Comparative Effectiveness of Patient Education Methods for Type 2 Diabetes

Abstract

clinicaltrials.gov Identifier: NCT00652509.

How can clinical practices pragmatically increase physical activity for patients with type 2 diabetes? A systematic review

“…This suggests that PA interventions conducted in more real-world settings may be less effective when compared to studies in more idealized and heavily resourced contexts. Nevertheless, among the behavioral interventions that we ranked in the most pragmatic tertile by composite PRECIS-2 scores, four interventions by SperlHillen et al [39], Christian et al [50], Di Loreto et al [53], and Glasgow et al [54] effectively improved PA outcomes-two of these four effective PA interventions also improved HbA1c outcomes [31,45].…”

“…These tools included a simplified form of in-person motivational interviewing [53], a computerized self-assessment that automatically generated individualized and tailored feedback [50,54], or the use of a Bconversation map^of diabetes self-management challenges [39]. While we already know much about what factors are necessary for effective interventions, we need to better understand how to ensure that these techniques are effective when delivered pragmatically in clinical settings.…”

“…While we already know much about what factors are necessary for effective interventions, we need to better understand how to ensure that these techniques are effective when delivered pragmatically in clinical settings. For example, both the effectiveness on PA/HbA1c outcomes and the pragmatism of Sperl-Hillen's intervention were superior when delivered 1:1 rather than using a group visit delivery format [39]. This finding stands in stark contrast to the existing literature that suggests that group and individual diabetes self-management education are equivalent [77] and suggests that further pragmatic trials to assess the comparative effe ct ive ness of individu al a nd grou p selfmanagement education of T2D in usual practice may be warranted.…”

Diabetes education in primary care: a randomized clinical trial

“…A subsequent meta-analysis 7 compared group versus individualized education; no differences were found between the two approaches, but the observed effect of both interventions was much smaller (-0.3% in HbA1c) and was only seen in patients with baseline HbA1c > 8%. A recent randomized clinical trial 16 has questioned the benefit of group diabetes mellitus education. Group education decreased HbA1c by 0.27%, which was comparable with the reduction observed in the control group (-0.24%, p = 0.83) and lower than the reduction attributed to individualized education (-0.51%, p = 0.01).…”

“…Based on our previous experience with diabetes mellitus education trials and the available literature 15,16,17,18 , we expected HbA1c to decrease after the intervention. However, the differences in HbA1c between the groups in the current study were due to stabilization of values in the intervention group and an increase in controls.…”