Structured Diabetes Education Programme Research Articles

Improving Self-care Behavior and Removing Barriers by Structured Diabetes Education Program in Primary Health-care Settings of Puducherry: Evidence from a Mixed-method Intervention Study

Abstract Context: Diabetes self-management education (DSME) improves patients’ clinical outcomes and quality of life by encouraging self-care behavior. Aims: This study aimed to find out the effectiveness of a DSME by comparing changes in stages of self-care behavior and to explore perceived barriers in diet, exercise, and foot care among patients with type 2 diabetes mellitus in an urban primary health center (PHC) of Puducherry. Settings and Design: A mixed-method intervention study was conducted among 314 patients with type 2 diabetes mellitus in two urban PHCs randomly allocated to intervention and control arm. Subjects and Methods: The stages of behavior change and barriers perceived in the domains of diet, physical activity, and foot care were captured using a pretested questionnaire. Intervention consisted of DSME along with information leaflets and self-care kits for the intervention group. At the end of 6 months, end-line assessment and in-depth interviews were conducted. Statistical Analysis Used: Quantitative data were analyzed in STATA while manual coding and deductive thematic analysis were done for qualitative data. Results: Footcare showed an improvement of 31%, while diet and exercise domains saw an improvement of 5% each from preaction to action stage when compared with control arm. The main barriers perceived in dietary modification and foot care were lack of awareness. For exercise, the main barriers were lack of perceived need and being physically unfit. Foot-care barriers witnessed maximum resolution (27%) following the intervention. Conclusions: DSME intervention helps in improving stages of behavior change while resolving self-care barriers. Culturally-oriented DSME and patient-tailored interventions are key to empower people living with diabetes by improving self-care.

Mediterranean diet adherence and glycemic control in children and adolescents with type 1 diabetes.

To effectively manage type 1 diabetes (T1D) insulin is essential, with dosages based on lifestyle. The Mediterranean diet has demonstrated its advantages in preventing and enhancing the management of chronic diseases. Our objective was to investigate the potential mediation of sensor activity on the relationship between adherence to the Mediterranean diet and glycemic control in children and adolescents. A total of 150 children and adolescents (mean age = 13.09, SD = 3.54; 44% female) with T1D were recruited. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire which evaluates 16 items and gives higher scores when adherence is higher. Glycemic control and the duration of sensor activity were evaluated with data from flash glucose monitoring. The data confirmed our hypothesis by revealing that adherence to the Mediterranean diet positively influenced glycemic control (direct effect = 1.505; P < 0.01) and that this relationship was mediated by the duration of sensor activity (indirect effect = 0.531; P < 0.01). Conclusions: Our results support the increased utilization of glycemic control devices, as they contribute to improve glycemic control and mediate on the positive relationship between adherence to the Mediterranean diet and adequate glycemic control. Furthermore, our findings highlight the importance of incorporating Mediterranean diet recommendations to achieve better glycemic control in children and adolescents with T1D. What is Known: • The Mediterranean diet and glycemic control have proven benefits in improving cardiovascular health in the general population. Scarce evidence exists of these benefits among children and adolescents with T1D. What is New: • Adherence to the Mediterranean diet and greater use of glucose monitoring devices in children and adolescents with T1D are related to better glycemic control. These variables can be enhanced by psychoeducational interventions such as structured diabetes education programs or peer group-based sessions, which highlights the importance of focusing on these aspects.

Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline.

