Educational interventions appear to be effective for patients with poorly controlled diabetes

Three randomized controlled trials published Online First today in Archives of Internal Medicine examine the effectiveness of behavioral and educational interventions for patients with poorly controlled diabetes. All three reports are part of the journal's Health Care Reform series.

In one report, Katie Weinger, Ed.D., of the Joslin Diabetes Center, Boston, and colleagues, evaluated the efficacy of a behavioral intervention for improving glycemic control among patients with long-duration poorly controlled diabetes. The trial randomized 222 adults with diabetes to three treatment groups: structured behavioral treatment (included a five-session manual-based, educator-led structural intervention with cognitive behavioral strategies), group attention control (educator-led attention control group education program) and individual control (unlimited individual nurse and dietitian education sessions for six months).

The authors found that all participants, regardless of treatment group, showed glycemic improvement, however the structured behavioral group showed greater improvements compared to the other two treatment groups. Additionally, participants with type 2 diabetes showed greater improvement than patients with type 1 diabetes. Quality of life, number of daily glucose meter checks and frequency of diabetes self-care did not differ by type of intervention over time; however, patients with type 2 diabetes showed higher quality of life scores than patients with type 1. The authors concluded that, "a structured, cognitive behavioral program is more effective than two control interventions in improving glycemia in adults with long-duration diabetes."

In a second report, JoAnn Sperl-Hillen, M.D., of HealthPartners Research Foundation and HealthPartners Medical Group, Minneapolis, and colleagues evaluated a total of 623 adults from Minnesota and New Mexico with type 2 diabetes and glycosylated hemoglobin (HbA1c) concentrations of 7 percent or higher. Participants were randomized to receive either group education, individual education or usual care (no assigned education; control group).

The authors found that individual education resulted in better glucose control in patients with established suboptimally controlled diabetes than did group education. Although mean (average) HbA1c concentrations decreased across all treatment groups, levels decreased significantly more in the individual education group (-0.51 percent) when compared with the group education (-0.27 percent) and the usual care (-0.24 percent) groups. Participants in the individual education group also were more likely to have HbA1c levels at or below 7 percent than participants in either the group education or usual care treatments. "In conclusion, among patients with type 2 diabetes of relatively long duration and HbA1c levels of 7 percent or higher, short-term glucose control improved more in those receiving individual diabetes education than in those receiving group diabetes education or assigned to no education," the authors write.