[Principles, means and evaluation of a programme for diabetes education (author's transl)]

Abstract

A programme of patient information and education, as a primary tool of diabetes treatment, has been developed during the past 5 years, aiming to an effective self-management of diabetes. The programme is patient-oriented, with an essential psychological approach, based on a realistic language and following the concepts of a simple "diabetes philosophy". The diabetes is considered as an human condition, not necessarily a disease. Two phases are proposed. The first, termed "basic information", essentially consists of: 1) an individual checklist of 20 main-items to be gradually completed, with sharing of responsibilities between professionals and diabetics, according to the Etzwiler's contract concept; 2) a set of six original slide-tapes (Bell a. Howell and Reflex projectors) and video-tape films (Fairchild), with personal comments; 3) the red booklet "Condizione diabete" published in 1978 by the Karen Bruni Diabetes Centre. The second phase of the programme, termed "advanced information", is intended for a continuous up-to-dating of diabetological knowledge. The means used are: 1) periodical information meetings with discussion on various existential problems of diabetics; 2) a quarterly magazine "Centro KB", in which new techniques and investigations (such as C peptide and insulin antibody determination) are explained or local events are commented. The effectiveness of the programme has been evaluated through a questionnaire given to 305 subjects attending both the diabetes ward (in-patients and out-patients) and the diabetes clinic (out-patients only). The questionnaire asks 20 specific questions, of the multiple choice type, about day-to-day care complications, natural history of the diabetes, and so on. The percentage of total correct responses, as well as of correct responses to 3 key questions (hypoglycaemia, hyperglycaemia, complicating infections) has been analyzed on a computer PDP 11/23 (FORTRAN) in relation to demographic and diabetological variables. The educational level appears to be positively correlated with attendance to the ward (initial hospitalization) in comparison to the out-patients clinic, young age and insulin-dependence, and schooling. No relationship was found between level of information and metabolic control, as assessed by HbA1C. Following conclusions are drawn: 1) the complete programme of patient education is particularly valuable for young insulin dependent (ID) diabetics, who really need and properly use the information; 2) to the adult-old, non insulin-dependent diabetics (NID) a limited information programme seems to be more suitable; 3) a separation between ID and NID diabetics has to be considered when planning a future information programme; 4) permanent hard personal engagement by the diabetologist, and continuous review and criticism of information means and techniques, are requested if the tasks of a really patient-oriented teaching have to be attained.