Intensive individualized reinforcement education is important for the prevention of hypoglycemia in patients with type 2 diabetes

Abstract

Background: We investigated whether an intensive individualized reinforcement education program could influence the prevention of hypoglycemic events in patients with type 2 diabetes.

Methods: From March 2013 to September 2013, patients aged 35 to 75 years with type 2 diabetes who had not previously participated in diabetes education, and treated with insulin or a sulfonylurea-containing regimen were included in the study. After structured group education, the patients assigned to the intensive individualized education group (IT) were requested to visit for reinforcement. All subjects in the IT were encouraged to self-manage dose adjustments. Participants in both groups (control group [CG, group education only; n=22] and IT [n=24]) attended follow-up visits at 2, 8, 12, and 24 weeks. At each visit, all patients were asked whether they had experienced hypoglycemia.

Results: The total study population consisted of 20 men (43.5%; mean age and diabetic duration of 55.9±11.0 and 5.1±7.3 years, respectively). At 24 weeks, there were no significant differences in hemoglobin A1c values between the CG and IT. The total number of hypoglycemic events per patient was 5.26±6.5 in the CG and 2.58±2.3 times in the IT (P=0.004). Adherence to lifestyle modification including frequency of exercise, self-monitoring of blood glucose, or dietary habit was not significantly different between the groups. However, adherence to hypoglycemia management, especially the dose adjustment of medication, was significantly higher in the IT compared with the CG.

Conclusion: Compared with the structured group education, additional IT resulted in additional benefits in terms of avoidance of hypoglycemia and treating hypoglycemia in patients with type 2 diabetes.

Keywords: Diabetes education; Diabetes mellitus, type 2; Hypoglycemia.

Fig. 1. Summary of the study design. SMBG, self-monitoring of blood glucose; HbA1c, hemoglobin A1c.

Fig. 2. The number of hypoglycemic events per patient at each time point and causes of hypoglycemia. (A) Episodes of hypoglycemia per patient were significantly lower in the intensive group (IT) compared with the control group (CG) (P=0.002), and the difference in the mean number of hypoglycemic events between the two groups was consistent across each time point (P for interaction=0.674). At 12 weeks, however, hypoglycemic events per patient were significantly higher in the CG. (B) The causes of hypoglycemia were significantly different between the groups (P=0.029). The cause of hypoglycemia was classified as (1) diet (delayed or missed meal, eating less food in a meal than planned); (2) exercise (unexpected or more vigorous exercise than usual); (3) medication (no adjustment of medication in spite of lower than normal glycemic range); (4) others (concurrent illness, unknown cause). ^aP<0.05 vs. IT.

Fig. 3. Adherence to hypoglycemia management at 24 weeks. The percentage of patients with good compliance to hypoglycemia management was significantly higher in the intensive group (IT). SMBG, self-monitoring of blood glucose. ^aP<0.05 vs. control group (CG).