Is group diabetes education effective on hemoglobin A1c level?

Abstract

Objectives. Diabetes education decreases hemoglobin A1c (HbA1c) level by 1% in patients with diabetes mellitus. In addition, education delays development or progression of complications by improving psychosocial, clinical, and behavioural aspects of diabetes mellitus, improves quality of life, modifies life style behaviours including healthy eating and regular exercise. In this study, we aimed to evaluate efficacy of diabetes group education programme called diabetes school on glycemic control by comparing HbA1c levels of patients with diabetes mellitus measured before and after education. Methods. Electronic medical records of patients with DM who were registered to diabetes school executed by endocrine units of two hospitals between 2015 and 2017 were retrospectively evaluated. Diabetes school programme was composed of 90 minutes sessions a week for 4 consecutive weeks. Education sessions were executed in a didactic and interactive pattern. Results. The attendees (n = 65) had signicantly lower HbA1c levels after the education programme (before 9.09 ± 2.46%, after 7.88 ± 1.90%; p = 0.001) than the non-attendees (n = 41) (before 8.96 ± 2.35%, after 8.35 ± 2.00%; p = 0.091). Insulin users had significantly higher baseline HbA1c values and benefited more than non-insulin users (p < 0.0001). Conclusions: The diabetes school education programme has positive impact on glycemic control in patients with diabetes mellitus. A large team may lessen the burden of education sessions on health specialists. The school executed by a team consisting of specialists may reach a larger number of patients while the patients get the opportunity to repeat the sessions anytime they need. 

Keywords

• diabetes education,hemoglobin A1c,diabetes school,group education

References

1. [1] U.S. Department of Health and Human Services’ National Institutes of Health and Centers for Disease Control and Prevention.Guiding principles for the care of people with or at risk for diabetes. National Diabetes Education Programme. 2014, USA.
2. [2] Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002;25:1551-6.
3. [3] Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169-80.
4. [4] Glycemic targets. American Diabetes Association. Diabetes Care 2017;40:S48-S56.
5. [5] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 2016;387:1513-30.
6. [6] TC Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu. Türkiye Diyabet Programı, 2015-2020. 2014, Ankara.
7. [7] Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2009;(1):CD005268.
8. [8] TC Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu. Erişkin diyabetli bireyler için eğitimci rehberi. 2014, Ankara.

9. [9] Uluslarası Diyabet Federasyonu. Uluslarası Diyabet Eğitim standartları. 3rd ed. Istanbul: EOS Ajans Yayıncılık; 2009.
10. [10] AADE 7™ Self-Care Behaviors. American Association of Diabetes Educators (AADE) Position Statement. Available at: www.diabeteseducator.org/docs/default-source/practice/practice-resources/position-statements/aade7-self-care-behaviors-position-statement.pdf?sfvrsn=6. Accessed August 4, 2017.
11. [11] Lawal M, Lawal F. Individual versus group diabetes education: Assessing the evidence. J Diabetes Nurs 2016;20:247-50.
12. [12] Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, 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. BMJ 2008;336:491-5.
13. [13] Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005;(2):CD003417. Update in: Cochrane Database Syst Rev. 2015;6:CD003417.
14. [14] Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 2002;25:1159-71.
15. [15] Rickheim PL, Weaver TW, Flader JL, Kendall DM. Assessment of group versus individual diabetes education: a randomized study. Diabetes Care 2002;25:269-74.
16. [16] Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabet Med 2006;23:944-54.
17. [17] Adolfsson ET, Walker-Engström ML, Smide B, Wikblad K. Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study. Diabetes Res Clin Pract 2007;76:341-50.
18. [18] Gucciardi E, Demelo M, Lee RN, Grace SL. Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes. Ethn Health 2007;12:163-87.
19. [19] Merakou K, Knithaki A, Karageorgos G, Theodoridis D, Barbouni A. Group patient education: effectiveness of a brief intervention in people with type 2 diabetes mellitus in primary health care in Greece: a clinically controlled trial. Health Educ Res 2015;30:223-32.
20. [20] Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Cavallo F, et al. A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care 2004;27:670-5.
21. [21] Samancıoğlu S, Bakır E, Doğan U, Karadağ A, Erkan E, Aktürk A, et al. [The content of diabetes education in type 2 diabetic patients and their attitude towards the disease]. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2017;2:1-5. [Article in Turkish]
22. [22] Mollaoğlu M, Beyazıt E. Influence of diabetic education on patient metabolic control. Appl Nurs Res 2009;22:183-90.
23. [23] Kartal A, Özsoy SA. [Effect of planned diabetes education on health beliefs and metabolic control in type 2 diabetes patients]. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2014;1:1-15. [Article in Turkish]
24. [24] Ersoy C, Tuncel E, Özdemir B, Ertürk E, İmamoğlu Ş. [Diabetes education and metabolic control in patients with type 2 diabetes mellitus under insulin treatment]. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2006;32:43-7. [Article in Turkish]
25. [25] Trento M, Passera P, Tomalino M, Bajardi M, Pomero F, Allione A, et al. Group visits improve metabolic control in type 2 diabetes: a 2-year follow-up. Diabetes Care 2001;24:995-1000.
26. [26] Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clin Diabetes 2016;34:70-80.
27. [27] Smaldone A, Ganda OP, McMurrich S, Hannagan K, Lin S, Caballero AE, et al. Should group education classes be separated by type of diabetes? Diabetes Care 2006;29:1656-8.