Improved A1C and Lipid Profile in Patients Referred to Diabetes Education Programs in a Wide Health Care Network: A Retrospective Study

Diabetes is a chronic disease characterized by high blood glucose levels and caused either by a deficiency of insulin or a defect in the way the body responds to insulin.1,2 The increased prevalence of type 2 diabetes is believed to be the consequence of an aging population, increased physical inactivity and obesity, and genetic factors.3,4 Diabetes is one of the leading causes of blindness and renal failure,5,6 and people with diabetes who have an increased A1C level and uncontrolled lipid levels have increased rates of morbidity and mortality. Complications usually fall into three main groups: acute metabolic abnormalities, microvascular anomalies, and long-term cardiovascular disorders specific to diabetes.7 The main treatment goals for diabetes are controlling blood glucose and cholesterol levels and maintaining a normal blood pressure.8 Tight control and management of blood glucose and blood pressure has been proven to prevent or delay complications of diabetes.9 Involving patients in their care through selfmanagement is of utmost importance to achieving these goals. Yet, selfmanagement is difficult to attain and maintain because of the complexity of the processes involved and the lack of motivation and skills on the part of some patients.10 Frequently reported barriers to self-management11,12 include knowledge deficits, poor patient-provider communication, low self-efficacy, limitations of time or resources, financial constraints, lack of individualized and coordinated care, and lifestyle differences among family members. An extensive review of 16 studies identified barriers from five different perspectives: psychosocial, socioeconomic, physical, environmental, and cultural.13 It is widely believed that educating patients about diabetes may be a mechanism to encourage and support them in assuming active responsibility for self-management. Based on this belief, several educational programs have been developed.14,15 Diabetes education, also known as diabetes self-management training (DSMT) or diabetes self-management education (DSME), has been defined as a collaborative process through which people with diabetes gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions.16,17 It is an ongoing, interactive process involving a person with diabetes and a team of educators, including nurses, dietitians, and pharmacists. Such interventions aim to help patients achieve optimal health and better quality of life, reducing the need for costly health care by preventing or postponing complications. Despite the belief in, and popularity of, diabetes education, our current understanding is inconclusive regarding the effectiveness of an educational approach in patients with type 2 diabetes. A meta-analysis of 31 studies looking at the effect of self-management education on glycemic control found little evidence in support of such education programs.18 A recent qualitative review of 80 studies conducted from 2004 to 2007 revealed mixed results,19 but many studies reported positive changes. The reported positive results of diabetes education with regard to bioclinical factors included WATCH SCIENTIFIC SESSIONS PRESENTATIONS ANY TIME, ANYWHERE HAVE YOU MISSED THE MEETING? GET THE WEBCASTS