Hypoglycemia in people with diabetes is common, especially in those taking medications such as insulin and sulfonylureas (SU) that place them at higher risk. Hypoglycemia is associated with distress in those with diabetes and their families, medication nonadherence, and disruption of life and work, and it leads to costly emergency department visits and hospitalizations, morbidity, and mortality. To review and update the diabetes-specific parts of the 2009 Evaluation and Management of Adult Hypoglycemic Disorders: Endocrine Society Clinical Practice Guideline and to address developing issues surrounding hypoglycemia in both adults and children living with diabetes. The overriding objectives are to reduce and prevent hypoglycemia. A multidisciplinary panel of clinician experts, together with a patient representative, and methodologists with expertise in evidence synthesis and guideline development, identified and prioritized 10 clinical questions related to hypoglycemia in people living with diabetes. Systematic reviews were conducted to address all the questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. The panel agreed on 10 questions specific to hypoglycemia risk and prevention in people with diabetes for which 10 recommendations were made. The guideline includes conditional recommendations for use of real-time continuous glucose monitoring (CGM) and algorithm-driven insulin pumps in people with type 1 diabetes (T1D), use of CGM for outpatients with type 2 diabetes at high risk for hypoglycemia, use of long-acting and rapid-acting insulin analogs, and initiation of and continuation of CGM for select inpatient populations at high risk for hypoglycemia. Strong recommendations were made for structured diabetes education programs for those at high risk for hypoglycemia, use of glucagon preparations that do not require reconstitution vs those that do for managing severe outpatient hypoglycemia for adults and children, use of real-time CGM for individuals with T1D receiving multiple daily injections, and the use of inpatient glycemic management programs leveraging electronic health record data to reduce the risk of hypoglycemia. The recommendations are based on the consideration of critical outcomes as well as implementation factors such as feasibility and values and preferences of people with diabetes. These recommendations can be used to inform clinical practice and health care system improvement for this important complication for people living with diabetes.

CHOICE - structured diabetes education programme for children and young people in northern ireland

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Pharmacists’ perceived role in supporting diabetes education and self-management in Ireland: a qualitative study

Background: Support for people with diabetes is necessary for optimal self-management. Structured diabetes education programmes fulfil this need, but attendance rates are consistently low. The role of pharmacists has expanded but the profession remains underutilised in chronic disease management. The objective of this study is to explore pharmacists’ perceived role in the support of diabetes education and self-management behaviours. Methods: A qualitative study using semi-structured interviews of community pharmacists in Ireland was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Ten pharmacists were interviewed. The four themes identified illustrate the juxtaposition of pharmacists’ potential in diabetes care with the realities of current pharmaceutical practice. One theme outlined the relationship between the person with diabetes and the pharmacist, ‘Patient or customer: the nature of the pharmacist relationship’. Two themes described the pharmacists’ role in supporting diabetes education and self-management, ‘Beyond medication: pharmacists’ current and potential role in diabetes management’ and ‘Need for diabetes education’. The final theme highlighted the barriers to a more engaged role in patient care, ‘Barriers: “all the stuff that gets in the way”’. Conclusion: The relationship between pharmacists and people with diabetes could facilitate pharmacists in supporting diabetes self-management. However, variability across pharmacists’ level of involvement and consistent resource barriers were noted. Pharmacists were poorly informed about structured diabetes education programmes. Further research is needed to explore this variability but there may be potential to enhance the pharmacist role in promoting attendance at structured diabetes education programmes.

Improved blood glucose control, cardiovascular health and empowerment in people attending X‐PERT structured diabetes education

AbstractThe aim of the audit was to assess the change in key health markers in people with, or at risk of, diabetes who attended X‐PERT structured diabetes education.Data from X‐PERT programmes are entered into a central database. Twelve‐month changes in anthropometric and clinical variables – and diabetes medication usage – are reported for programmes run between 1 January 2017 and 31 December 2018. Where appropriate, paired t‐tests were performed.In total, 29,703 participants were registered to attend a programme during this period, of which 23,118 (78%) attended at least one session. Of those who attended at least one session 18,039 (78%) completed a programme. Ninety‐nine percent (3342) of participants with clinical data available had type 2 diabetes. Meaningful reductions in HbA1c were seen (‐8.6mmol/mol, 95% CI ‐9.2 to ‐8.0mmol/mol [‐0.8%, 95% CI ‐0.8 to ‐0.7%]; n=2957; p&lt;0.001); and there were statistically significant reductions in body weight, BMI, waist circumference, fasting blood glucose, total cholesterol, low‐density lipoprotein cholesterol, triglycerides, total cholesterol to high‐density lipoprotein cholesterol ratio, and triglycerides to high‐density lipoprotein cholesterol ratio (all p&lt;0.001). No change in high‐density lipoprotein cholesterol was observed. Of the 1180 participants who were recorded as taking diabetes medication at baseline, 632 (54%) were able to reduce the number of medications they were taking and 278 (24%) were able to omit them entirely. Participant empowerment score increased by 20%.Improvements in glycaemic control, weight management and cardiovascular disease risk, as well as reduced medication requirements and an increased feeling of empowerment, were observed in people who attended X‐PERT structured diabetes education programmes. Copyright © 2021 John Wiley &amp; Sons.

