December 17, 2024

Structured Education in Type 2 Diabetes

Dr. Rajesh Jain August 18, 2021 123
glycemic control

glycemic control

Review of the Evidence for the Benefits of Structured Education in Type 2
Diabetes

 

INTRODUCTION

type 2 diabetes
type 2 diabetes

Globally, type 2 diabetes accounts for most deaths, sufferings, and burdens to individuals and health care services. There is a wealth of evidence to prove that high-quality structured diabetes self-management education (DSME) can significantly affect health outcomes and enhance patients’ quality of life.  This summative report aims at reviewing the evidence for the benefits of structured education in Type 2 diabetes. KNOWLEDGE DSME is the cornerstone to successful everyday diabetes management and can be transformative for individuals who have diabetes. This is evident in a systematic review of group-based education for patients with Type 2 diabetes in which 21 randomized controlled trials (RCTs) on diabetes structured education were assessed. This study revealed major improvement in participants’ knowledge about diabetes. Diabetes education is key for diabetes Prevention.

Structured education in type 2 diabetes
Structured education in type 2 diabetes

Lifestyle

See also: Diet in diabetes

People with diabetes can benefit from education about the disease and treatment, dietary changes, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.

diet for diabetes
diet for diabetes type 2

Weight loss can prevent progression from prediabetes to diabetes type 2, decrease the risk of cardiovascular disease, or result in a partial remission in people with diabetes. No single dietary pattern is best for all people with diabetes.

Healthy dietary patterns, such as the Mediterranean diet, low-carbohydrate diet, or DASH diet, are often recommended, although evidence does not support one over the others. According to the ADA, “reducing overall carbohydrate intake for individuals with diabetes has

effective weight loss
effective weight loss

demonstrated the most evidence for improving glycemia”, and for individuals with type 2 diabetes who cannot meet the glycemic targets or where reducing anti-glycemic medications is a priority, low or very-low-carbohydrate diets are a viable approach. For overweight people with type 2 diabetes, any diet that achieves weight loss is effective.

CLINICAL OUTCOME, SELF-MANAGEMENT, AND BEHAVIOR CHANGE

DSME programs have also shown major improvement in glycemic control and diabetes outcomes. Norris et al. [5] demonstrated that HbA1c levels decreased by 0.76% in participants who undertook DSME. Chala et al.  also reviewed existing literature and found similar reductions in HbA1c, with the greatest reduction of 0.88% in both individual and group settings for participants who completed
DSME. Nonetheless, in the former studies, the effect of  DSME was not sustainable long after intervention amongst participants compared to the latter.

glycemic control
glycemic control

This is quite substantial as the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that even a 0.9% decrease in HbA1c is associated with reductions in microvascular complications, diabetes-related mortality, and all-cause
mortality. In the UK, DESMOND’s (Diabetes Education and Self Management for Ongoing and Newly Diagnosed)
the intervention has yielded similar results. Khunti et al. reported a 1.49% decrease in HbA1c after 12 months and a sustained decrease after 3 years (-1.32%). However, there were no significant differences in other biomedical factors such as blood pressure and 10-year cardiovascular disease risk.

In similar terms, the reviews by DESMOND and 8 showed that greater exposure to structured education was linked to better glycemic control. An Italian-based intervention, ROMEO (Rethink Organization to iMprove Education and Outcomes), built on the efforts of these earlier studies to develop a lifestyle-change education program focusing on metabolic control, which was carried out over a longer duration of 2 years. The findings demonstrated that the participants in the ROMEO study had improved HbA1C, lipid profile, blood pressure, and BMI than in the control groups.

 

This suggests that an ongoing model of structured education may result in improvements in glycemic control and other biomedical factors, which can likely lead to fewer long-term complications.
In addition to improving health outcomes in individuals with type 2 diabetes, DESMOND’s programs also showed that structured education was beneficial in helping participants self-manage their diabetes and change health behaviors.

Structured Education
Structured Education

Examined this and found that after 12 months, the odds of having stopped smoking were up to 3.5 times higher in the intervention group than the control group. Positive results were also seen in areas of physical activities and diet change. Rygg et al., in their study, “examined the experience of participants in DSME about change in diet and physical activity and the generating learning process that facilitated this change.”

