Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care

Abstract

Aims: Education is an essential part of the management of patients with Type 2 diabetes, but the long-term effects are unclear and not well investigated in primary care.

Methods: Fifty-four patients (39-75 years) treated with maximal dosages of oral hypoglycaemic agents, needing to start insulin (HbA(1c)> or = 7.0%), were randomly allocated to a 6-month educational programme by a diabetes nurse (DN group) or usual care (UC group). Main outcome measures were HbA(1c), number of patients with HbA(1c) < 7.0%, and number of patients treated with insulin 18 months after baseline.

Results: Six weeks after the intervention HbA(1c) levels had improved from 8.2 (1.1) to 7.2 (1.3) in the DN group, and from 8.8 (1.5) to 8.4 (1.7) in the UC group. Adjusted for baseline values, at 6 weeks HbA(1c) improved 0.7% (95% confidence interval 0.1, 1.4) more in DN than in UC. Of the patients in DN, 60% reached HbA(1c) < 7.0% compared with 17% in UC (P < 0.01). However, at 18 months there were no significant differences for HbA(1c), number of patients with HbA(1c) < 7.0%, or number treated with insulin.

Conclusions: Education was effective in improving glycaemic control and in delaying the need for insulin therapy in patients treated with maximal oral hypoglycaemic therapy. The reduced effect after 1 year was probably due to the discontinuation of the educational programme. Short-term education should not be offered without regular reinforcements integrated into standard diabetes care.