Two-Year Follow-up of a Multimodal Intervention on Functional Capacity and Muscle Power in Frail Patients With Type 2 Diabetes

ObjectivesTo analyze the effects of a program composed of resistance training and nutritional interventions on functional capacity, maximal strength, and power output after 2 years of follow-up, including 2 periods of 16 weeks of intervention followed by several weeks of intervention cessation in frail patients with type 2 diabetes. DesignMIDPOW is a substudy of a multicenter, multimodal intervention composed of resistance training combined with a structured diabetes and nutritional education program in frail and prefrail older people with type 2 diabetes (MID-Frail). Setting and ParticipantsThis study recruited 52 participants (mean age: 79 ± 5.6, 63% women), with type 2 diabetes mellitus, frail or prefrail using Fried's frailty phenotype. MethodsPrimary outcomes of this substudy were Short Physical Performance Battery (SPPB) and maximal power output at 30% and 80% of 1RM. ResultsEach set of 16 weeks of intervention resulted in significant improvements in SPPB performance by a mean of 36.1% at week 18 (P < .001) and 10.2% at week 68 (P < .05). Maximal power output improvements at 30% and 80% of the 1RM ranged from 45.2% to 57.2% at week 18 (P < .01–.001); and no significant changes were observed after the second period of intervention. After 2 years of follow-up, the SPPB and maximal power values observed remained significantly higher than the baseline. Conclusions and ImplicationsResistance training combined with nutritional program improved SPPB, maximal strength, and power output in older frail patients with diabetes. These improvements were maintained above the basal levels after several weeks of intervention cessation during a 2-year follow-up.

Pharmacists’ perceived role in supporting diabetes education and self-management in Ireland: a qualitative study

Background: Support for people with diabetes is necessary for optimal self-management. Structured diabetes education programmes fulfil this need, but attendance rates are consistently low. The role of pharmacists has expanded but the profession remains underutilised in chronic disease management. The objective of this study is to explore pharmacists’ perceived role in the support of diabetes education and self-management behaviours. Methods: A qualitative study using semi-structured interviews of community pharmacists in Ireland was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Ten pharmacists were interviewed. The four themes identified illustrate the juxtaposition of pharmacists’ potential in diabetes care with the realities of current pharmaceutical practice. One theme outlined the relationship between the person with diabetes and the pharmacist, ‘Patient or customer: the nature of the pharmacist relationship’. Two themes described the pharmacists’ role in supporting diabetes education and self-management, ‘Beyond medication: pharmacists’ current and potential role in diabetes management’ and ‘Need for diabetes education’. The final theme highlighted the barriers to a more engaged role in patient care, ‘Barriers: “all the stuff that gets in the way”’. Conclusion: The relationship between pharmacists and people with diabetes could facilitate pharmacists in supporting diabetes self-management. However, variability across pharmacists’ level of involvement and consistent resource barriers were noted. Pharmacists were poorly informed about structured diabetes education programmes. Further research is needed to explore this variability but there may be potential to enhance the pharmacist role in promoting attendance at structured diabetes education programmes.

Pharmacists' perceived role in supporting diabetes education and self-management in Ireland: a qualitative study.

Background: Support for people with diabetes is necessary for optimal self-management. Structured diabetes education programmes fulfil this need, but attendance rates are consistently low. The role of pharmacists has expanded but the profession remains underutilised in chronic disease management. The objective of this study is to explore pharmacists' perceived role in the support of diabetes education and self-management behaviours. Methods: A qualitative study using semi-structured interviews of community pharmacists in Ireland was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Ten pharmacists were interviewed. The four themes identified illustrate the juxtaposition of pharmacists' potential in diabetes care with the realities of current pharmaceutical practice. One theme outlined the relationship between the person with diabetes and the pharmacist, 'Patient or customer: the nature of the pharmacist relationship'. Two themes described the pharmacists' role in supporting diabetes education and self-management, 'Beyond medication: pharmacists' current and potential role in diabetes management' and 'Need for diabetes education'. The final theme highlighted the barriers to a more engaged role in patient care, 'Barriers: "all the stuff that gets in the way"'. Conclusion: The relationship between pharmacists and people with diabetes could facilitate pharmacists in supporting diabetes self-management. However, variability across pharmacists' level of involvement and consistent resource barriers were noted. Pharmacists were poorly informed about structured diabetes education programmes. Further research is needed to explore this variability but there may be potential to enhance the pharmacist role in promoting attendance at structured diabetes education programmes.