 

Their findings revealed that participants experienced a life of more confidence, security, increased control, and well-being. The participants also experienced significant improvement in their diet and physical activity 6 months after completing the DSME program. Similar findings of improved diet were reported by X-PERT programs, and a significant increase in the frequency of physical activity was reported by Davies et al. in their RCTs. X-PERT programs also showed positive results in self-management of blood glucose (SMBG),

SMBG
SMBG (Self-monitoring Blood Glucose )

although the increase in SMBG only lasted for 4 months. Results after 14 months revealed no significant difference between participants and the control group. Nevertheless, in their study, The Diabetes Equity Project (DEP) confirmed improvement in the regularity of SMBG, which lasted 12 months. SMBG and results of other activities indicated increased competence in managing their diabetes.

These education programs did not specifically measure adherence to medical treatment and care, though the positive results suggest that overall adherence improved. Van Netten et al. in their systematic review of 30 studies with 19 RCTs, revealed that DSME might have no impact in improving foot care behavior.

 SELF-DETERMINATION AND PSYCHOSOCIAL ADJUSTMENT

Khunti et al., in their research, has conclusively proven that well-structured education programs have contributed tremendously towards self-determination and mental adjustments in patients with diabetes. This is corroborated with the study from Essien et al., which indicated that DSME and social support positively affect self-efficacy and patient empowerment.

Crop unrecognizable female psychologist and patient discussing mental problems during session
patient empowerment

There are also studies suggesting that DSME has proven to promote healthy coping mechanisms and decrease diabetes-related distress and depression in their studies evidence significant improvement of quality of life for participants with diabetes-related stress after completing the DSME.

LONG-TERM OUTCOMES

Although many studies have shown that structured education can cause significant improvement in lifestyle, clinical and psychosocial outcomes, its role in preventing diabetes complications is an area of emerging research. An early study by Nicolucci et al. showed that complications such as; critical limb ischemia, amputation, chronic renal failure, dialysis treatment, proliferative retinopathy, and blindness could occur approximately 4 times more often in diabetic individuals with no education.

 

A more recent study that looked at the effects of glycemic control and incidence of cardiovascular complications showed that Patient Empowerment Programme participants were associated with lower incidence of first micro-vascular event and nephropathy.

Photo Of People Doing Handshakes
Program participants

The population-based cohort analysis study of the Patient Empowerment Programme by Wong et al. in obese type 2 diabetes patients again revealed that Patient Empowerment Programme participants had lesser incidence rates of all-cause mortality and first macro-vascular or micro-vascular disease events from diabetes.

A systematic review of literature from 2001 to 2011 by Nazar et al. revealed that diabetes complications could be minimized by developing enhanced diabetes knowledge and education to treat diabetes at the right time. This can, in turn, reduce morbidity and mortality amongst patients with diabetes.

These studies further explored that amputation rates can be reduced through DSME, which can result in huge cost savings. A long-term study with 13 years of follow-up investigated the impact gender may have on diabetes outcomes and found that structured education could reduce mortality and morbidity in women but not in men.

UTILISATION OF HEALTH CARE SERVICES

Although there is a wealth of evidence to prove that DSME can improve health outcomes and life quality for individuals with Type 2 diabetes, there is minimal recent research to prove that DSME can minimize healthcare services.

A Paramedic Woman Standing Inside the Ambulance
health care services

Norris et al., in a systematic review of five studies, only reported one study that experienced a reduction in emergency room visits four months after receiving DSME. Their findings from four other studies on admissions outcomes and hospital length of stay showed no major difference between participants who had DSME and the control group.

Greisinger et al. reviewed one study covering hospitalizations between 1993 and 2001 and concluded that patients with low income served by primary healthcare could react differently to these services than patients with highincome. There was no significant reduction in the use of eye specialist services, as reported by Norris et al.

DELIVERY MODE AND COST-EFFECTIVENESS

DSME can be delivered by nurses, physicians, specialists, and other healthcare professionals in hospitals, communities, outpatient clinics, diabetes centers, and primary care settings. DSME can be delivered as a group or one-to-one session depending on the individual’s needs. According to systematic review studies carried out by Chrvala et al. and Van Netten et al. both groups and individual education have shown significant improvements in participants‘ clinical outcomes and lifestyle changes.

Emergency Signage

According to Van Netten et al. the yearly cost for each participant without labor and admin in the X-PERT structured program was £26. On average, one medication costs £433 yearly. However, after completing the DSME with people having better outcomes, it is estimated that the cost for medication savings was £56,723 for 432 diabetic patients. Hence, over £367 million could be saved yearly if all 2.8 million patients with diabetes in the UK participated in XPERT programs.

