Closing the gap between literature and practice: evaluation of a teaching programme (in the absence of a structured treatment) on both type 1 and type 2 diabetes

Abstract

Athough education is considered an integral part of diabetes management, it remains low in the practical priorities of clinicians. We performed the first structured educational intervention in a diabetic outpatient department, where patients were controlled with no provider autonomy support available. We recruited 77 Type 1 (T1DM) and 154 Type 2 diabetic (T2DM) patients as well as 87 matched control subjects. Baseline evaluation included: medical interview; questionnaires concerning diabetes knowledge, diabetes quality of life, state-trait anxiety, depression and general perceived self-efficacy; biochemical examination (fasting blood glucose, HbA1c, lipids, uric acid, urinary glucose and albumin excretion). Of the 231 diabetic patients, 154 agreed to attend an educational course, yet only 101 patients (37 T1DM and 64 T2DM) completed it (intervention group) due to organisational barriers. Intervention and reference (non-participant patients) groups received identical medical care, except that the educational group met with the educator during five teaching sessions. Three to six months after the completion of the course, they underwent a final assessment. Prospective results were: 1) in T1DM, a reduction in HbA1c levels and an increase in plasma HDL cholesterol with no change in drug treatment (the reference group showed no change in HbA1c values despite an increased insulin dose), improved technical skill, knowledge, quality of life and self-efficacy; 2) in T2DM, a reduction in fasting plasma glucose and an improvement in knowledge and quality of life. Analysis of the cross-sectional data at baseline evidenced: 3) the same levels of anxiety, depression and general self-efficacy in diabetic patients compared with healthy control subjects; 4) lower diabetes-specific quality of life associated with established insulin treatment in T2DM; 5) significant gender differences among healthy as well as diabetic subjects in degree of psychological distress. Education by itself is more than simply offering information to people (even in a troubled context) and its infrequent incorporation in practice really contradicts resource efficiency.