Diabetes Educational intervention in Society to Improve (DESI) quality of life

Background: Diabetes self-management education (DSME) is globally recognized as an integral part of diabetes management and in majority of the developed countries, it is delivered by trained diabetes educators. Unfortunately, in India, it is still not considered an essential part of diabetes management. Materials and Methods: A self-structured diabetes education program, of a 75-min duration, was developed over a period of six months. To assess the knowledge, before and after the implementation of the education program, a validated questionnaire, Diabetes Knowledge Questionnaire 24 (DKQ24) was used. Results: A total of 50 patients (34 males; 74%) were recruited in the study. The mean age of the study participants was 54.98 ± 12.02years, with a mean duration of diabetes 12.34 ± 8.76years and mean HbA1c 8.1 ± 1.49%. A statistically significant (P < 0.05) improvement in the proportion of correct responses (14 out of 24 questions; 58.3%) was seen after the implementation of the DSME program. Conclusion: There is limited research available in India on DSME. To meet the need of a structured diabetes education program in India, we have evolved one such program (duration of 75 min) within a period of six months. We anticipate this program to have enough potential in developing countries in the long run.

Not Scared of Sugar™: Outcomes of a structured type 2 diabetes group education program for Chinese Australians.

Type 2 diabetes disproportionately affects the Chinese population yet there are no structured diabetes education programs specifically designed for this community in Australia. This project aimed to develop and evaluate a pilot type 2 diabetes group education program designed specifically for Chinese migrants living in Australia. A non-randomised pre- versus post-intervention trial was conducted between March 2017 and November 2018. A culturally tailored group education program (Not Scared of Sugar™) was developed and piloted with Melbourne-based Cantonese-speaking people with type 2 diabetes. Program teaching styles were aligned with the Confucian cultural process of learning and incorporated culturally specific strategies to promote healthy behaviour change. Thirty-four individuals (35% male) attended five education sessions over ten weeks, delivered by a Cantonese-speaking facilitator and multidisciplinary clinicians. Data were collected from participants at baseline, on program completion and at 6months follow-up. Mean (SD) participant age was 69 (9) years, with a mean time of 25.7 (10.8) years in Australia and a median duration of diabetes of 10 (IQR=2.8-20.5) years. At program completion, mean participant waist circumference (90.5 versus 89.2cm, p<.001) and waist-to-height ratio (0.574 vs. 0.566, p<.001) was significantly reduced and both were further reduced at 6-month follow-up (p<.05). There was a significant increase in the median frequency of diabetes self-care behaviours undertaken, with American Association of Diabetes Educators Questionnaire Score: 30 (22-32.3) versus 33 (29.8-35.0), p<.001 at 6-month follow-up. Diabetes-related distress assessed by PAID-C was also significantly reduced at 6-month follow-up (p<.05). Mean HbA1c was unchanged after 6months; 51 (7.9) versus 50 (7.8) mmol/mol, p=.316. Program attrition was 6%. Not Scared of Sugar™ successfully reduced waist circumference, increased diabetes self-management behaviours and reduced diabetes distress in Cantonese-speaking Australians, which may positively impact long-term risk of vascular complications.

