Evaluation of the effectiveness of an ambulatory teaching/treatment programme for non-insulin dependent (type 2) diabetic patients

Abstract

The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent (type 2) diabetic patients. The programme was aimed at improving the overall treatment quality in these patients through measures involving self-care, diet, exercise and weight reduction. Four theoretical-practical teaching units were given once a week to group of 5-8 ambulatory patients by previously trained general practitioners. Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment, but receiving no structured teaching before or during the survey period (control group). The drop-out percentage in the intervention group (25%) was significantly lower than in the control group (45%, P < 0.05), suggesting an incentive toward greater compliance in the former. At the end of the 1-year follow-up, the mean differences observed in the control and in the intervention groups were: body weight loss -2.4 +/- 0.5 kg vs -0.4 +/- 0.5 (P < 0.001); haemoglobin HbA1 -0.2% +/- 0.4% vs +0.8% +/- 0.4% (NS); number of daily oral hypoglycaemic agent intake -1.4 +/- 0.2 vs +0.9 +/- 0.2 tablets (P < 0.001). Our results strongly suggest that this programme, applied through family doctors, may constitute an efficient tool to improve the compliance and clinico-metabolic control of type 2 patients at the primary health care level.

Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review

“…Following the selection criteria of the reviews, 16 publications [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] referring to our three reference programmes should have been identified. In practice, a total of 11 were identified [5,28,30,32,34,38,39,[43][44][45][46], and seven [28,32,34,35,38,39,46] were included in at least one of the reviews. In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25].…”

“…In six reviews the main controlled trials of our reference programmes [28, 30-32, 38, 44] were included in data synthesis [10,11,16,18,19,25]. Out of 25 [5, 33-37, 39, 41-43, 45-59] replication trials (phase 4, see text box: Phases of 'increasing evidence of complex interventions') four [34,35,39,46] were included in six reviews [16,19,21,22,24,25]. Different reviews on identical topics included different publications referring to the same reference programme.…”

“…Nine reviews included qualitative data synthesis within categories [13,[19][20][21][22][24][25][26][27] (Table 1). In some reviews [10,11,18] the allocation into categories did not meet the type of intervention [32,34,35].…”

Patient education - evaluation of a complex intervention

“…The impossibility to clearly separate interventions according to these criteria is reflected by the handling of three publications on an identical intervention that is the group treatment and teaching programme for patients with Type II diabetes as described in the present article. The review included the publication by Pieber et al [47], but not those by Kronsbein et al [46] and Domenech et al [48]. All three studies had a similar study design.…”

“…In addition to improvement of triglyceride concentrations, glycosylated haemoglobin concentrations were reduced by almost 1% and blood pressure was lowered. In a further 1-year prospective controlled trial with comparable results, it was shown that the programme was transferable to Argentina [48]. For this latter project the teaching materials were translated and adapted to the special cultural conditions of Latin America.…”