Patient educationEfficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial
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.
References (31)
Can newer therapies delay the progression of type 2 diabetes mellitus?
Endocr Pract
(2008)- et al.
Patient empowerment: myths and misconceptions
Patient Educ Couns
(2010) - et al.
Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study
Diabetes Res Clin Pract
(2007) - et al.
The quality of life of elderly diabetic patients
J Diabetes Complications
(2000) - et al.
Patient concerns in their first year with type 2 diabetes: patient and practice nurse views
Patient Educ Couns
(2001) - et al.
A trial of empowerment-based education in type 2 diabetes – global rather than glycaemic benefits
Diabetes Res Clin Pract
(2008) - et al.
The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project
International Quality of Life Assessment. J. Clin. Epidemiol
(1998) - et al.
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030
Diabetes Care
(2004) - et al.
Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial
Brit Med J
(2008) - et al.
Structured patient education: the diabetes X-PERT programme makes a difference
Diabetic Med
(2006)
Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial
Med Care
Group based training for self-management strategies in people with type 2 diabetes mellitus
Cochrane Database Syst Rev
An intensified lifestyle intervention programme may be superior to insulin treatment in poorly controlled type 2 diabetic patients on oral hypoglycaemic agents: results of a feasibility study
Diabetic Med
Steve de Shazer and the future of solution-focused therapy
J Marital Fam Ther
Development and testing of a short form of the patient activation measure
Health Serv Res
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