[An intervention to improve diabetes control in Chile]

Abstract

Objective: Previous research has shown that controlling blood glucose improves short-term and long-term outcomes among patients who have either type 1 or type 2 diabetes. The objective of this study was to investigate, in a developing country, the effectiveness of an intervention that included patient education, self-monitoring of blood glucose, and determination of the level of glycosylated hemoglobin (HbA1c).

Methods: The patients were grouped into three categories, taking into account such clinical manifestations as the duration of their diabetes, its treatment, and their hospitalization history. After the inclusion and exclusion criteria were applied, the persons were randomly assigned to two groups. One group (210 patients) received the educational intervention, and the control group (206 patients) received customary care. The intervention group received educational information needed for self-monitoring of blood glucose and for the self-evaluation of positive and negative behaviors related to metabolic control of the disease.

Results: The two groups were similar with respect to age (mean of 52.3 and 50.5 years) and to the proportion of patients with type 1 diabetes (13.8% and 16.0%). There were no initial differences in the average concentration of HbA1c in the two groups (8.9% +/- 0.1% and 8.9% +/- 1.4%). A total of 50 persons dropped out of the study, 14.8% of those in the intervention group and 9.2% of those in the control group. In the intervention group, compliance with dietary recommendations increased by 43.5%, from 57.5% at the beginning of the study to 82.5% at the end (P < 0.001); in the control group there was also a change but it was not significant. Although patients with a high initial HbA1c concentration were underrepresented in this study, the average HbA1c concentration declined significantly in the intervention group (-0.4% +/- 1.1%, P = 0.001) but not in the control group (-0.1% +/- 0.1%).

Conclusions: In one developing country, educating patients about diabetes helped improve metabolic control, a fact that can be attributed mainly to the intervention's positive impact on those persons' diet.