.</citation>
    <PMID>18516274</PMID>
  </reference>
  <reference>
    <citation>Funnell M. Beyond the data: moving towards a new DAWN in diabetes. Diabet Med. 2013 Jul;30(7):765-6. doi: 10.1111/dme.12244. No abstract available.</citation>
    <PMID>23710971</PMID>
  </reference>
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    <citation>Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93. doi: 10.1056/NEJMoa021778.</citation>
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    <citation>Grabowski, D, Jensen, BB, Willaing, I, Zoffmann, V, Schiøtz, M. Sundhedspædagogik in patientuddannelse. A literature-based review of selected health education principles used in patient education. 2010; Steno Diabetes Center</citation>
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    <citation>Hansen, UM, Engelund, G, à Rogvi, S, Willaing, I (2014). The Balancing Person: an innovative approach to person-centered education in chronic illness. The European Journal of Person Centered Healthcare vol 2(3): 290-302</citation>
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    <citation>Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011. doi: 10.1002/14651858.CD000011.pub3.</citation>
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    <citation>Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, Magid DJ. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006 Sep 25;166(17):1836-41. doi: 10.1001/archinte.166.17.1836.</citation>
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    <PMID>24636386</PMID>
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    <citation>Kerse N, Buetow S, Mainous AG 3rd, Young G, Coster G, Arroll B. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med. 2004 Sep-Oct;2(5):455-61. doi: 10.1370/afm.139.</citation>
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    <citation>Kvale,S. Interviews: an introduction to qualitative research interviewing. 1996. Thousand Oaks, CA; London, Sage</citation>
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    <citation>Linn AJ, van Weert JC, Schouten BC, Smit EG, van Bodegraven AA, van Dijk L. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior. Patient Prefer Adherence. 2012;6:871-85. doi: 10.2147/PPA.S36195. Epub 2012 Dec 11.</citation>
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    <citation>Manca A, Hawkins N, Sculpher MJ. Estimating mean QALYs in trial-based cost-effectiveness analysis: the importance of controlling for baseline utility. Health Econ. 2005 May;14(5):487-96. doi: 10.1002/hec.944.</citation>
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    <PMID>16079372</PMID>
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    <citation>Peyrot M, Rubin RR. Behavioral and psychosocial interventions in diabetes: a conceptual review. Diabetes Care. 2007 Oct;30(10):2433-40. doi: 10.2337/dc07-1222. Epub 2007 Jul 31. No abstract available.</citation>
    <PMID>17666457</PMID>
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    <citation>Rhee MK, Slocum Pawson &amp; Tilley. Realistic Evaluation. 1997. London: Sage</citation>
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    <citation>Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, Gallina DL, Barnes C, Phillips LS. Patient adherence improves glycemic control. Diabetes Educ. 2005 Mar-Apr;31(2):240-50. doi: 10.1177/0145721705274927.</citation>
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    <citation>Teasdale, T &amp; Svendsen, H. Psykologiske &amp; pædagogiske metoder. Kvalitative og kvantitative forskningsmetoder I praksis. Jensen T.B. and Christensen G (eds.). 2005. Frederiksberg:Roskilde Universitetsforla</citation>
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    <citation>van Dulmen S. The value of tailored communication for person-centred outcomes. J Eval Clin Pract. 2011 Apr;17(2):381-3. doi: 10.1111/j.1365-2753.2010.01586.x. Epub 2010 Nov 18.</citation>
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    <citation>Vallis M. Behaviour change counselling--how do I know if I am doing it well? The development of the Behaviour Change Counselling Scale (BCCS). Can J Diabetes. 2013 Feb;37(1):18-26. doi: 10.1016/j.jcjd.2013.01.005. Epub 2013 Mar 14.</citation>
    <PMID>24070744</PMID>
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  <reference>
    <citation>Varming, A. Development and usability of a participatory adherence programme aimed at patients with type 2 diabetes in poor glycemic control. 2012. Master thesis (Master of Drug Management), University of Copenhagen</citation>
