Targeting educational therapy for type 2 diabetes: identification of predictors of therapeutic success

Abstract

Patient education is a key component of diabetes care. Limits in resources often prevent the participation of many patients with type 2 diabetes to structured education programs. The identification of predictors of response to group education could help in selecting those patients in whom the intervention is more cost-effective. A structured interactive group program was proposed to a consecutive series of 150 type 2 diabetes patients, who were then followed prospectively in 24 months, with measurements of HbA1c, BMI, quality of life, eating habits. For comparison, another consecutive series of 113 patients who had received no intervention was also observed for 12 months. A significant reduction in HbA1c was observed in the intervention group at 12 and 24 months (from 7.5 ± 1.4 to 6.9 ± 1.2 and 6.6 ± 1.1% at 12 and 24 months, respectively, both P < 0.01), with no variation in BMI and quality of life. A sustained reduction in total energy, protein, and fat intake was observed after education. The proportion of success (HbA1c < 7% and/or HbA1c reduction from baseline > 1%) in the intervention group was 60.7% (vs. 38.1% in controls) and 63.3% at 12 and 24 months, respectively. In the intervention group, patients with success at 12 months showed lower baseline HbA1c, BMI, duration of diabetes, protein, and cholesterol intake. Patients with a lower duration of diabetes appear to have a greater response to structured group education, whereas age is not a predictor of response. Therefore, educational intervention should be planned in the earlier phases of the disease.

Diabetes conversation map - a novel tool for diabetes management self-efficacy among type 2 diabetes patients in Pakistan: a randomized controlled trial

“…Since, we measured the change in HbA1c only after 3 months of the enrollment and during the initial 1 month, 4 weekly sessions were conducted thus the time to bring change in the daily routines, behaviors, practices based on the education resulting in improvement of HbA1c might not be sufficient. Secondly, studies in the past have reported that improvement in the HbA1c level is relatively difficult among diabetes patients with longer duration of the illness as compared to the patients who are newly diagnosed [33]. Since the average of duration of illness in this study was 10 and 9 years among patients in the DCM and RC arms respectively, therefore, longer duration might have resulted in no significant improvement in HbA1c during the 3 months duration after enrollment.…”

Factors Associated with Prolonged Poor Glycemic Control in Type 2 Diabetes Mellitus (T2DM) Patients Followed in the Department of Internal Medicine at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)

“…Similarly, in the Da Vico study, where the proportion of poor diabetes mellitus control was 36.7% at 12 months after the diagnostic of diabetes mellitus, all patients had received therapeutic education [34]. Our high proportion of poor diabetes mellitus control could be explained by the low completion rate of therapeutic education in the patient population, 24.3% [35] versus 100% [34]. Indeed, therapeutics education creates conditions for improved patient compliance and follow-up.…”

“…Distribution of study patients by diabetes mellitus characteristics (N = 270).In multivariate analysis with bivariate logistic regression, six factors were independently associated with prolonged poor diabetes mellitus control. These were no formal education (OR = 8 34,. 95% CI [1.97 -35.22]; p < 0.01); family support for diabetes mellitus management (OR = 0.65, 95% CI [0.45 -0.94]; p = 0.02); presence of abdominal obesity (OR = 2.27, 95% CI [1.08 -4.77]; p = 0.03); a history of hospitalization (OR = 7.39, 95% CI [2.97 -18.39]; p < 0.01); poor adherence to antidiabetic treatment (OR = 2.97, 95% CI [1.42 -6.18]; p < 0.01); presence of microangiopathy (OR = 5.05, 95% CI [2.36 -10.81]; p < 0.01).…”

Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms

“…As expected, patients with higher BMI had greater problems with snacking between main meals than patients with normal weight. This finding may have clinical implications because higher basal BMI is a negative predictor of success in diabetes treatment,19 and obesity is associated with worsened glycemic control in patients with T2DM treated with insulin 20…”