Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project. Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial. Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Patients' perspectives on diabetes health care education. The Effect of Diabetes Self-Management Education With Frequent Follow-Up on the Health Outcomes of African American Men Assessment of the function and effect of diabetes education programs in Taiwan. Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial Effects of an Outpatient Diabetes Self-Management Education on Patients with Type 2 Diabetes in China: A Randomized Controlled Trial Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial. Diabetes self-management education: acceptability of using trained lay educators A Randomized Study of the Effects of a Home Diabetes Education Program An Empowerment-Based Diabetes Self-management Education Program for Hispanic/Latinos Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample Diabetes Learning in Virtual Environments: Testing the Efficacy of Self-Management Training and Support in Virtual Environments (Randomized Controlled Trial Protocol). Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes The relative effectiveness of self-management programs for type 2 diabetes.
Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels AIM Patient education that enhances one 's self-management ability is of utmost importance for improving patient outcomes in chronic diseases . We developed a 12 month self-management education program for type 2 diabetes , based on a previous 6 month program , and examined its efficacy . METHODS A r and omized controlled trial was carried out on out patients with type 2 diabetes from two hospitals who met the criteria and gave consent to participate . They were r and omly divided into an intervention group that followed the program and a control group that followed usual clinical practise . The intervention group received < 30 min of monthly interviews based on the program 's textbook and biweekly telephone calls from a nurse educator throughout the 12 months . RESULTS Of the 50 participants in the intervention group and the 25 participants in the control group , 42 and 23 , respectively , completed the program ( a completion rate of 84.0 % ) . The body weight , HbA1c , self-efficacy , dietary and exercise stages , quality of life , diastolic blood pressure , and total cholesterol level were significant by two-way repeated- measures anova . As for changes over time within the groups , only the intervention group showed significant differences by Friedman 's test . The complication prevention behaviors showed a high implementation rate in the intervention group . The overall evaluation of this program by the participants was very high and , therefore , they highly recognized the need for this type of program . CONCLUSIONS Self-management education works successfully in relation to patients ' behavior modification skills , degree of goal attainment , and self-efficacy , consequently improving their health outcomes AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs Living with Type 2 diabetes requires that patients develop a range of competencies that allow them to take greater control over the treatment of their disease . This requires education that promotes health whilst respecting individuals ' self-perceived needs and voluntary choices . Whilst such a concept is not new in the field of diabetes , health professionals are still struggling with how to administer it successfully . This paper presents the findings of a research trial of a theoretically constructed educational intervention . It focuses on the patients ' perspectives of what they valued about the intervention which was found to be clinical ly effective over a short-term period only . Limitations to maintaining effects were associated with a number of factors . The study found that whilst patients can be educated toward greater autonomy , not all health professionals are ready to work in partnership with them . It highlighted the importance of clinical staff not only gaining a better underst and ing of diabetes management , but also of the theoretical principles underlying patient empowerment . This paper outlines these principles and shows how they were synthesized to produce a framework for informing practice . Patients ' views are utilized to provide guidelines for improving the outcomes of patient education PURPOSE This study was conducted to determine whether objective clinical , patient performance , quality -of-life , and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program . METHODS Prior to the diabetes self-management education program , 30 African American men with type 2 diabetes were r and omly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period . Information obtained at follow-up contact included HbA1c level , perception of general health , and present diabetes knowledge . In addition , daily foot care , dietary , exercise , and medication compliance measures were assessed postprogram . RESULTS There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical , patient performance , quality -of-life , and subjective outcomes . CONCLUSIONS This cross-sectional study showed that telephone follow-up at 3 month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up A multi-center prospect i ve study was conducted to assess the function and impact of diabetic education programs on diabetic control . A total of 208 subjects with type 2 diabetes were recruited .  