Premium
Long‐term effects of self‐management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care
Author(s) -
Goudswaard A. N.,
Stolk R. P.,
Zuithoff N. P. A.,
De Valk H. W.,
Rutten G. E. H. M.
Publication year - 2004
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2004.01153.x
Subject(s) - medicine , discontinuation , type 2 diabetes , diabetes mellitus , insulin , randomized controlled trial , confidence interval , dose , gastroenterology , endocrinology
Aims Education is an essential part of the management of patients with Type 2 diabetes, but the long‐term effects are unclear and not well investigated in primary care. Methods Fifty‐four patients (39–75 years) treated with maximal dosages of oral hypoglycaemic agents, needing to start insulin (HbA 1c ≥ 7.0%), were randomly allocated to a 6‐month educational programme by a diabetes nurse (DN group) or usual care (UC group). Main outcome measures were HbA 1c , number of patients with HbA 1c < 7.0%, and number of patients treated with insulin 18 months after baseline. Results Six weeks after the intervention HbA 1c levels had improved from 8.2 (1.1) to 7.2 (1.3) in the DN group, and from 8.8 (1.5) to 8.4 (1.7) in the UC group. Adjusted for baseline values, at 6 weeks HbA 1c improved 0.7% (95% confidence interval 0.1, 1.4) more in DN than in UC. Of the patients in DN, 60% reached HbA 1c < 7.0% compared with 17% in UC ( P < 0 . 01). However, at 18 months there were no significant differences for HbA 1c , number of patients with HbA 1c < 7.0%, or number treated with insulin. Conclusions Education was effective in improving glycaemic control and in delaying the need for insulin therapy in patients treated with maximal oral hypoglycaemic therapy. The reduced effect after 1 year was probably due to the discontinuation of the educational programme. Short‐term education should not be offered without regular reinforcements integrated into standard diabetes care.