Diabetes Education Research

In this issue, Norris, Engelgau, and Narayan (1) provide a systematic comprehensive examination of 72 randomized controlled trials (RCTs) published since 1980 that tested various forms of self-management training (SMT) in type 2 diabetes. By their definition, SMT includes any instruction or counseling involving lifestyle behaviors (such as diet, physical activity, skill development, and coping), as well as the provision of knowledge/information. Their conclusion that “evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term,” is not as strong or prescriptive as diabetes educators, educational researchers, and policy makers would like it to be, given the seemingly large number of “gold standard” RCTs. Indeed, except for the clear call for further, more focused, and better research, strong evidence-based conclusions and recommendations about diabetes education remain elusive.

Virtually all diabetes care providers intuitively recognize that diabetes education/SMT is an essential component of diabetes treatment. Why aren’t more studies published that provide strong evidence-based guidelines for diabetes education?

One possible answer is that few studies have been conducted; however, this is not the case. Every year Diabetes Care receives a substantial number of descriptive as well as analytical educational research manuscripts. Unfortunately for the authors, many are rejected outright because of methodological issues, e.g., seriously flawed study design. Others are subject to major revisions for both fixable problems, such as inappropriate statistics or conclusions not reflecting results, and those not fixable after study completion, such as lack of appropriate comparison groups. Quality educational research is imperative as policy makers increasingly use evidence-based data to develop clinical care and reimbursement guidelines, as health professional education becomes increasingly evidence-based, and as voluntary health organizations such as the American Diabetes Association base position statements on evidence-based studies. For these …