Education as Prescription for Patients with Type 2 Diabetes Mellitus: Compliance and Efficacy in Clinical Practice

Abstract

BackgroundDiabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription.MethodsWe retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis.ResultsAmong the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001) or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037). The hemoglobin A1c decreased greater in the compliant group (from 7.84±1.54 at baseline to 6.79±1.06 at 3 months and 6.97±1.20 at 12 months after prescription in the compliant group vs. from 7.74±1.25 to 7.14±1.02 and 7.24±1.24 in the non-compliant group; P=0.001). The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032).ConclusionIn our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

Educational attainment moderates the associations of diabetes education with health outcomes

“…The lack of differences in health behaviour and glycaemic control between people with diabetes education and those without indicated that actual lifestyle modification to achieve glycaemic control and health benefits was not successfully accomplished after the education. These findings might reflect the content of education in the current health system in South Korea, which mostly comprises the concept of diabetes and diet management; generally, education does not incorporate behavioural or psychological strategies for diabetes management . Although detailed characteristics and the format of the diabetes education attended could not be examined in this study, the findings suggest that diabetes education has considerable room for improvement in the current health care system of South Korea.…”

“…These findings might reflect the content of education in the current health system in South Korea, which mostly comprises the concept of diabetes and diet management; generally, education does not incorporate behavioural or psychological strategies for diabetes management. 19,20 Although detailed characteristics and the format of the diabetes education attended could not be examined in this study, the findings suggest that diabetes education has considerable room for improvement in the current health care system of South Korea. The inconsistency of our results with those from previous intervention studies showing the benefit of diabetes education on reducing HbA 1 C 4,11,21 could be explained by the highly diverse and unclear quality of diabetes education in clinical circumstances in South Korea.…”

Barrier Factors to the Completion of Diabetes Education in Korean Diabetic Adult Patients: Korea National Health and Nutrition Examination Surveys 2007-2012

“…Previous studies have suggested that several barriers are associated with diabetes education, including geographical distance, area of residence, cost issues, scheduling conflicts, feeling that education is unnecessary, health issues, and hearing impairments, 16 17 18 19) as well as being male, having a disability, and level of education. 20 21 22) However, the previous studies were based on surveys of diabetic patients or those who were involved in diabetes education and showed inconsistent results.…”

Determinants of glycaemic control in a practice setting: the role of weight loss and treatment adherence (The DELTA Study)

“…related goals is poor medication adherence (14). Non-adherence has been associated with poor clinical outcomes in diabetes and can influence the magnitude of the treatment effect (15,16). For instance, one study found that patients who were ≥ 80% adherent to their diabetes therapy, as measured by medication event monitoring systems, had lower follow-up HbA1c levels than those who were less adherent (17).…”