Although there have been significant advances in the provision of diabetes education since 2000, further improvements are still needed, say researchers.
A greater range of intervention approaches and more long-term education is needed in Type 2 diabetes care if improvements in patient outcomes are to be maintained on a long-term basis, said David Caven (Bournemouth Diabetes and Endocrine Centre, UK) at the European Association for the Study of Diabetes 48th Annual Meeting in Berlin, Germany.
The researchers compared one of the main programs delivered at centers across the UK, the Diabetes Education Self Management Ongoing and Newly Diagnosed (DESMOND), with a local initiative in Bournemouth called Focus. Cavan and team found that after 3 to 4 months, patients demonstrated similar patterns in glycemic control with both programs, after diagnosis of new-onset diabetes.
DESMOND, which is delivered in a 6-hour session over a single day within 12 weeks of diabetes diagnosis, encourages lifestyle change and modification of cardiovascular risk factors. Focus is generally delivered within 1 week of diagnosis, comprises three, 2-hour group sessions over 6 weeks, and places emphasis on dietary advice, weight reduction, and reducing cardiovascular risk.
In 2004, a study of outcomes from Focus showed that there was a significant reduction in glycated hemoglobin (HbA1c) 3 months after diabetes diagnosis. This was largely maintained for the following 3 years.
On comparing this with outcome results from the DESMOND program, a very similar pattern in control of glycated hemoglobin (HbA1c) emerged, says Caven.
The researchers were also interested to see if the pattern was replicated in the outcomes of the United Kingdom Prospective Diabetes Study as, before randomization, every individual included in this study was seen by a dietician on 3 occasions for mandatory advice. They found that, again, the same pattern occurred.
All three programs were equally effective in promoting behavioral change, which improved metabolic control after diagnosis and for up to 3 years, said Caven.
He highlighted some key issues in diabetes care including whether the emphasis at diagnosis of Type 2 diabetes should focus on lifestyle advice to promote weight loss with more complex interventions saved for later on, whether reversal of diabetes through weight loss should become an objective of education at diagnosis, and finally, whether more complex interventions should be used to support maintenance of behavior.
While many areas provide one-off interventions, a greater variety of approaches, together with ongoing education are needed to maintain lasting improvements in outcomes, he concluded.
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