Diabetes self-care , assessed by question naire , was evaluated before , and 4 months after attending a diabetes education course . A total of 121 subjects who received advanced diabetes education courses  were design ated as the experimental group . A second group of 87 cases receiving a basic course  served as controls . In addition to basic knowledge , the advanced education programs included  dietary control , blood glucose monitoring , management of hypoglycemia , medication compliance , foot care and exercise . Diabetes self-care techniques were significantly improved in the experimental group . The overall score for diabetes self-care techniques improved in both groups at the 4th month over baseline values . The change was significant with the controls ' ( P < 0.001 ) . Multiple regression analysis confirmed the intensity of diabetic education was the only significant variable correlated with the decrease of fasting blood glucose and systolic blood pressure . In conclusion , integrated and intensive diabetes education program in diabetes education centers provides an effective method for improving diabetes self-care techniques and metabolic outcome Background Diabetes specific emotional problems interfere with the dem and ing daily management of living with type 2 diabetes mellitus ( T2DM ) . Possibly , offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients ' belief they are able to manage their illness . It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy . Methods and design Six hundred patients with T2DM ( 45 ≤ 75 years ) who receive care in a structured diabetes care system , HbA1c ≥ 7.0 % , and not using insulin  will be recruited and r and omized into 3 groups ; Self-monitoring of Blood Glucose ( SMBG ) , Self-monitoring of Urine Glucose ( SMUG ) and usual care ( n = 200 per group ) . Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year . All 3 groups will receive st and ardized diabetes care . The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results . Main outcome measures are changes in diabetes specific emotional distress and self-efficacy . Secondary outcome measures include difference in HbA1c , patient satisfaction , occurrence of hypoglycaemia , physical activity , costs of direct and indirect healthcare and changes in illness beliefs . Discussion The IN CONTROL-trial is design ed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy . Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions , guiding the patient to reduce emotional responses to experienced threats , and influences the patients ability to perform and maintain self-management skills . Trial registration Current Controlled Trials IS RCT Objective This study is aim ed at assessing the effectiveness of a simple outpatient diabetes self-management education programme . Methods In the study , 60 patients with type 2 diabetes mellitus were r and omly allocated into the control group ( n = 30 ) and intervention group ( n = 30 ) . Regular and 2-session health education programmes were provided . The summary of diabetes self-care activity measure , problem areas in the diabetes scale , fasting blood glucose , postpr and ial 2 h blood glucose , and HbA1c were measured before and after the intervention to assess the effects of this 2-session diabetes education programme . Results The total mean score of the summary of diabetes self-care activities measure was 17.60 ± 6.63 points . The problem areas in the diabetes scale revealed that the total mean score was 29.82 ± 15.22 points ; 27 % of the patients had diabetes-related distress , while 9 % suffered from severe emotional distress . Compared with the control group , scores of the summary of diabetes self-care activities measure and problem areas in the diabetes scale , fasting blood glucose , postpr and ial 2 h blood glucose , and HbA1c were significantly improved in the intervention group after the intervention ( P < 0.01 ) . Conclusion This study showed that the 2-session diabetes education programme could effectively improve the level of self-reported self-management , psychological distress , and glycemic control in patients with type 2 diabetes mellitus BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources OBJECTIVE To evaluate the efficacy of ongoing group based diabetes self-management education ( DSME ) for patients with type 2 diabetes . METHODS 146 patients were r and omised to either group education or waiting list control . Primary outcomes were A1C and patient activation measured with patient activation measure ( PAM ) . RESULTS There were no differences in the primary outcomes between the groups at 12 months , but the control group had an increase in A1C of 0.3 % points during follow-up . Diabetes knowledge and some self-management skills improved significantly in the intervention group compared to the control group . A sub group analysis was conducted for the quartile with the highest A1C at baseline ( > 7.7 , n=18 in both groups ) . There were significant improvements within the intervention group at 12 month follow-up for both A1C and PAM and a trend for better outcome in the intervention group compared to the control . CONCLUSIONS The locally developed ongoing diabetes self-management education programs prevented an increase in A1C and can have an effect on A1C in patients with higher A1C level . PRACTICE IMPLICATION S Locally developed programs may be less effective than programs developed for studies Background The use of lay people to deliver education programmes for people with chronic conditions is a potential method of addressing healthcare staff capacity and increasing the cost efficiency of delivering education . This qualitative sub study is embedded within an equivalence trial ( 2008–2011 including development stage ) . Objectives In the qualitative sub study , we aim ed to elicit the views of key stakeholders ( patients , educators ) about using lay people to deliver education to people recently diagnosed with type 2 diabetes , alongside a healthcare professional educator with an equal role . In this way , we sought to explore perceptions about acceptability and also contribute to underst and ing the reasons underlying positive or negative quantitative findings from main trial . Methods We conducted  27 telephone interviews