MON-654 Attitudes and Practice of Fasting Ramadan in Patients with Diabetes

Background: Fasting Ramadan is practiced by Muslims globally. Compliance with health team advice on ability to fast or not, medication and lifestyle adjustments are the corner stone of achieving optimal diabetes control and avoiding complications with fasting. We aimed in this study to evaluate the attitudes and practice of Muslim patients with diabetes during fasting Ramadan, and to assess their compliance with the medical instructions provided by their healthcare team. Methods: A cross-sectional study conducted in four Medical Centers under the Ministry of National Guard health affairs in four cities: Al-Ahsa, Dammam, Jeddah and Riyadh. All patients with diabetes followed in the diabetes clinics within three months post Ramadan and who met the study inclusion and exclusion criteria were approached and consented for participation in the study, and then filled a self-administered validated 15 items questionnaire. Results: Data for 1438 diabetics were analyzed; 1207 (83.9%) T2DM and 231 (16.1%) T1DM. The mean age was 57.9 ± 14.9 years. 270 (18.8%) suffered multiple comorbidities. 559 (46.3%) of T2DM vs 22 (9.5%) of T1DM were not familiar with the type of their diabetes. 883 (73.2%) of T2DM were on combination therapy. There was a significant difference between T1DM and T2DM in health education received from the treating physician 168 (72.7%) vs 574 (47.6%) and from a dietician 165 (71.4%) vs 613 (50.8%) (p<0.0001), but education received from diabetes educators was not significantly different 189 (81.8%) vs 936 (77.6%) (p=0.15). Patients who followed diet advise were only 55 (23.8%) vs 43 (36.4%), respectively, (p=0.0002). 1191 (82.8%) reported fasting the full month, 162 (11.3%) were advised by their physicians to not fast. Patients who did not fast full Ramadan were 247 (17.2%), one third 92 (37.25%) of them based on physician advise with a compliance rate of (56.8%). Blood sugar was not well controlled before Ramadan and did not change significantly after Ramadan with a mean HbA1c (8.41 ± 2.0 and 8.40 ± 2.1) respectively, p-value 0.53. Multivariate analyses revealed that being on insulin, and prior hospitalization for diabetes were significant predictors of compliance with physicians advice related to fasting Ramadan [(OR 4.5, 95% CI, 1.7 - 12.2, p-value 0.003), (2.3, 95% CI, 1.2 - 5.1, p-value 0.048)] respectively, while lack of receiving education, type of diabetes, and degree of glycemic control did not predict compliance with statistical significance [(OR 1.9, 95% CI, 0.8 - 4.6, p-value 1.5), (1.06, 95% CI, 0.4 - 2.6, p-value 0.89), (1.3, 95% CI, 0.5 - 3.5, p-value 0.56)] respectively. Majority of patients were aware of a religious “Fatwa” on fasting with diabetes but their understanding of it varied. Conclusion: The study shows low level of patient awareness and compliance to health providers advice. Results indicate prior hospitalization and being on insulin treatment as predictors of patient compliance. This signifies the need for better structured diabetes and fasting education programs. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Systematic Review of Randomized Controlled Trials Evaluating Glycemic Efficacy and Patient Satisfaction of Intermittent-Scanned Continuous Glucose Monitoring in Patients with Diabetes.

Introduction: Intermittent-scanned continuous glucose monitoring (isCGM) has the ability to allow for greater personalization of diabetes self-management. The purpose of this systematic review is to provide an updated analysis of the efficacy and patient satisfaction of isCGM in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Methods: A research librarian searched PubMed, EMBASE, and Cochrane Library using keywords and subject headings to identify studies assessing efficacy and use of isCGMs in patients with T1DM and T2DM. Results: Nine randomized controlled trials (RCTs) involving patients with T1DM and T2DM using isCGM were included. Based on available RCT evidence investigating isCGM in patients with diabetes, isCGM may lead to a small decrease hemoglobin A1c (HbA1c) in certain subgroups of patients with uncontrolled T2DM (those using multiple daily insulin injections and aged 65 years or younger). Patients with uncontrolled T1DM using insulin may also benefit from isCGM, when combined with a structured diabetes education program. Evidence is mixed regarding isCGM impact on improving time in glycemic range, glycemic variability, and hypoglycemia. isCGM has demonstrated greater patient satisfaction and lower diabetes distress compared with usual care. Conclusions: isCGM may lead to improvements in HbA1c in certain subgroups of patients. Additional benefit with isCGM on time in glycemic range, glycemic variability, and hypoglycemia is unclear at this time. Future clinical trials are warranted to investigate the role of isCGM in patients with uncontrolled T2DM using insulin and oral antidiabetic drugs.

"What's the Point?": Understanding Why People With Type 2 Diabetes Decline Structured Education.