  </reference>
  <reference>
    <citation>Varming, A., Andrésdóttir, G., Engelund, G., Jelstrup, L., Persson, F. I. EMMA: Empowerment, Motivation &amp; Medical Adherence. Dialogue tools for diabetes consultations. ISBN 978-87-92759-07-8. Steno Diabetes Center. 2013 Gentofte.</citation>
  </reference>
  <reference>
    <citation>Williams A, Manias E, Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs. 2008 Jul;63(2):132-43. doi: 10.1111/j.1365-2648.2008.04656.x.</citation>
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    <citation>World Health Organization. Adherence to long-term therapies: evidence for action. 2003</citation>
  </reference>
  <verification_date>August 2018</verification_date>
  <study_first_submitted>December 29, 2016</study_first_submitted>
  <study_first_submitted_qc>December 29, 2016</study_first_submitted_qc>
  <study_first_posted type="Estimate">January 2, 2017</study_first_posted>
  <last_update_submitted>August 1, 2018</last_update_submitted>
  <last_update_submitted_qc>August 1, 2018</last_update_submitted_qc>
  <last_update_posted type="Actual">August 3, 2018</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Nova Scotia Health Authority</investigator_affiliation>
    <investigator_full_name>Michael Vallis</investigator_full_name>
    <investigator_title>Lead, Behaviour Change Institute and Associate Professor, Family Medicine, Dalhousie University</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Diabetes Mellitus, Type 2</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03008395
org study id: NSHABCIEMMA
nct id: NCT03008395
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
Outcomes in type 2 diabetes are largely achieved by self-management efforts by individuals
      living with diabetes. Diabetes self-management is typically provided using the principles of
      adult education. Current evidence suggests that standard educational interventions are
      suboptimal. This study evaluates a novel approach to diabetes self-management using dialogue
      tools based on empowerment and motivational communication methods. The approach evaluated in
      this study is called EMMA: empowerment, motivation and medical adherence. Participants will
      be randomized to EMMA and treatment as usual, treated for a period of 4 months and evaluated
      over a period of 12 months.
The management of type 2 diabetes (T2D) is experienced by many patients as being very
      complex. This is especially true when diabetes management includes multiple medical
      interventions such as oral agents and injectable medication (insulin, GLP-1; DPP-4s) in
      combination with diabetes specific behaviours such as blood glucose monitoring and foot care
      as well as healthy lifestyle behaviours such as physical activity and healthy eating. Studies
      show that 40-50 % of patients with T2D have suboptimal adherence to self-management
      recommendations. In general, it is estimated that about half of patients with chronic
      diseases do not take their medications as prescribed. Suboptimal medical adherence drives
      poor glycemic control as well as poor quality of life for an individual patient not to
      mention increased health care costs due to comorbidities, reduced work function and hospital
      admissions.

      Suboptimal adherence may be driven by numerous factors, including lack of symptoms of TD2
      (perceived nonseriousness of the disease), side-effects of treatments (GI distress associated
      with metformin, weight gain associated with insulin) in conjunction with a complex dosing
      regimen, lack of knowledge or belief in the efficiency of the medication, lack of motivation,
      cultural factors as well as poor instruction and judgmental communication between the
      healthcare professional and patient.

      There is a need for new methods to understand the drivers of nonadherence and support the
      patient to proactively self-manage their TD2. There is also a need for new tools (i.e.,
      knowledge translation methods) to support healthcare professionals to engage patients based
      on dialogue (collaboration) and active patient involvement (self-management), to overcome the
      barriers to adherence and thereby improve their ability to obtain good glycemic control. The
      purpose of this study is to evaluate a self-management support intervention called EMMA:
      Empowerment, motivation & medical adherence.