CONCLUSION

In conclusion, this essay has examined the review of the benefits of structured education in type 2 diabetes about increasing patients’ knowledge, self-management, behavior change, clinical outcome, healthcare service utilization, long-term outcomes, psychological adjustment, and self-determination. It looked into the effectiveness of the delivery modes of type 2 diabetes structured education and discussed the cost-effectiveness and socio-economic implication of type 2 diabetes structured education.

In the studies reviewed, there is no concrete evidence that diabetes structured education may reduce healthcare services and 10-year cardiovascular risk. Nonetheless, there is substantial evidence that diabetes structured education can improve the general health outcome of individuals with type 2 diabetes, especially in areas such as physical activities, diet, medication adherence, smoke cessation, glycemic control, as well as the psychosocial well-being of the individual with type 2 diabetes. Diabetes structured education can also
reduce the huge cost on both individuals and health care services.

REFERENCES

1. International Diabetes Federation (2017) Diabetes Atlas. 8th Edn. Available at: http://www.idf.org/diabetesatlas
(Accessed: 13 May 2018).
2. Odgers-Jewell K, Ball LE, Kelly JT, Isenring EA, Reidlinger DP, et al. (2017) Effectiveness of group-based self-management education for individuals with type 2 diabetes education: A systematic review with meta-analyses and meta-regression. J Br Diabet Assoc 34: 1027-1039.
3. Skinner TC, Carey ME, Cradock S, Daly H, Davies MJ, et al. (2006) Diabetes education and self-management for on-going and newly diagnosed (DESMOND): Process modeling of a pilot study. Patient Educ Couns 64: 369-377.
4. Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey, et al. (2008) Effectiveness of the diabetes education and self-management for on-going and newly diagnosed (DESMOND) program for people with newly diagnosed type 2 diabetes: Cluster randomized controlled trial. Br Med J 336: 491-495.
5. Norris S, Lau J, Smith S, Schmid C, Engelgau M (2002a) Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care 25: 1159-1171.
6. Chrvala C, Sherr D, Lipman R (2016) Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns 99: 926-943.
7. the United Kingdom Prospective Diabetes Study (UKPDS) Group (1998) Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 352: 854-865.
8. Khunti K, Gray L, Skinner T, Carey M, Realf K, et al. (2012) Effectiveness of diabetes education and self-management program (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: Three-year follow-up of a cluster randomized controlled trial in
primary care. Br Med J 344: e2333-e2333.
9. Trento M, Gamba S, Gentile L, Grassi G, Miselli V, et al. (2010) Rethink Organization to iMprove Education and Outcomes (ROMEO): A multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care 33: 745-747.
10. Rygg LO, Lohre A, Hellzen O (2017) Lifestyle changes in diet and physical activities after group education for type 2 diabetes — the active ingredient in the education: A qualitative study. Open J Nurs 7: 1181-1190.
11. Deakin TA, Cade JE, Williams R, Greenwood DC (2006) Structured patient education: The Diabetes XPERT Programme makes a difference. Diabet Med 23: 944-954.
12. van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, et al. (2016) Prevention of foot ulcers in the at-risk patients with diabetes: A systematic review. Diabetes Metab Res Rev 32: 84-98.
13. Essien O, Out A, Umoh V, Enang O, Hicks JP, et al. (2017) Intensive patient education improves glycemic control in Diabetes compared to conventional education: A randomized controlled trial in a Nigerian Tertiary Care Hospital. PLoS One 12: e0168835.
14. Tang TS, Funnell MM, Oh M (2012) Lasting effects of a 2-year diabetes self-management support intervention: Outcome at 1-year follow-up. Prevent Chronic Dis 9: E109

15. Steinsbekk KA, Rygg LQ, Lisulo M, Rise MB, Fretheim A (2012) Group-based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus: A systematic review with meta-analysis. BMC Health Serv Res, p:23.
16. Nicolucci A, Cavaliere D, Scorpiglione N, Carinci F, Capani F, et al. (1996) A comprehensive assessment of the avoidability of long-term complications of diabetes: A case-control study. SID-AMD Italian Study Group for the Implementation of the St. Vincent Declaration. Diabetes Care 19: 927-933.

