Group Education for Obese Patients with Type 2 Diabetes: Greater Success at Less Cost

Abstract

It has been suggested that much effort expended in teaching diabetic diets is ineffective and wasteful. We have tested a different system by randomly allocating 75 newly diagnosed obese Type 2 diabetic patients to usual 'unstructured' clinic care or to group education by diabetes specialist nurses and a dietitian. Patients allocated to group education attended five 90-min group sessions during the first 6 months. Six months after diagnosis they had lost more weight (median (95% Cl), 7 (5.5-9) vs 2(1-5)kg, p less than 0.002) and were better controlled (HbA1:7.5 (7.0-8.1) vs 9.5 (8.7-10.4)%, p less than 0.001) than those randomized to the usual clinic system. At 1 year (after no further visits) the difference in weight loss was less (5.5 (4-6.5) vs 3 (2-4) kg, p less than 0.05) and diabetic control was similar (HbA1:9.0(8.2-9.8) vs 9.9(8.9-10.9)%. At 1 year only 14(39%) of the education group and 9(23%) of those attending the clinic had a fasting blood glucose less than 7.0 mmol l-1.

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

“…The amount of weight loss in the intervention group (À2.4 kg) resulted in a significant decrease in hemoglobin Alc (HbAlc) of 2.4%. Heller et al (1988) reported similar results in a randomized study where a weight loss of 5 kg was achieved through diet, resulting in a significant reduction of HbAlc of 2% at 6 months.…”

Effectiveness of Self-Management Training in Type 2 Diabetes

“…Lifestyle interventions were generally more effective in group settings, with positive outcomes noted for weight loss (8,36,47,48,72,74,76,77,94) and glycemic control (31,36,71,76,79), although two studies of lifestyle interventions in individual settings had positive effects on weight (38,80). Both individual (38,39,66 -68) and group (72,75,93) lifestyle interventions had positive effects on diet and self-care behaviors.…”

“…Thirteen studies demonstrated positive effects on weight loss; the average weight loss for these studies was ϳ2 kg (range 1.3-3.1) (28,36,38,47,66,72,74,76,80,82,84,89). Most studies with positive results involved regular contacts or reinforcement sessions (38,47,66,76,82,84) or very short follow-up periods (72,74), although four studies had follow-up periods of Ն5 months (36,38,80,82).…”

“…Thirteen studies demonstrated positive effects on weight loss; the average weight loss for these studies was ϳ2 kg (range 1.3-3.1) (28,36,38,47,66,72,74,76,80,82,84,89). Most studies with positive results involved regular contacts or reinforcement sessions (38,47,66,76,82,84) or very short follow-up periods (72,74), although four studies had follow-up periods of Ն5 months (36,38,80,82). All other studies with follow-up of Ն6 months after the end of the intervention failed to show significant differences in weight loss between control and interventiongroups (30,31,61,65,71,73,77,79,84,87,88,90,91).…”

Group Education in Diabetes: Effectiveness and Implementation

“…5,7 Group education is a costeffective alternative to individual education. 6,8,9 Fiscal intermediaries and reimbursement constraints are important factors influencing the format of diabetes education in today's practice. The federal Balanced Budget Act of 1997 resulted in changes in reimbursement by the Centers for Medicaid and Medicare Services (CMS, formerly the Health Care Financing Administration) that supported group delivery of diabetes education.…”