      EMMA is a concept consisting of a number of dialogue tools for use in diabetes consultations
      (see below). The concept was, in its original form tested, in a feasibility study (N = 19
      T2D) in 2011-12. The study showed significant reduction in HbA1c (EMMA: median decrease of
      2.0 mmol / mol (-1.0 to 3.0) versus control: median increase 2.5 mmol / mol (-2.0 to -4.5) p
      = 0.05) (Varming 2012; Andrésdóttir 2014). The investigators have been collaborating with the
      Danish group who have developed the EMMA protocol and have developed training programs to
      support the diabetes educator in the delivery of the intervention. The use of the EMMA method
      is very consistent with motivational communication and behaviour change counselling. The
      investigators plan to conduct a small scale randomized comparison trial of the EMMA method
      with diabetes services at the NSHA Central Zone.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Supportive Care
masking: None (Open Label)
measure: Hemoglobin A1c
time frame: 12 months
description: Hemoglobin A1c is a blood test that is considered to be the gold standard of diabetes control
measure: WHO-QoL Scale
time frame: 12 months
description: The validated WHO quality of life self-report index will be used to assess quality of life
measure: Support for autonomous control over diabetes
time frame: 12 months
description: The validated Healthcare Climate Questionnaire (HCCQ), measures the support for autonomy from healthcare professionals experienced by the patient
measure: Self-management of diabetes
time frame: 12 Months
description: The validated self-report scale, Treatment Self-Regulation Questionnaire (TSRQ), measures the patient's motivation for health behaviour change
measure: Self-Efficacy at diabetes self-management
time frame: 12 Months
description: The validated self-report scale, the Perceived Competence in Diabetes (PCD), measures the patient's experience of competence in diabetes self-management
measure: Diabetes Distress
time frame: 12 Months
description: The validated scale, the Diabetes Distress Scale (DDS) measures the experience of the burden of diabetes in everyday life
arm group label: EMMA
arm group type: Experimental
description: These participants will receive diabetes self-management education using the dialogue tools, which emphasize empowerment and use the principles of motivational communication and behaviour modification. There will be a series of four visits using the dialogue tools to guide the patient toward meaningful self-management tasks. This is not the typical approach, where providers tell the patient the behaviours they, not the patient, consider priorities. This intervention will evaluate if medical outcomes (A1c) and adherence are improved using a patient-centered not a clinician-cantered approach in individuals with poor diabetes control.
arm group label: Treatment as Usual
arm group type: Active Comparator
description: The participants will receive standard diabetes education via group and individual sessions with certified diabetes educators. In this method the patient is provided structured education in which there is an emphasis on covering clinician-determined aspects of diabetes knowledge and self-management. The emphasis vis on diabetes educator recommendations.
intervention type: Behavioral
intervention name: EMMA
description: Dialogue tools will be used to develop personally relevant behavioural goals consistent with diabetes self-management
arm group label: EMMA
intervention type: Other
intervention name: Treatment as Usual
description: Participants randomized to this intervention will receive standard diabetes education sessions. These include group education session and follow up session based on clinician-generated recommendations.
arm group label: Treatment as Usual
other name: Standard Diabetes Education
criteria: 
gender: All
minimum age: 18 Years
maximum age: 65 Years
healthy volunteers: Accepts Healthy Volunteers
last name: Michael Vallis, PhD
role: Principal Investigator
affiliation: Lead, Behaviour Change Institute, NSHA and Associate Professor, Family Medicine, Dalhousie University
citation: Anderson RM, Funnell MM, Aikens JE, Krein SL, Fitzgerald JT, Nwankwo R, Tannas CL, Tang TS. Evaluating the Efficacy of an Empowerment-Based Self-Management Consultant Intervention: Results of a Two-Year Randomized Controlled Trial. Ther Patient Educ. 2009 Jun 1;1(1):3-11. doi: 10.1051/tpe/2009002.
PMID: 20076768
citation: Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in Type 2 diabetes. Diabet Med. 2013 Mar;30(3):338-44. doi: 10.1111/dme.12046.
PMID: 23075262
citation: Cushing A, Metcalfe R. Optimizing medicines management: From compliance to concordance. Ther Clin Risk Manag. 2007 Dec;3(6):1047-58.
PMID: 18516274
citation: Funnell M. Beyond the data: moving towards a new DAWN in diabetes. Diabet Med. 2013 Jul;30(7):765-6. doi: 10.1111/dme.12244. No abstract available.
PMID: 23710971
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responsible party type: Principal Investigator
investigator affiliation: Nova Scotia Health Authority
investigator full name: Michael Vallis
investigator title: Lead, Behaviour Change Institute and Associate Professor, Family Medicine, Dalhousie University
mesh term: Diabetes Mellitus, Type 2
sharing ipd: No