Empowering diabetes out-patients with structured education: short-term and long-term effects of functional insulin treatment on perceived control over diabetes

Abstract

Objective: To investigate short-term and long-term effects of structured outpatient education for Functional Insulin Treatment (FIT: selective insulin dosages for eating, fasting or correcting hyperglycaemia) on perceived control over diabetes and related health beliefs. FIT was thought to influence the perception of self-efficacy in diabetes, in contrast to conventional treatment, based on scheduled, rigid food intake and insulin delivery--it allows flexible eating, provided independent control of glycemia.

Methods: Structured, comprehensive, outpatient group training in FIT for selective use of insulin either for eating, fasting or correction included practical "insulin games." The FIT program focused on everyday criteria for choices of insulin dosages and thus on the patient's ability to execute his/her newly gained flexible treatment to his/her everyday life while preventing acute and late complications. To evaluate effects of FIT on "Perceived Control over Diabetes" and related "Health Beliefs Concerning Diabetes" (Bradley's questionnaires, 1984), a fully randomized short-term controlled Study 1 (four weeks, 32 patients), and long-term uncontrolled pilot Study 2 (three years, 68 patients) were performed.

Results: The short-term study revealed that FIT induced the feeling of independence from situational control while self-managing diabetes. In the long-term study, the patients were increasingly freed from the feeling of being under the control of physician and treatment-related restrictions, which--together with higher perceived self-efficacy--contributed to the feeling of "empowerment." This was associated with high treatment satisfaction and significant improvement of glycemic control.

Conclusion: Structured out-patient group training for FIT results in measurable improvement of patients' perceived control over diabetes and self-efficacy.