ORIGINAL RESEARCH
The Efficacy of Diabetes Patient Education and Self-Management Education in Type 2 Diabetes

https://doi.org/10.1016/S1499-2671(11)51008-1Get rights and content

ABSTRACT

OBJECTIVE: The goal of this randomized, controlled trial was to compare the 6-month efficacy of didactic diabetes patient education to a model that augmented this education with a self-management program.

METHODS: Adults with type 2 diabetes were randomly assigned to a group that received diabetes patient education or to a group that received this education augmented by a community self-management program. Outcome measures were taken at baseline and 6 months. Analysis included pre- and 6-month-post-program paired comparison for each group; a comparison of change between groups; and an intent-to-treat comparison of change between groups.

RESULTS: At baseline, there were no between-condition differences with respect to behavioural or biological outcomes or healthcare utilization. The pre- and 6-month-post-program comparison found statistically significant improvements in both groups in terms of glycated hemoglobin (A1C) and weight, and the experimental group had statistically significant improvements in 4 additional outcomes. A 12-month analysis found that baseline scores were statistically lower for both A1C and weight in the experimental group and statistically higher than baseline A1C in the control group.

CONCLUSION: Augmenting diabetes patient education with a low-cost community self-management education program brought about additional improvements. Study limitations included self-selection of participants, short-term study duration and lack of comparison studies.

RÉSUMÉ

OBJECTIF : Cet essai contrôlé avec répartition aléatoire avait pour objet de comparer l'efficacité, après six mois, d'un programme d'éducation sur le diabète à un modèle associant ce programme à un programme d'autogestion.

MÉTHODES : Des adultes atteints de diabète de type 2 ont été répartis au hasard pour participer au programme d'éducation sur le diabète seulement ou à ce programme et à un programme communautaire d'autogestion. Des mesures ont été effectuées au départ et six mois plus tard. Trois analyses ont été effectuées : une comparaison par paires des valeurs obtenues avant le programme et après six mois dans chaque groupe, une comparaison du changement entre les groupes et une comparaison en intention de traiter du changement entre les groupes.

RÉSULTATS : Au départ, il n'y avait pas de différences entre les groupes pour ce qui est des comportements, des valeurs biologiques ou de l'utilisation des services de santé. La comparaison entre les mesures effectuées avant le programme et six mois plus tard a montré qu'il y avait eu des améliorations statistiquement significatives dans les deux groupes de l'hémoglobine glycosylée (HbA1c) et du poids. Dans le groupe expérimental, il y a eu des améliorations statistiquement significatives de quatre autres mesures. Une analyse effectuée douze mois plus tard a montré que les scores de base étaient statistiquement plus bas tant pour le taux d'HbA1c que pour le poids dans le groupe expérimental et statistiquement plus hauts pour le taux d'HbA1c dans le groupe témoin.

CONCLUSION : L'association d'un programme communautaire d'autogestion peu coûteux à un programme d'éducation sur le diabète a produit d'autres améliorations. Les limites de l'étude étaient l'auto-sélection des participants, la courte durée de l'étude et le manque d'études de comparaison.

Section snippets

INTRODUCTION

The United States (US) national standards for diabetes self-management education (1) and the Canadian Diabetes Association 2008 clinical practice guidelines (2) provide a comprehensive description of the evidence-based education that is effective for improving clinical outcomes and quality of life for people with diabetes. Education that couples diabetes disease management with behavioural strategies—namely the use of action plans and problem solving—has been shown to bring about improved

METHODS

The standard protocol for diabetes care in British Columbia, Canada, is that adults diagnosed with type 2 diabetes are referred to a diabetes education centre. Between April 2004 and December 2006, all persons referred to the diabetes education centre at Richmond Hospital, Richmond, British Columbia (approximately 1400 in total) were informed about this study. Diabetes education centre staff explained the purpose and process of the study, and inquired about patients’ interest in participating.

RESULTS

In total, 321 people registered in the study; 169 were randomly assigned to the experimental group, and 152 to the control group. Of the 169 subjects randomly assigned to the experimental group, only 82 (49%) agreed to take the community CDSMP after receiving diabetes patient education, even though they had all agreed to so when they registered in the study. The main reasons provided for not wanting to take the community CDSMP were as follows: not able to take time off work (n=19), not having

DISCUSSION

This study compared the efficacy of a didactic model of diabetes patient education provided at a diabetes education centre in British Columbia, Canada, to that of a model that combined diabetes patient education with a community self-management program. Results showed that at 6 months post-program, subjects in both the experimental and control groups had made improvements in key diabetes measures, namely A1C level and weight. Adjustment for baseline A1C levels and weight did not account for the

CONCLUSION

A subset of patients receiving diabetes patient education agreed to also participate in a 6-week community selfmanagement program. By examining pre- and post-program changes in self-report and biometric disease measures the findings suggest incorporating a low-cost community selfmanagement program into routine diabetes care can bring about additional patient improvements. The community lay-led self-management program provided support for the clinical services delivered by diabetes health

AUTHOR DISCLOSURES

This research was supported by a grant from the Vancouver Foundation (BCM03-0095). Parts of this study were orally presented at the Showcase of Research in Aging, University of Victoria, Victoria, British Columbia, Canada, on June 20, 2007; and at the Taking Charge of Our Health, Canadian Conference on Integrated Chronic Disease Self-Management, Toronto, Ontario, Canada, on October 23, 2008.

ACKNOWLEDGMENTS

I would like to thank project advisory committee members of Richmond Hospital (Moira Bradshaw BSc, Ann Dauphinee MScN, Barbara Leslie BA, James Lu MD MHSc and Suman Prasad RN), Fran Hensen RN BScN Med, Sherry Lynch MSW, for project coordination and Jonathan Berkowitz PhD for expertise in data analysis and presentation.

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