Patient education
Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial

https://doi.org/10.1016/j.pec.2011.04.008Get rights and content

Abstract

Objective

To evaluate the efficacy of ongoing group based diabetes self-management education (DSME) for patients with type 2 diabetes.

Methods

146 patients were randomised to either group education or waiting list control. Primary outcomes were A1C and patient activation measured with patient activation measure (PAM).

Results

There were no differences in the primary outcomes between the groups at 12 months, but the control group had an increase in A1C of 0.3% points during follow-up. Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group. A sub group analysis was conducted for the quartile with the highest A1C at baseline (>7.7, n = 18 in both groups). There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control.

Conclusions

The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level.

Practice implications

Locally developed programs may be less effective than programs developed for studies.

Introduction

Diabetes mellitus is an increasing health problem worldwide. The total number of people with diabetes is projected to double in the next two decades to 366 million in 2030 due to population growth, aging, urbanization, increasing prevalence of obesity and physical inactivity [1]. Type 2 diabetes accounts for about 90% of all cases of diabetes [2].

Much of the treatment of type 2 diabetes, in addition to medical treatment, is based on a high degree of self-management [3]. There are several group based education programs for diabetes that have been developed and delivered as part of studies [4], [5], [6], [7]. A review of such studies found them to be effective in improving blood sugar control and glycated haemoglobin, diabetes knowledge, reducing systolic blood pressure levels, body weight and the requirement for diabetes medication [8]. However, there are many ongoing diabetes education programs that are developed locally, most likely without the help of specialised personnel who have extensive expertise in patient education and not build on a theoretical model. In the descriptions of interventions in published papers, we found no randomised studies that investigated the effect of diabetes self-management education (DSME) that were locally developed and used in everyday practice. There is thus a lack of studies on the effect of such locally developed self-management programs, programs that are the ones most likely to be delivered to the largest proportion of patients. This is also the situation in Norway where DSME programs are widely offered, yet the only one that has been evaluated was developed as part of a study [9].

The aim of this study was therefore to evaluate the efficacy of ongoing, locally developed group based diabetes self-management education for patients with type 2 diabetes.

Section snippets

Methods

This was an open pragmatic, parallel group, randomised controlled trial conducted in Central Norway from May 2006 to November 2008. The study was approved by the Regional Ethical Committee and the Norwegian Social Science Data Services.

Results

Letters of invitation were sent to 523 persons, 160 (30.5%) replied and were eligible and 146 participants were randomised (Fig. 1). Of those who dropped out or had missing data, 9 (12.3%) were in the intervention group and 4 (5.4%) were in the control group. Participation of the intervention group was as follows: 12 (16%) did not attend any of the DSME, 4 participants attended 2 of 3 days and 57 participants attended all 3 days. The leaders of the DSME programs reported that the patients in

Discussion

There was no statistically significant effect between the groups on the A1C level or patient activation, but the A1C level in the control group worsened significantly while it was unchanged in the intervention group. The intervention group showed better diabetes knowledge and improved self-management skills after the program, yet showed a trend for worse mental quality of life. For the sub group with an A1C level above 7.7% the intervention showed a trend for effect on both A1C and patient

Funding

This work was supported by the Central Norway Health Authorities, Samarbeidsorganet (grant # 46011600-47).

Conflicts of interest

There are no potential conflicts of interest relevant to this article.

Acknowledgements

The authors wish to thank the staff at the diabetes out-patient clinic and Lærings-og mestringssentret in Helse Nord-Trondelag HF and the patients who took part in the study. The study was supported by the Central Norway Health Authorities.

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