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Diabetes Care 26:251, 2003
© 2003 by the American Diabetes Association, Inc.

Letters: Observations
Letter

Effect of Structured Group Education on Glycemic Control and Hypoglycemia in Insulin-Treated Patients

Dragomir J. Koev, MD, DMSC1, Tzvetalina I. Tankova, MD, PHD1 and Plamen G. Kozlovski, MD2

1 Diabetic Clinic, Medical University, Sofia, Bulgaria
2 Novo Nordisk A/S, Bagsværd, Denmark

We investigated the effect of a structured group diabetes education program (1) on insulin-treated patients who had received individual counseling (at the time of diagnosis and insulin initiation). A total of 1,369 type 1 and insulin-treated type 2 diabetic patients with mean disease duration of 11.7 and 13.7 years, respectively, were allocated to receive or not receive structured group education, which was delivered in 10 45-min sessions over 3–5 days.

Baseline GHb levels of type 1 diabetic patients were 9.3% for the education group and 9.13% for the control group and decreased at 6 months by -0.82 and -0.22%, respectively (P = 0.0005). The number of injections per day and self-monitoring increased, while the total insulin dose remained unchanged. The incidence of severe hypoglycemia was reduced by 0.18 events/6 months in the education group, whereas it increased by 0.03 events/6 months in the control group (P = 0.003).

In type 2 diabetic patients, baseline GHb was 9.1% in the education and 8.7% in the control group, with a significant difference in the changes after 6 months in favor of the education group: -0.48 vs. 0.17%, respectively (P = 0.0005). A trend of reduced incidence of hypoglycemic episodes was observed.

Education for people with diabetes is a prerequisite for an understanding and acceptance of their condition and its successful self-management (2). A recent study found that group education was as effective as individual tuition in achieving improvements in glycemic control (3). In our study, structured group education after initial individual counseling at diagnosis and insulin initiation resulted in improved glycemic control and reduction of hypoglycemia. This observation is in line with results from previous publications (4,5). These improvements could be attributed to better self-care (increased frequency of self-monitoring in both type 1 and insulin-treated type 2 diabetic patients) and the increase in the number of insulin injections (in type 1 diabetic patients). It should be noted that there was not a significant difference in the mean insulin doses at the 6-month follow-up visit compared with baseline in both type 1 and type 2 diabetic patients; therefore, it was not the amount of injected insulin but the educational intervention that contributed to the improved glycemic control.

It can be suggested that a group education program following individual counseling could be an effective tool in diabetes management.

Footnotes

Address correspondence to Plamen Kozlovski, MD, Novo Nordisk A/S, Novo Allé, 2880 Bagsvaerd, Denmark. E-mail: plko{at}novonordisk.com.

References

  1. Diabetes Education Program in Bulgaria (DEPB) Project Group: Diabetes education program in Bulgaria. Patient Educ Counsel 43:111–114, 2001[Medline]
  2. Assal JP, Muhlhauser I, Pernet A, Gfeller R, Jorgens V, Berger M: Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 28:602–613, 1985[Medline]
  3. Rickeim PL, Weaver TW, Flader JL, Kendall DM: Assessment of group versus individual diabetes education: a randomized study. Diabetes Care 25:269–274, 2002[Abstract/Free Full Text]
  4. Tilly KF, Belton AB, McLachlan JF: Continuous monitoring of health status outcomes: experience with diabetes education. Diabetes Educ 21:413–419, 1995
  5. Pieber TR, Brunner GA, Schenedl WJ, Schattenberg Kaufmann P, Krejs GJ: Evaluation of a structured outpatient group education program for intensive insulin therapy. Diabetes Care 18:625–630, 1995[Abstract]

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This Article
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