Significant HbA1c Reduction with Target-Focused Glucose Education and Patient-Led Follow-Up in Uncontrolled Type 2 Diabetes Mellitus

Öz

Aim: Although most patients with diabetes (DM) own a glucose monitoring device, inadequate knowledge of fasting and postprandial target values often prevents correct interpretation of results and effective use of this technology. This study aimed to evaluate the effect of target-oriented education and a patient-responsibility-based follow-up system, combined with medical therapy, on HbA1c levels. Material and Methods: This single-arm, prospective interventional study included 84 adults with type 2 diabetes mellitus (T2DM) and HbA1c ≥8.0%. At baseline, a questionnaire assessed participants’ knowledge of fasting and postprandial glucose targets and educational level. Participants then received standardized written and verbal education on these targets. A patient-led follow-up model was implemented, instructing patients to attend the outpatient clinic when self-measured glucose values exceeded target levels. Statistical analyses included Friedman, Wilcoxon signed-rank, and Kruskal-Wallis tests. Results: The mean age was 57.8 ± 8.4 years; 42.9% (n=36) were male. At baseline, only 10.7% correctly identified fasting and 1.2% postprandial glucose targets. Median HbA1c decreased from 9.7% (IQR 8.6-11.5) to 8.1% (IQR 7.63-9.0) at 3 months and 7.1% (IQR 6.9-7.57) at 6 months (all p<0.001). Clinic visit frequency increased significantly during the first 3 months and declined as glycemic targets were approached (p<0.001).Conclusion: Awareness of fasting and postprandial glucose targets was critically low among patients with T2DM. A minimalist, targetfocused educational strategy combined with a patient-led monitoring model achieved a clinically meaningful reduction in HbA1c levels.

Anahtar Kelimeler

• Blood glucose self-monitoring
• Diabetes mellitus
• Glycemic control
• Patient education as topic

Kontrolsüz Tip 2 Diabetes Mellitus'ta Hedef Odaklı Glukoz Eğitimi ve Hasta Önderliğinde Takip ile HbA1c'de Anlamlı Düşüş

Öz

Amaç: Diyabetli (DM) hastaların çoğunda glukoz ölçüm cihazı bulunmasına rağmen, açlık ve yemek sonrası hedef değerlerine ilişkin yetersiz bilgi, sonuçların doğru yorumlanmasını ve bu teknolojinin etkili kullanımını sıklıkla engellemektedir. Bu çalışma, hedef odaklı eğitim ve hasta sorumluluğuna dayalı bir takip sisteminin, tıbbi tedavi ile birlikte, HbA1c düzeyleri üzerindeki etkisini değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Bu tek kollu, prospektif müdahale çalışmasına, HbA1c ≥%8,0 olan tip 2 diyabetli (T2DM) 84 yetişkin dahil edilmiştir. Başlangıçta, katılımcıların açlık ve yemek sonrası glukoz hedeflerine ilişkin bilgileri ve eğitim düzeyleri bir anketle değerlendirilmiştir. Daha sonra katılımcılara bu hedefler hakkında standartlaştırılmış yazılı ve sözlü eğitim verilmiştir. Hasta sorumluluğuna dayalı bir takip modeli uygulanmış ve hastalara kendi ölçtükleri glukoz değerleri hedef düzeyleri aştığında polikliniğe başvurmaları talimatı verilmiştir. İstatistiksel analizler Friedman, Wilcoxon işaretli sıralama ve Kruskal-Wallis testlerini içermiştir. Bulgular: Ortalama yaş 57,8 ± 8,4 yıldı; %42,9'u (n=36) erkekti. Başlangıçta, sadece %10,7'si açlık ve %1,2'si yemek sonrası glukoz hedeflerini doğru bir şekilde belirleyebildi. Medyan HbA1c, 3 ayda %9,7'den (IQR 8,6-11,5) %8,1'e (IQR 7,63-9,0) ve 6 ayda %7,1'e (IQR 6,9-7,57) düştü (tüm p<0,001). Klinik ziyaret sıklığı ilk 3 ay boyunca önemli ölçüde arttı ve glisemik hedeflere yaklaşıldıkça azaldı (p<0,001). Sonuç: T2DM’li hastalarda açlık ve yemek sonrası glukoz hedeflerine ilişkin farkındalık kritik derecede düşüktü. Sade ve hedef odaklı bir eğitim stratejisinin, hasta sorumluluğuna dayalı bir izleme modeliyle birleştirildiğinde, HbA1c düzeylerinde klinik olarak anlamlı bir azalma sağlanmıştır.

Anahtar Kelimeler

• Diabetes Mellitus
• Glisemik kontrol
• Hasta eğitimi
• Kan şekeri izlemi

Kaynakça

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