An evaluation of an insulin transfer programme delivered in a group setting

Abstract

This study assesses the efficacy of a group education programme through the improvement of the patients' HbA1c status and their overall understanding of diabetes. The transfer from tablets to insulin is a crucial time for patients with diabetes. The provision of diabetes education is essential, enabling patients to develop a knowledge base from which to manage their diabetes and consequently take control of their life. The growing numbers of referrals for insulin transfer meant that the traditional one-to-one education approach is unrealistic and a local diabetes team developed a group programme to meet the demand. The study has a pre-post test design. Biomedical outcomes are: HbA1c and weight. Self-report outcomes are: diabetes knowledge, diabetes treatment satisfaction (DTSQ) and quality of life (EQ-5D). All outcomes were measured prior to the group education programme and then after the programme had been completed. HbA1c was also measured again at three months after the education programme had finished. A repeated measures anova was used to analyse the main data. Seventy-two patients were recruited into the study and at follow-up 77% (n = 65) remained in the study. The mean age of the participants was 64.5 (SD 12.01) years and the median time since being diagnosed with diabetes was 7.3 years (range two months to 20 years). There was an overall significant reduction in the HbA1c scores across the three time points (F(1.5) = 57.87, p < 0.0001). Post hoc tests indicate there are significant reductions (p < 0.0001) from the pregroup mean at both the postgroup (9.84% vs. 8.54%) and three-month follow up means (9.84% vs. 8.10%). The difference from times 2 and 3 (8.54% vs. 8.10%) was also significant (p < 0.0001). There were no significant changes in weight. After the programme, satisfaction with diabetes treatment was high and knowledge about diabetes had improved (t(54) = 7.46, p < 0.0001). There were significant improvements reported on the five health dimensions of the EQ-5D. These results indicate that a group education programme can be an effective method of helping patients transfer from tablets to insulin. These group sessions have reduced waiting times for patients transferring from tablets to insulin and have proved an effective use of time management by Diabetes Specialist Nurses.