Structured diabetes education (SDE) is an evidence-based intervention that supports self-management in people with type 2 diabetes. In the United Kingdom, health care providers working in primary care settings are responsible for referring people with type 2 diabetes to SDE programs. However, national audits record a high percentage of nonattenders. We explored the personal experience of living with type 2 diabetes that led to individuals declining invitations to attend SDE programs. The themes suggested that emotional, cognitive, and social issues related to diagnosis and living with diabetes may be responsible for declining to attend SDE and that these factors may be masked by explanations of practical barriers. A person-centered approach to understanding the personal meaning of being diagnosed and living with type 2 diabetes may help to identify individuals' psychosocial barriers to attending SDE.

How has psycho-behavioural research advanced our understanding of hypoglycaemia in type 1 diabetes?

Almost 100 years since the discovery of insulin, hypoglycaemia remains a barrier for people with type 1 diabetes to achieve and maintain blood glucose at levels which prevent long-term diabetes-related complications. Although hypoglycaemia is primarily attributable to the limitations of current treatment and defective hormonal counter-regulation in type 1 diabetes, the central role of psycho-behavioural factors in preventing, recognizing and treating hypoglycaemia has been acknowledged since the early 1980s. Over the past 25 years, as documented in the present review, there has been a substantial increase in psycho-behavioural research focused on understanding the experience and impact of hypoglycaemia. The significant contributions have been in understanding the impact of hypoglycaemia on a person's emotional well-being and aspects of life (e.g. sleep, driving, work/social life), identifying modifiable psychological and behavioural risk factors, as well as in developing psycho-behavioural interventions to prevent and better manage (severe) hypoglycaemia. The impact of hypoglycaemia on family members has also been confirmed. Structured diabetes education programmes and psycho-behavioural interventions with a focus on hypoglycaemia have both been shown to be effective in addressing problematic hypoglycaemia. However, the findings have also revealed the complexity of the problem and the need for a personalized approach, taking into account the individual's knowledge of, and emotional/behavioural reactions to hypoglycaemia. Evidence is emerging that people with persistent and recurrent severe hypoglycaemia, characterized by deeply entrenched cognitions and lack of concern around hypoglycaemia, can benefit from tailored cognitive behavioural therapy.

Investigating the cost-effectiveness of structured diabetes education

Background/Aims The National Institute for Health and Care Excellence recommend that people with type 2 diabetes should have access to structured diabetes education. The aim of this study was to evaluate the outcomes and the impact of the EMPOWER T2n structured diabetes education programme. Methods Audit data were obtained from 443 participants from four Clinical Commissioning Groups in England. Clinical parameters, including glycated haemoglobin levels and cholesterol, were collected before EMPOWER T2n started, as well as at 6 months into the programme and 14-months after its completion. Results There was a statistically significant reduction in glycated haemoglobin at 6-months (−8.2mmol/mol), which was maintained at 14 months (−7.8mmol/mol). Modelled 3-year changes in costs in the base case were -£42.30 for coronary heart disease, -£0.75 for stroke and -£7.79 for microvascular events. The mean number of medicines used decreased from 0.5 at baseline to 0.37 at 14 months (-13.1%). This produced an actual saving of £44.28, with a further saving of £98.78, compared to the modelled increase in medicine use over time. All of these changes translated into an overall gross saving of £193.89 per participant over the 3-year model timeframe. These savings exceeded the average cost of delivering EMPOWER T2n (£96.17 per participant). Conclusion Participation in the EMPOWER T2n structured diabetes education programme was associated with improvements against a range of clinical parameters and associated with modelled net cost savings over a 3-year timeframe.

Learning types and learning success in a structured diabetes education programme for patients with type 2 diabetes: study protocol of a prospective, longitudinal study

IntroductionDiabetes mellitus (DM) has had a wide-ranging impact on healthcare politics. Secondary diseases and complications caused by diabetes are relevant cost and utilisation factors in the healthcare system. For decades,...

