Diabetes education and knowledge in patients with type 2 diabetes from the community

Abstract

Background: Diabetic patients obtain knowledge of the condition from a variety of sources. These include education programs and encounters with health-care staff such as during instruction on self-monitoring of blood glucose (SMBG). Objective: To assess whether diabetes knowledge is related to prior attendance at diabetes education programs, visits to dieticians or the current use of SMBG in a community-based cohort of subjects with type 2 diabetes. Patients: 1264 type 2 patients from the Fremantle Diabetes Study (FDS) cohort. Methods: Subjects answered 15 standard multiple-choice questions about diabetes and its management. Recall of past diabetes education, dietician consultations, and use of SMBG were recorded. Analysis of variance was used to determine whether these activities or other social and demographic factors predicted diabetes knowledge. Results: Attendance at education programs, visits to dieticians, and SMBG were independently associated with greater diabetes knowledge. Subjects who were older, whose schooling was limited, who were not fluent in English and/or who were from Southern European or indigenous Australian ethnic groups had significantly lower knowledge scores. Patients who were older, not fluent in English or from an indigenous Australian background were significantly less likely to have received diabetes education, dietetic advice or to be performing SMBG. Conclusions: Diabetes education programs, diabetes-related visits to dieticians and SMBG are associated with, and may be important sources of, improved diabetes knowledge in patients with type 2 diabetes. Our data provide evidence that barriers to access or utilization of contemporary diabetes education confront older patients, minority groups and those with language difficulties. These groups are likely to benefit from specialized programs.

Introduction

Adequate knowledge of diabetes is a key component of diabetes care (Beaser, Richardson, & Hollerworth, 1994). The potential benefits of diabetes knowledge include a sense of empowerment and improved quality of life Beaser et al., 1994, Brown, 1990, Padgett et al., 1988. While it has been difficult to demonstrate that formal diabetes education per se leads to improved metabolic control (Lockington, Meadows, & Wise, 1984), it is clear that improvements in outcomes cannot occur without adequate instruction about diabetes (Beaser et al., 1994). To this end, all people with diabetes are encouraged by the American Diabetes Association to attend formal diabetes education programs (Department of Health and Human Services, 1991).

Information about diabetes is obtained from a variety of sources including one-to-one interactions with doctors, nurses and dieticians. Self-monitoring of blood glucose (SMBG) requires considerable instruction and could be an important additional source of diabetes knowledge for many patients. The value of SMBG in patients with type 2 DM who are not on insulin treatment has been questioned because of doubts about beneficial effects on glycemic control Evans et al., 1999, Faas et al., 1997, Kennedy, 2001. Nevertheless, the potential impact of SMBG on diabetes knowledge has not been examined previously.

We have examined whether prior attendance at group diabetes education programs, diabetes-related visits to dieticians or the performance of SMBG were associated with scores on a diabetes knowledge questionnaire in a large, multiethnic community-based sample of patients with type 2 diabetes. We also examined determinants of participation in these important self-care behaviors.