Bicentric evaluation of a teaching and treatment programme for Type 1 (insulin-dependent) diabetic patients

Effects of an individual intensive educational control program for insulin-dependent diabetic subjects with poor metabolic control

The aim of our study was to evaluate the efficiency of an individual intensive educational control program on improving the metabolic control of insulin-dependent diabetic patients at short- and long-term follow-up. Fifteen insulin-dependent diabetic subjects with poor metabolic control (hemoglobin A1c > 9%) were included. At entry, their knowledge of diabetes (DKQ2 test), total energy intake and its distribution, insulin schedule, technical skill for insulin administration and self monitoring of blood glucose were evaluated. According to the initial evaluation, individual goals were stipulated and monitored in weekly visits. Individual life-style was particularly kept in mind. Thereafter, patients were switched to our ambulatory clinic for outpatients. At 1, 6, 12 and 24 months of follow-up, the items analyzed at the beginning were reevaluated. After 1 month, the program produced a significant decrease in hemoglobin A1c and an increase in knowledge of diabetes. The same beneficial effects were present at 6, 12 and 24 months evaluation compared to those values recorded at entry. There were neither major changes in dietary intake nor insulin schedule nor any increase in the frequency of hypoglycemic episodes. In conclusion, our program (5.2 +/- 0.8 weekly visits) significantly reduced and sustained hemoglobin A1c values close to those levels recommended by multicenter controlled trials. We consider that our program produced two major changes: a long-lasting improvement in knowledge of diabetes and an increase in self-monitoring blood glucose which provided the key for optimal self-regulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge, attitudes, technical competence, and blood glucose control of Type 1 diabetic patients during and after an education programme

Thirty-one Type 1 diabetic patients entered a 12-month education programme in which attitudes to diabetes, knowledge of diabetes, and technical competence were assessed using questionnaires and practical tests. A closely matched group of 25 control patients continued to receive routine clinic care. Patients completing the education programme showed improved blood glucose control (HbA1 decreased from 11.8 +/- 0.4% to 10.5 +/- 0.3%, mean +/- SE, p less than 0.01), whereas blood glucose control was not altered in the control group (HbA1 11.8 +/- 0.5% before and 11.6 +/- 0.4% after 12 months). Patients completing the education programme also showed greater knowledge (p less than 0.001), more favourable attitudes (p less than 0.03), and increased competence in technical skills (p less than 0.02) compared with the control group. Six months after completing the programme blood glucose control deteriorated (HbA1 11.0 +/- 0.4%, p less than 0.05), although knowledge, attitudes, and technical competence were unchanged. This might reflect the withdrawal of extrinsic motivation and attention provided during the programme. Thus consideration should be given to development of the patient's intrinsic motivation to prolong the benefits of diabetes education programmes.

Use of a course on self-control behavior techniques to increase adherence to prescribed frequency for self-monitoring blood glucose

A 12-week behavioral change program consisting of a course on Self-Control Behavior Techniques, which used a self-study format and included self-management techniques, was developed and implemented to evaluate the effectiveness of the course and the behavioral change techniques in helping people with insulin-treated diabetes mellitus to increase adherence to the prescribed frequency for self-monitoring blood glucose (SMBG). A two-group pretest-posttest experimental design was used (treatment n = 11, control n = 14). The treatment group achieved significantly higher posttest scores for the course. However, the control group achieved a significantly higher goal-adherence rate. The course was effective in teaching the knowledge and skills necessary for learning the techniques; the educational approach was an effective method for learning; and the application of the techniques resulted in an increase in frequency of SMBG but did not result in achievement of adherence to the goal for frequency of SMBG.