The Impact of Structured Diabetes Education on Glycemic Control in Patients with Type 2 Diabetes at Initiation of Basal Insulin – The Basal-EDUC-RO Study: A Randomized Prospective Study

Abstract Background: Basal-EDUC-RO Study evaluated the impact of structured education provided at the initiation of basal insulin therapy on glycaemic control in patients with uncontrolled type 2 diabetes mellitus (T2D). Methods: This was a prospective, multicenter, randomized, parallel group study (ACTRN12616001273471) which enrolled 711 patients initiated on insulin therapy with a basal insulin analogue. The subjects were randomized (1:1) to either structured education (structured education group; 353 patients) or standard education (control group; 358 patients) and followed for 6 months. Results: The median HbA1c levels at 6 months after start of basal insulin were significantly lower in the structured education group than in the control group (7.2% vs. 7.4%, p &lt;0.001). In the structured education group, 49.4% of subjects achieved HbA1c targets vs. 34.4% in the control group, p &lt;0.001. Number of documented symptomatic hypoglycemic episodes (all and nocturnal) was lower in the intervention group (139 vs. 217 for all episodes and 13 vs. 26 for nocturnal hypoglycemia) but with no statistical significance. No effect of intervention was seen on body weight, but there was no weight gain in any of the groups at 6 months. Conclusions: A structured diabetes education program delivered to patients with T2D started on a basal insulin analogue significantly improved glucose control at 6 months compared to a less intense education strategy. The positive effect was mainly seen on the percentage of patients who achieved individualized HbA1c pre-set targets, with a non-significant reduction in episodes of overall and nocturnal documented symptomatic hypoglycemia.

Structured Diabetes Education Program for Improving Self-care Behavior in Primary Care Settings of Puducherry: Evidence from a Randomized Controlled Trial.

Context:Diabetes self-management education plays a critical role in improving patients’ clinical outcome and quality of life.Aims:This study aims to study the effectiveness of a structured diabetes educational program on improvement of self-care behavior among type 2 diabetics in urban Primary Health Centres (PHCs) of Puducherry.Settings and Design:A community-based open-label parallel-arm randomized controlled trial was conducted in two randomly selected urban PHCs of Puducherry during December 2015–February 2017.Subjects and Methods:Using systematic random sampling, 157 eligible participants were recruited in intervention and control PHCs each. Sociodemographic, disease characteristics, and anthropometric measures were captured using a pretested questionnaire at baseline. Self-care behavior was recorded with Summary of Diabetes Self-Care Activities scale. Intervention consisted of structured diabetes education sessions with distribution of information leaflets and self-care kits to the intervention-arm participants, while control arm received standard care. At the end of 6 months, endline assessment was done for both groups. Data were analyzed by intention-to-treat, per-protocol, and difference-in-difference analysis using STATA.Results:Footcare increased significantly by 1.95 days/week compared to control arm, while a moderate change of 0.49 days/week in diet compliance and a minimal change of 0.10 days/week in physical activity were observed. Medication adherence, regular blood sugar testing, and smoking behavior also showed improvement in intervention arm.Conclusions:A structured education program that is culturally tailored showed an overall improvement in self-care behavior. This research supports the need for structured education program for diabetics to empower them and improve self-care practices.Trial registration:CTRI/2017/06/008772

Barriers and facilitators to attendance at Type 2 diabetes structured education programmes: a qualitative study of educators and attendees.

Attendance at structured diabetes education has been recommended internationally for all people with Type 2 diabetes. However, attendance rates are consistently low. This qualitative study aimed to explore experiences of attending and delivering Type 2 diabetes structured education programmes in Ireland and barriers and facilitators to attendance. People with Type 2 diabetes who had attended one of the three programmes delivered in Ireland and educators from the three programmes took part in semi-structured telephone interviews. Interviews were audio-taped, transcribed and analysed using inductive thematic analysis. Twelve attendees and 14 educators were interviewed. Two themes were identified in relation to experiences of programme attendance and delivery: 'Structured education: addressing an unmet need' and 'The problem of non-attendance'. The third theme 'Barriers to attendance: can't go, won't go, don't know and poor system flow' outlined how practicalities of attending, lack of knowledge of the existence and benefits, and limited resources and support for education within the diabetes care pathway impacts on attendance. The final theme 'Supporting attendance: healthcare professionals and the diabetes care pathway' describes facilitators to participants' attendance and the strategies educators perceived to be important in increasing attendance. Healthcare professionals have an important role in improving attendance at structured diabetes education programmes. Improving attendance may require promotion by healthcare professionals and for education to be better embedded and supported within the diabetes care pathway.