ORIGINAL RESEARCHThe Efficacy of Diabetes Patient Education and Self-Management Education in Type 2 Diabetes
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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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2015, Canadian Journal of DiabetesCitation Excerpt :Research conducted in the United States found that both the CDSMP and the DSMP improve patient outcomes for type 2 diabetes at 6 and 12 months Research conducted in the United States found that participation in a community self-management program enhances outcomes of patients who have already received diabetes-patient education (17). However, there was still a lack of evidence regarding these self-management programs, namely:
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2014, Canadian Journal of DiabetesCitation Excerpt :Self-efficacy attainment has been shown to influence individuals' motivations, accomplishments, self-regulation, and efforts to perform self-care actions (25). We note that patient education programs grounded in self-efficacy theory have been shown to enhance patients' adherence to self-care behaviour that has in turn been shown to improve clinical outcomes (26–29). Based on the principles of social cognition theory, our approach was to develop a specialized behaviour-change strategy that first assesses the physicians' and patients' readiness to undertake behaviour-change interventions and then, in response to the physicians' and patients' readiness levels, stipulate a personalized behaviour-change program.