with a purposive sample of patients , lay educators and healthcare professional educators involved in the main trial . Thematic analysis of transcribed data was underpinned by the constant comparative approach and structured using Framework methodology . Results Overall , the data suggested that the use of lay educators was acceptable to educators and patients . Perceived difference in knowledge levels between lay and healthcare professional educators did not appear to have an impact on perceived acceptability or the effectiveness of the education received . Additional themes explored were related to peer status of educators and feasibility . Some concerns were raised about lay educators with diabetes , transferring personal issues and about the impact of healthcare professional time taken up by mentoring and supporting lay educators . Conclusions Positive perceptions about the use of lay educators support the positive quantitative findings from the main trial . Acceptability is an important consideration in relation to implementation of the model of delivery studied . Concerns raised within the interviews should be considered in the design of training for lay educators . Trial registration number IS RCT N 99350009 Home health nurses provided individualized instruction in diabetes self-care within the home environment of 393 diabetic individuals . Each subject was r and omly assigned to either the intervention ( those receiving home teaching ) or control ( those not receiving home teaching ) group . At 6 mo postenrollment , intervention subjects showed significantly greater self-care knowledge and skills than control subjects , although the actual differences between the two groups in terms of self-care skills were probably too small to have any practical meaning . The primary objective of the study , which was the reduction of the number of preventable diabetes-related hospitalizations ( ketoacidosis , ketotic coma , nonketotic coma , insulin reaction , and diabetes out of control ) , was not achieved ; no differences between the groups were noted after 12 mo of follow-up . Similarly , length of hospital stay , foot problems , emergency room and physician visits , and sick days were roughly equivalent in both groups during the follow-up year . These results suggest that , in the absence of concurrent changes in the health-care delivery system and strategies for influencing attitudes toward self-care , education alone is ineffective Purpose The purpose of this pilot study was to evaluate the effects of a culturally sensitive , empowerment-based diabetes self-management education program for Spanish-speaking Hispanic/Latinos . Methods A prospect i ve quasi-experimental repeated measures design tested the effectiveness of the ¡ Si , Yo Puedo Controlar Mi Diabetes ! diabetes self-management education program . In sum , 144 persons residing in 2 Texas counties at the Texas-Mexico border ( Starr and Hidalgo ) served as participants . Two groups were formed , an intervention and a control ( wait list ) . Clinical ( A1C ) , cognitive , attitudinal , behavioral , and cultural assessment s were collected at baseline and 3 months . Results Demographic characteristics for the intervention and control groups were similar . Both groups were predominately female , low income , older than 40 years , and minimally acculturated . Baseline and posttest findings showed that the intervention group had a significant reduction in A1C values ; median difference was 0.3 ( n = 45 ) , especially for those with higher baseline values . Participants in the intervention group also improved in their self-efficacy and self-care scores . Conclusions Findings from the study suggest that additional dissemination of a diabetes self-management education program for Spanish-speaking Hispanic/Latinos is warranted to improve clinical outcomes and associated diabetes self-efficacy and self-care behaviors Background Lower socioeconomic status is associated with excess disease burden from diabetes .  Diabetes self-management support interventions are needed that are effective in engaging lower income patients , addressing competing life priorities and barriers to self-care , and facilitating behavior change . Objective To pilot test feasibility , acceptability , and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility . Design Two-arm r and omized controlled trial powered to detect a 0.50 % change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis . Participants Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar , blood pressure , or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization . Interventions A group , problem-based diabetes self-management training design ed for delivery in an intensive and a condensed program format . Three intensive and three condensed program groups were conducted during the trial . Main Measures Clinical ( A1C , systolic blood pressure [ SBP ] , diastolic blood pressure [ DBP ] , LDL and HDL cholesterol ) and behavioral ( knowledge , problem solving , self-management behavior ) data were measured at baseline , post-intervention , and 3 months post-intervention ( corresponding with 6–9 months following baseline ) . Results Adoption of both programs was high ( > 85 % attendance rates , 95 % retention ) . At 3 months post-intervention , the between-group difference in A1C change was −0.72 % ( p = 0.02 ) , in favor of the intensive program . A1C reduction was partially mediated by problem-solving skill at follow-up ( ß = −0.13 , p = 0.04 ) . Intensive program patients demonstrated within-group improvements in knowledge ( p < 0.001 ) , problem-solving ( p = 0.01 ) , and self-management behaviors ( p = 0.04 ) . Among the subsets of patients with suboptimal blood pressure or lipids at baseline , the intensive program yielded clinical ly significant individual improvements in SBP , DBP , and LDL cholesterol . Patient