17. Wong C, Wong W, Wan Y, Chan A, Chan F, et al. (2015) Patient Empowerment Programme (PEP) and risk of microvascular diseases among patients with type 2 diabetes in primary care: A population-based propensity-matched cohort study. Diabetes Care 38:
e116-e117.
18. Wong C, Wong W, Wan E, Chan A, Chan F, et al. (2016) Macrovascular and microvascular disease in obese patients with type 2 diabetes attending structured diabetes education program: A population-based propensity-matched cohort analysis of Patient
Empowerment Programme (PEP). Endocrine 53: 412-422.
19. Nazar CMJ, Bojerenu MM, Safdar M, Marwat J (2016) Effectiveness of diabetes education and awareness of diabetes mellitus in combating diabetes in the United Kingdom: A literature review. J Ethnopharmacol 5: 110-115.
20. Gazzaruso C, Fodaro M, Coppola A (2016) Structured therapeutic education in diabetes: Is it time to re-write the chapter on the prevention of diabetic complications? Endocrine 53: 347-349.
21. Krag MØ, Hasselbalch L, Siersma V, Nielsen A, Reventlow S, et al. (2015) The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: A 13-year follow-up. Diabetologia 59: 275-285.
22. He X, Li J, Wang B, Yao Q, Li L, et al. (2016) Diabetes self-management education reduces the risk of all-cause mortality in type 2 diabetes patients: A systematic review and meta-analysis. Endocrine 55: 712-731.
23. Norris SL, Engelgau MM, Narayan KM (2001) Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care 24: 561-587.
24. Greisinger AJ, Balkrishnan R, Shenolikar RA, Wehmanen OA, Muhammad S, et al. (2004) Diabetes care management participation in a primary care setting and subsequent hospitalization risk. Dis Manage 7: 325-
332.
25. Norris SL, Nichols PJ, Caspersen CJ, Glasgow RE, Engelgau MM, et al. (2002b) Increasing diabetes self-management education in community settings – A systematic review. Am J Prev Med 22: 39-66

Citation: Jain R, Olejas S, Edwards A, Feh AR, Iqbal M, et al. (2019) Review of the Evidence for the Benefits of Structured Education in Type 2 Diabetes. Int J Diabetes Current Res, 1(2): 29-32.

Diabetes is just one of the many chronic ailments prevalent in the U.S., with millions of people suffering each year and thousands newly diagnosed by the same token.

And whether you have type 1 or 2 diabetes, making healthy lifestyle choices in the form of exercise (physical and mental), diet, and mental health management are vital for keeping this life-threatening illness at bay. to see the Complete article pls

https://www.diabetesasia.org/magazine/category/lifestyle-medicine/

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Dr. Rajesh Jain MD PG Diploma Diabetes, UK

The diabetesasia is the advocate for the people currently living with diabetes Burden & NCDs Risk. Global Diabetes Walk campaign remind us to Prevent diabetes.

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123 thoughts on “Structured Education in Type 2 Diabetes”

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  104. Корея и Япония заявляют, что ракета достигла максимальной высоты 2000000 м.
    Корея выложила снимки, сделанные при самом мощном запуске ракеты за последние пять лет.
    На необычных снимках, снятых из космоса, показаны части Корейского полуострова и прилегающие районы.
    В начале рабочей недели Пхеньян заявил, что провел испытания ракеты средней дальности (БРСД).
    Набрав полную мощность он может преодолевать огромные расстояния, оставляя в пределах досягаемости такие районы, как территория США Гуам.
    Это учение вновь вызвало тревогу у международного сообщества.
    За последние несколько недель Пхеньян сделал огромное количество запусков ракет — семь пусков — интенсивная активность, которая была резко осуждена США, Южной Кореей, Японией и другими странами.
    Что хочет Корея?
    Почему Северная Корея выпустила так много ракет в этом месяце?
    Северная Корея собирается сосредоточиться на экономике в 2022 году
    ООН не одобряет такие запуски баллистического и ядерного оружия и ввела санкйии. Но Северная Корея постояно игнорирует запрет.
    Уполномоченные персоны США в понедельник сообщили, что недавний рост активности требует возобновления переговоров с Пхеньяном.
    Что же случилось На испытаниях?
    ЮК и Япония сразу же заявили об испытаниях в воскресенье после обнаружения его в своих противоракетных системах.
    Они считают, что, он прошел огромное расстояние для такого типа ракет, преодолев расстояние около 800 км (497 миль) и достигнув высоты 2000 км, перед приземлением в океани около Японии. На предельной мощи и по стандартной траектории ракета может пролететь до 4000 км.
    Почему Северная Корея запустила ракету?
    Аналитик Северной Кореи Анкит Панда предположил, что отсутствие Кима и язык, использованный в СМИ для создания образа запуска, позволяют предположить, что это испытание было предназначено чтобы проверить, что БРСД работает должным образом, а не для того, чтобы продемонстрировать новую силу.
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