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OBJECTIVE -To study time course changes in knowledge, problem solving ability, and quality of life in patients with type 2 diabetes managed by group compared with individual care and education.RESEARCH DESIGN AND METHODS -We conducted a 5-year randomized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit. There were 120 patients with non-insulin-treated type 2 diabetes enrolled and randomly allocated to group or individual care. Eight did not start and 28 did not complete the study. The main outcome measures were knowledge of diabetes, problem solving ability, quality of life, HbA 1c , BMI, and HDL cholesterol.RESULTS -Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects (P Ͻ 0.001 for both). Quality of life improved from year 2 with group care but worsened with individual care (P Ͻ 0.001). HbA 1c level progressively increased over 5 years among control subjects (ϩ1.7%, 95% CI 1.1-2.2) but not group care patients (ϩ0.1%, Ϫ0.5 to 0.4), in whom BMI decreased (Ϫ1.4, Ϫ2.0 to Ϫ0.7) and HDL cholesterol increased (ϩ0.14 mmol/l, 0.07-0.22).CONCLUSIONS -Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and settings tailored to their needs. Traditional one-to-one care, although delivered according to optimized criteria, is associated with progressive deterioration of knowledge, problem solving ability, and quality of life. Better cognitive and psychosocial results are associated with more favorable clinical outcomes.

The aim was to develop and test a brief revised version of the family affluence scale. A total of 7120 students from Denmark, Greenland, Italy, Norway, Poland, Romania, Scotland and Slovakia reported on a list of 16 potential indicators of affluence. Responses were subject to item screening and test of dimensionality. Bifactor analysis revealed a strong general factor of affluence in all countries, but with additional specific factors in all countries. The specific factors mainly reflected overlapping item content. Item screening was conducted to eliminate items with low discrimination and local dependence, reducing the number of items from sixteen to six: Number of computers, number of cars, own bedroom, holidays abroad, dishwasher, and bathroom. The six-item version was estimated with Samejima's graded response model, and tested for differential item functioning by country. Three of the six items were invariant across countries, thus anchoring the scale to a common metric across countries. The six-item Child Ind Res (2016) 9:771-784

Aims/hypothesis. Metabolic control worsens progressively in Type II (non-insulin-dependent) diabetes mellitus despite intensified pharmacological treatment and lifestyle intervention, when these are implemented on a one-to-one basis. We compared traditional individual diabetes care with a model in which routine follow-up is managed by interactive group visits while individual consultations are reserved for emerging medical problems and yearly checks for complications. Methods. A randomized controlled clinical trial of 56 patients with non-insulin-treated Type II diabetes managed by systemic group education and 56 control patients managed by individual consultations and education. Results. Observation times were 51.2±2.1 months for group care and 51.2±1.8 for control subjects. Glycated haemoglobin increased in the control group but not in the group of patients (p<0.001), in whom BMI decreased (p<0.001) and HDL-cholesterol increased (p<0.001). Quality of life, knowledge of diabetes and health behaviours improved with group care (p<0.001, all) and worsened among the control patients (p=0.004 to p<0.001). Dosage of hypoglycaemic agents decreased (p<0.001) and retinopathy progressed less (p<0.009) among the group care patients than the control subjects. Diastolic blood pressure (p<0.001) and relative cardiovascular risk (p<0.05) decreased from baseline in group patients and control patients alike. Over the study period, group care required 196 min and 756.54 US $ per patient, compared with 150 min and 665.77 US $ for the control patients, resulting in an additional 2.12 US $ spent per point gained in the quality of life score. Conclusion/interpretation. Group care by systemic education is feasible in an ordinary diabetes clinic and cost-effective in preventing the deterioration of metabolic control and quality of life in Type II diabetes without increasing pharmacological treatment. [Diabetologia (2002)

Increasing social and gender role pressure with growing age, as well as restricted access to material resources and psychosocial strains are discussed as potential explanations for the observed health inequalities.