satisfaction and usability ratings were high for both programs . Conclusions A literacy-adapted , intensive , problem-solving-based diabetes self-management training was effective for key clinical and behavioral outcomes in a lower income patient sample BACKGROUND Ongoing self-management improves outcomes for those with Type 2 diabetes ( T2D ) ; however , there are many barriers to patients receiving assistance in this from the healthcare system and peers . Findings from our pilot study showed that a virtual diabetes community on the Internet with real-time interaction among peers with T2D- and with healthcare professionals-is feasible and has the potential to influence clinical and psychosocial outcomes . OBJECTIVE The purpose of this article is to present the protocol for the Diabetes Learning in Virtual Environments ( LIVE ) trial . PROTOCOL Diabetes LIVE is a two-group , r and omized controlled trial to compare effects of a virtual environment and traditional Web site on diet and physical activity . Our secondary aims will determine the effects on metabolic outcomes ; effects of level of engagement and social network formation in LIVE on behavioral outcomes ; potential mediating effects of changes in self-efficacy ; and diabetes knowledge , diabetes-related distress , and social support on behavior change and metabolic outcomes . We will enroll 300 subjects at two sites ( Duke University/Raleigh-Durham , NC and New York University/New York , NY ) who have T2D and do not have serious complications or comorbidities . Those r and omly assigned to the intervention group have access to the LIVE site where they can find information , synchronous classes with diabetes educators , and peer support to enhance self-management . Those in the control group have access to the same informational and educational content in a traditional asynchronous Web format . Measures of self-management , clinical outcomes , and psychosocial outcomes are assessed at baseline and 3 , 6 , 12 , and 18 months . DISCUSSION Should LIVE prove effective in improved self-management of diabetes , similar interventions could be applied to other prevalent chronic diseases . Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of self-management training and support In recent years , great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes . Studies have reported that nurses , compared to other healthcare professionals , are more likely to promote preventive healthcare seeking behaviors . The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin . A two-arm parallel-group r and omized controlled trial with the blinded outcome assessors was design ed . One hundred forty-two adults with type 2 diabetes were r and omized to receive either usual diabetes care ( control group ) or usual care plus a nurse-led diabetes self-management education ( intervention group ) . Duration of the intervention was 12 weeks . The primary outcome was glycosylated hemoglobin ( HbA1c values ) . Secondary outcomes were changes in blood pressure , body weight , lipid profiles , self-efficacy ( efficacy expectation and outcome expectation ) , self-management behaviors , quality of life , social support , and depression . Outcome measures were assessed at baseline and at 12-week and 24-week postr and omizations . Patients in the intervention group showed significant improvement in HbA1c , blood pressure , body weight , efficacy expectation , outcome expectation , and diabetes self-management behaviors . The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial result ing in sustained improvements in clinical , lifestyle , and psychosocial outcomes . This trial is registered with I RCT 2016062528627N1 OBJECTIVES The objectives of the study were to investigate the effectiveness of 2 types of peer-led self-management programs in bringing about improvements in subjects with type 2 diabetes mellitus and to determine whether there were differences in effectiveness between the 2 programs . METHODS The study used a 3-arm r and omized controlled trial design with clinical measures taken at baseline and at 6 and 12 months post-program . In total , 405 persons completed baseline question naires and were r and omly allocated to a diabetes self-management program ( n=130 ) , to a general self-management program ( n=109 ) or to a control group ( n=122 ) . A 2-way factorial analyses of variance was employed as the primary statistical analysis . RESULTS The findings showed that the self-management programs had affected 5 of the 30 measures : fatigue , cognitive symptom management , self-efficacy with regard to the disease in general , communication with physician , and the score on the Diabetes Empowerment Scale . In addition , 3 variables-social role limitations , total hospital nights and glycated hemoglobin levels-showed marginally significant interaction effects . The second analysis found similar results , with 4 of the 5 measures remaining statistically significant : fatigue , cognitive symptom management , communication with physician and diabetes empowerment , with neither program being more effective than the other . CONCLUSIONS The major findings are that although both programs were effective in bringing about positive changes in the outcome measures , there was little difference in effectiveness between the Diabetes Self-Management Program and the Chronic Disease Self-Management Program . This finding is consistent with the principle that behaviour-change strategies using self-efficacy are key components in health education programs
Conclusions The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients .
Background Diabetes self-management education is an essential part of diabetes care , but its impact on all-cause mortality risk of type 2 diabetes patients is unclear .
A systematic review and meta- analysis aim ing to eluci date the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed .