Assessment of the function and effect of diabetes education programs in Taiwan. Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review [Group versus individual education for type-2 diabetes patients]. A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes education in primary care: a randomized clinical trial. A Community-Based Diabetes Prevention Program A Nurse-Coaching Intervention for Women With Type 2 Diabetes Behavioural interventions for type 2 diabetes: an evidence-based analysis. Diabetes Learning in Virtual Environments: Testing the Efficacy of Self-Management Training and Support in Virtual Environments (Randomized Controlled Trial Protocol). Evaluation of a self-awareness intervention for adults with type 1 diabetes and hypoglycemia unawareness. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Nonadherence to insulin therapy in low-income, type 2 diabetic patients. Diabetes support groups improve health care of older diabetic patients. Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus A Pharmacotherapy Follow-Up Program in Patients with Type-2 Diabetes in Community Pharmacies in Spain Association of health literacy with self-management behavior in patients with diabetes. The ADDITION-Cambridge trial protocol: a cluster – randomised controlled trial of screening for type 2 diabetes and intensive treatment for screen-detected patients Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Randomized Clinical Trial of Clinic-Integrated, Low-Intensity Treatment to Prevent Deterioration of Disease Care in Adolescents With Type 1 Diabetes Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Promoting early diagnosis and treatment of type 2 diabetes: the National Diabetes Education Program. Integrated care for diabetes: clinical, psychosocial, and economic evaluation Problem oriented participatory education in the guidance of adults with non-insulin-treated type-II diabetes mellitus. Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Integrative Health Coaching for Patients With Type 2 Diabetes Can Asthma Education Improve Clinical Outcomes? An Evaluation of a Pediatric Asthma Education Program Randomized trial of a diabetes self-management education and family teamwork intervention in adolescents with Type 1 diabetes. Failure to maintain the benefits of home-based intervention in adolescents with poorly controlled type 1 diabetes. Assessment of group versus individual diabetes education: a randomized study. ROMEO: rethink organization to improve education and outcomes. Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Implementation and Evaluation of a Low Health Literacy and Culturally Sensitive Diabetes Education Program Feasibility and Efficacy of Intensive Insulin Therapy in Type 1 Diabetes Mellitus in Primary Care Evaluation of a food label nutrition intervention for women with type 2 diabetes mellitus. Does self monitoring of blood glucose as opposed to urinalysis provide additional benefit in patients newly diagnosed with type 2 diabetes receiving structured education? The DESMOND SMBG randomised controlled trial protocol A study protocol for a pilot randomised trial of a structured education programme for the self-management of Type 2 diabetes for adults with intellectual disabilities A Church-based Diabetes Self-management Education Program for African Americans With Type 2 Diabetes Rationale and design: telephone-delivered behavioral skills interventions for Blacks with type 2 diabetes Effectiveness of individual and group interventions for people with type 2 diabetes1 Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country Home-based Management Can Achieve Intensification Cost-effectively in Type I Diabetes A Clinical Trial of Chronic Care Diabetic Clinics in General Practice in the United Arab Emirates: A Preliminary Analysis The Presence and Severity of Chronic Kidney Disease Predicts All-Cause Mortality in Type 1 Diabetes Protocol for a randomised blocked design study using telephone and text-messaging to support cardiac patients with diabetes: a cross cultural international collaborative project Evaluation of a diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for mild type 2 diabetes and IGT Patient education in type 2 diabetes: a randomized controlled 1-year follow-up study. A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes.
A multi-center prospect i ve study was conducted to assess the function and impact of diabetic education programs on diabetic control . A total of 208 subjects with type 2 diabetes were recruited .  Diabetes self-care , assessed by question naire , was evaluated before , and 4 months after attending a diabetes education course . A total of 121 subjects who received advanced diabetes education courses  were design ated as the experimental group . A second group of 87 cases receiving a basic course  served as controls . In addition to basic knowledge , the advanced education programs included  dietary control , blood glucose monitoring , management of hypoglycemia , medication compliance , foot care and exercise . Diabetes self-care techniques were significantly improved in the experimental group . The overall score for diabetes self-care techniques improved in both groups at the 4th month over baseline values . The change was significant with the controls ' ( P < 0.001 ) . Multiple regression analysis confirmed the intensity of diabetic education was the only significant variable correlated with the decrease of fasting blood glucose and systolic blood pressure . In conclusion , integrated and intensive diabetes education program in diabetes education centers provides an effective method for improving diabetes self-care techniques and metabolic outcome Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration OBJECTIVES To compare the effectiveness of group ( GE ) and individual ( IE ) health education in type-2 diabetes patients , and identify the improvement in knowledge , metabolic control and risk factors . DESIGN R and omised clinical trial . SETTING Primary care . Participants . 68 patients with type-2 diabetes , diagnosed 6 months before the start of the study and who had not received GE . Patients aged over 75 , those with sensory , psychological and /or physical deficiencies and those not monitored in primary care were excluded ( alpha=0.05 ; beta=0.2 ) . Interventions . Patients were selected according to the inclusion criteria and allocated at r and om to the IE ( n=33 ) or GE ( n=35 ) group . Individual and group lessons were given at the same time for a year . The contents were evaluated with a vali date d , self-administered test . MAIN MEASUREMENTS General , demographic variables , analyses , blood pressure , the Body Mass Index ( BMI ) , the presence of cardiovascular risk factors , diabetes-related complications and therapeutic variables were all measured . RESULTS The two kinds of education showed no significant differences from each other . The two groups improved the level of knowledge ( P<0.001 ) , and reduced HbA1c ( P<0.001 ) , HDL-C ( P<0.001 ) , the BMI ( P=0.001 ) and systolic pressure ( P=0.004 ) , and increased their use of reactive strips ( P=0.02 ) . CONCLUSIONS Health education on diabetes improved knowledge of the disease , metabolic control and cardiovascular risk factors . The two educational methods evaluated were equally effective OBJECTIVE To study time course changes in knowledge , problem solving ability , and quality of life in patients with type 2 diabetes managed by group compared with individual care and education . RESEARCH DESIGN AND METHODS We conducted a 5-year r and omized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit . There were 120 patients with non-insulin-treated type 2 diabetes enrolled and r and omly allocated to group or individual care . Eight did not start and 28 did not complete the study . The main outcome measures were knowledge of diabetes , problem solving ability , quality of life , HbA1c , BMI , and HDL cholesterol . RESULTS Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects ( P<0.001 for both ) . Quality of life improved from year 2 with group care but worsened with individual care ( P<0.001 ) . HbA1c level progressively increased over 5 years among control subjects ( + 1.7 % , 95 % CI 1.1 - 2.2 ) but not group care patients ( + 0.1 % , -0.5 to 0.4 ) , in whom BMI decreased ( -1.4 , -2.0 to -0.7 ) and HDL cholesterol increased ( + 0.14 mmol/l , 0.07 - 0.22 ) . CONCLUSIONS Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and setting s tailored to their needs . Traditional one-to-one care , although delivered according to optimized criteria , is associated with progressive deterioration of knowledge , problem solving ability , and quality of life . Better cognitive and psychosocial results are associated with more favorable clinical outcomes The aim of the study was to evaluate the effect of a structured group education program administered by a primary care nurse in patients with type 2 diabetes mellitus . The sample included 137 patients with type 2 diabetes mellitus , r and omized into two groups : intervention ( 5-week educational course and reinforcements every 4 months for one year ) and control ( with no structured diabetes mellitus education ) with an evaluation of metabolic control , weight , blood pressure , distress scores , and knowledge on diabetes . There were no differences between the two groups in HbA1c at 4 , 8 , or 12 months when compared to baseline values . An increase in HbA1c was observed in the control group after adjusting for baseline HbA1c and insulin dose ( p = 0.044 between groups ) . Knowledge scores and diabetes-related distress improved after the intervention . A structured educational program administered to type 2 diabetes mellitus patients seen at a primary care unit improved the knowledge and distress associated with the disease . The results also suggest the prevention of an increase in HbA1c Purpose With growing numbers of people at risk for diabetes and cardiovascular disease , diabetes educators report increasing referrals for intervention in prevention of these conditions . Diabetes educators have expertise in diabetes self-management education ; however , they are generally not prepared for delivery of chronic disease primary prevention . The purpose of this project was to determine if individuals at risk for diabetes who participate in an intervention delivered by trained diabetes educators in existing diabetes self-management education community-based programs can reduce risk factors for diabetes and cardiovascular disease . Methods Diabetes educators in 3 outpatient-hospital programs ( urban , suburban , and rural ) received training and support for implementation of the Group Lifestyle Balance program , an adaptation of the Diabetes Prevention Program lifestyle intervention , from the Diabetes Prevention Support Center of the University of Pittsburgh . Adults with prediabetes and /or the metabolic syndrome were eligible to enroll in the program with physician referral . With use of existing diabetes educator networks , recruitment was completed via on-site physician in-services , informative letters , and e-mail contact as well as participant-directed newspaper advertisement . Results Eighty-one participants enrolled in the study ( 71 women , 10 men ) .  Mean overall weight loss was 11.3 lb ( 5.1 % , P < .001 ) ; in addition , significant decreases were noted in fasting plasma glucose , low-density lipoprotein cholesterol , triglycerides , and blood pressure . Conclusions These results suggest that the Group Lifestyle Balance program delivered by diabetes educators was successful in reducing risk for diabetes and cardiovascular disease in high-risk individuals . Furthermore , diabetes educators , already integrated within the existing health care system , provide yet another re source for delivery of primary prevention programs in the community PURPOSE The purpose of this pilot study was to determine the efficacy of a 6-month nurse-coaching intervention that was provided after diabetes education for women with type 2 diabetes . METHODS In this pilot study , 53 women were r and omized to the nurse-coaching intervention or a st and ard care control condition .  The nurse-coaching intervention consisted of 5 individualized sessions and 2 follow-up phone calls over 6 months . The nurse-coaching sessions included educational , behavioral , and affective strategies . Data were collected on physiologic adaptation ( hemoglobin A1c [ A1C ] and body mass index [ BMI ] ) , self-management ( dietary and exercise ) , psychosocial adaptation ( diabetes-related distress and integration ) , and treatment satisfaction at baseline , 3 months , and 6 months . RESULTS Women in the treatment group demonstrated better diet self-management , less diabetes-related distress , better integration , and more satisfaction with care , and had trends of better exercise self-management and BMI . The A1C levels improved in both groups at 3 months , yet the difference between the groups was not significant . Attendance at nurse-coaching sessions was 96 % . CONCLUSIONS This nurse-coaching intervention demonstrates promise as a means of improving self-management and psychosocial outcomes in women with type 2 diabetes UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT BACKGROUND Ongoing self-management improves outcomes for those with Type 2 diabetes ( T2D ) ; however , there are many barriers to patients receiving assistance in this from the healthcare system and peers . Findings from our pilot study showed that a virtual diabetes community on the Internet with real-time interaction among peers with T2D- and with healthcare professionals-is feasible and has the potential to influence clinical and psychosocial outcomes . OBJECTIVE The purpose of this article is to present the protocol for the Diabetes Learning in Virtual Environments ( LIVE ) trial . PROTOCOL Diabetes LIVE is a two-group , r and omized controlled trial to compare effects of a virtual environment and traditional Web site on diet and physical activity . Our secondary aims will determine the effects on metabolic outcomes ; effects of level of engagement and social network formation in LIVE on behavioral outcomes ; potential mediating effects of changes in self-efficacy ; and diabetes knowledge , diabetes-related distress , and social support on behavior change and metabolic outcomes . We will enroll 300 subjects at two sites ( Duke University/Raleigh-Durham , NC and New York University/New York , NY ) who have T2D and do not have serious complications or comorbidities . Those r and omly assigned to the intervention group have access to the LIVE site where they can find information , synchronous classes with diabetes educators , and peer support to enhance self-management . Those in the control group have access to the same informational and educational content in a traditional asynchronous Web format . Measures of self-management , clinical outcomes , and psychosocial outcomes are assessed at baseline and 3 , 6 , 12 , and 18 months . DISCUSSION Should LIVE prove effective in improved self-management of diabetes , similar interventions could be applied to other prevalent chronic diseases . Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of self-management training and support The purpose of this prospect i ve before- and -after study was to determine whether there are psychosocial and physical benefits of a self-awareness intervention for adults with type 1 diabetes and hypoglycemia unawareness ( HU ) . A total of 29 adults participated in the self-awareness intervention of 8 sessions , each lasting 3 hours . Psychosocial ( integration , diabetes quality of life ) and physical ( number of body cues , HU-related events , HbA1c ) measures were taken at baseline and at 6 , 12 , and 18 months post-intervention . Post-intervention the participants detected more cues of euglycemia and hypoglycemia and experienced significant increases in integration and metabolic control ( HbA1c ) . The number of HU-related events was not decreased and diabetes quality -of-life results were unstable . A self-awareness intervention can have physical and psychosocial benefits and has implication s for diabetes education . This intervention needs to be tested in a multi-centre r and omized control trial Overweight and obesity are major contributors to both type 2 diabetes and cardiovascular disease ( CVD ) . Moreover , individuals with type 2 diabetes who are overweight or obese are at particularly high risk for CVD morbidity and mortality . Although short-term weight loss has been shown to ameliorate obesity-related metabolic abnormalities and CVD risk factors , the long-term consequences of intentional weight loss in overweight or obese individuals with type 2 diabetes have not been adequately examined . The primary objective of the Look AHEAD clinical trial is to assess the long-term effects ( up to 11.5 years ) of an intensive weight loss program delivered over 4 years in overweight and obese individuals with type 2 diabetes . Approximately 5000 male and female participants who have type 2 diabetes , are 45 - 74 years of age , and have a body mass index > or=25 kg/m(2 ) will be r and omized to one of the two groups . The intensive lifestyle intervention is design ed to achieve and maintain weight loss through decreased caloric intake and increased physical activity . This program is compared to a control condition given diabetes support and education . The primary study outcome is time to incidence of a major CVD event . The study is design ed to provide a 0.90 probability of detecting an 18 % difference in major CVD event rates between the two groups . Other outcomes include components of CVD risk , cost and cost-effectiveness , diabetes control and complications , hospitalizations , intervention processes , and quality of life OBJECTIVE To evaluate the psychosocial barriers to insulin use in low-income , type 2 diabetic patients ; the clinical characteristics of these patients ; and the possible causes of nonadherence to insulin regimens months after prescription . METHODS We studied a prospect i ve cohort of low-income patients with type 2 diabetes mellitus , aged 45 to 75 years , attending a tertiary health care center in Mexico City , Mexico . Patients were eligible if their diabetes was not controlled with oral agents , and they were excluded if they had type 1 diabetes mellitus , a secondary cause of diabetes , had been admitted to the hospital within the month before study commencement , had been previously treated with insulin , had severe diabetic complications , or had a chronic or disabling medical illness . All patients were prescribed 6 to 10 units of neutral protamine Hagedorn insulin before bedtime and received a referral to visit with a diabetes nurse educator . The main outcome was adherence or nonadherence to insulin therapy  , and it was correlated with several variables including attitudes toward insulin , diabetes self-management , diabetes-related knowledge , depression , and diabetes-related distress . Brief medical history , complete battery of question naires , and laboratory workup were obtained at baseline and 1 to 3 months after insulin prescription . RESULTS Twenty-nine consecutive patients were included . Mean age ( + /- st and ard deviation ) was 59 + /- 8 years , 18 ( 62 % ) were women , mean diabetes duration was 14 + /- 9 years , and mean hemoglobin A1c level was 10.8 + /- 1.4 % .  Negative attitudes toward insulin  were very common , particularly in patients with less education and poorer diabetes-related knowledge ( odds ratio , 6.2 ; 95 % confidence interval , 1.04 - 47.3 ; P = .02 ) . Even when they received precise recommendations , 12 patients ( 41 % ) did not adhere to insulin treatment . Patients who did not adhere to therapy were most commonly women and were depressed ( P = .05 ) . Improved adherence was significantly associated with the additional support of a diabetes nurse educator ( odds ratio , 6.6 ; 95 % confidence interval , 1.0 - 55.7 ; P = .02 ) . CONCLUSIONS Improving patient perception and acceptance of insulin with the help of diabetes educators can facilitate earlier and more aggressive intervention and thus optimize glycemic control OBJECTIVE To assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients . DESIGN A partially r and omized controlled trial involving two groups of patients : Group A , subjects who received an education program followed by 18 months of support group sessions ; Group B , only the diabetes education program . A third convenience sample , Group C , received neither intervention . Groups A and B were assessed before and immediately after the education program , and all groups were assessed 2 years after the education program . SETTING Diabetes clinic at a Veterans Affairs Medical Center . PATIENTS All subjects were male ( mean age = 68 + /- 1.3 years , range = 57 - 82 years ; duration of diabetes = 10 + /- 2 years , range 3 - 16 ) . Sample sizes were 11 in Group A , 13 in Group B , and 8 in Group C. INTERVENTION The education program consisted of six weekly sessions covering aspects of diabetes self-care . The support group consisted of 18 monthly sessions for continuing education , discussion , and structured social activities . OUTCOME MEASURES Diabetes knowledge , psychosocial factors ( self-care-related quality of life , stress , family involvement in care , and social involvement ) , depression , and glycemic control . RESULTS Group A scored better ( at least P less than 0.05 ) on knowledge , quality of life , and depression than the other groups . Groups A and B showed less stress , greater family involvement , better glycemic control , but less involvement in social activities than Group C. CONCLUSION Diabetes education programs can have long term benefits on knowledge , psychosocial functioning , and glycemic control for older diabetic patients . The addition of support groups enhances diabetes knowledge and psychosocial functioning Background Individual health education is considered to be essential in the overall care of patients with type 2 diabetes ( DM2 ) , although there is some uncertainty regarding its metabolic control benefits . There have been very few r and omized studies on the effects of individual education on normal care in DM2 patients with a control group , and none of these have assessed the long-term results . Therefore , this study aims to use this design to assess the effectiveness of the PRECEDE ( Predisposing , Reinforcing , Enabling , Causes in Educational Diagnosis , and Evaluation ) education model in the metabolic control and the reduction of cardiovascular risk factors , in patients with type 2 diabetes . Methods An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area ( Spain ) . Six hundred patients with DM2 were r and omized in two groups : PRECEDE or conventional model for health promotion education . The main outcome measures were glycated hemoglobin A1c , body mass index ( BMI ) , blood pressure , lipids and control criteria during the 2-year follow-up period . Results Glycated hemoglobin A1c and systolic blood pressure ( SBP ) levels decreased significantly in the PRECEDE group ( multivariate analysis of covariance , with baseline glycated hemoglobin A1c , SBP , and variables showing statistically significant differences between groups at baseline visits ) . The decrease levels in diastolic blood pressure ( DBP ) , triglycerides and LDL cholesterol were nonsignificant . PRECEDE increased compliance in all control criteria , except for LDL cholesterol . BMI did not change during the study in either of the two models analyzed . Conclusions PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes , which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria , except for LDL cholesterol . Trial registration number Clinical Trials.gov Objective Poor metabolic control and high associated morbidity and mortality among type 2 diabetic patients require a level of care from the pharmacist that goes beyond usual dispensing . The aim of the present study was to evaluate the improvement in metabolic control , the resolution of drug-related problems ( DRPs ) and the increase in patient awareness of diabetes as outcomes of a pharmacotherapy follow-up program in type 2 diabetic patients . Method R and omized controlled trial conducted in 14 community pharmacies in the province of Pontevedra ( Spain ) with 112 patients between February 2003 and March 2004 . The control group received the usual care , and the intervention group patients were included in a pharmacotherapy follow-up program . This individualized program , which consists of the detection and resolution of DRPs and diabetes education , involves patients in their own care in order to obtain maximum benefit from the medication they use . Main outcome measures HbA1c , Fasting Blood Glucose ( FBG ) , lipid profile , blood pressure , body mass index ( BMI ) , DRPs and knowledge were evaluated at the onset of the program and periodically until conclusion . Results There was a significant difference in changes from baseline between the intervention and the control group in DRPs ( 1.7±1.2 versus 3.1±1.2 P<0.0001 ) , knowledge ( 17.9±3.7 versus 11.4±6.7 points P<0.0001 ) , HbA1c ( 7.9±1.7 versus 8.5±1.9 % P<0.0001 ) , FBG ( 154±61.3 versus 168±57.8 mg/dl P=0.0004 ) , total cholesterol ( 202±41.5 versus 217±43.5 mg/dl P=0.0054 ) and SBP ( 135±16.4 versus 150±19.9 mmHg P=0.0006 ) . Conclusions A substantial number of patients showed an improvement in their outcomes for the chosen metabolic indicators . Pharmacotherapy follow-up programs conducted by community pharmacists can play an important role in achieving therapeutic goals in patients with type 2 diabetes . This study shows that the incorporation of type 2 diabetic patients in a pharmacotherapy follow-up program may contribute to achieve positive clinical outcomes and will contribute to the implementation and progress of pharmacotherapy follow-up programs in community pharmacies Limited health literacy , common in patients with diabetes , has been associated with worse diabetes outcomes ( 1–4 ) . While patients with limited health literacy have worse diabetes knowledge ( 2–5 ) , knowledge does not necessarily predict outcomes ( 6–8 ) . Because diabetes requires extensive self-care , differences in self-management behaviors may be a key contributor to the disparity in outcomes . In fact , low health literacy has been associated with poor self-care in other chronic illnesses ( 9,10 ) . However , no study has examined the relationship between health literacy and self-management behaviors in patients with diabetes . In addition , studies have not assessed whether diabetes education , which is widely recommended , is effective in improving self-management behaviors in patients with limited health literacy . The objectives of our study were to examine the association of health literacy with self-management behaviors in patients with diabetes and to determine whether diabetes education  improves self-management behaviors in patients with limited compared with adequate health literacy . Underst and ing the relationship between health literacy and self-management behaviors should enhance efforts to improve diabetes outcomes . We conducted a prospect i ve observational study of patients enrolled in diabetes education classes at the Hospital of the University of Pennsylvania . The classes consist of an individual meeting with a diabetes educator and three weekly 3-h group classes and are recognized by the American Diabetes Association ( 11 ) . All patients ≥18 years of age present for a regularly scheduled diabetes class were recruited . Background The increasing prevalence of type 2 diabetes poses a major public health challenge . Population -based screening and early treatment for type 2 diabetes could reduce this growing burden . However , the benefits of such a strategy remain uncertain . Methods and design The ADDITION-Cambridge study aims to evaluate the effectiveness and cost-effectiveness of ( i ) a stepwise screening strategy for type 2 diabetes ; and ( ii ) intensive multifactorial treatment for people with screen-detected diabetes in primary care . 63 practice s in the East Anglia region participated . Three undertook the pilot study , 33 were allocated to three groups : no screening ( control ) , screening followed by intensive treatment ( IT ) and screening plus routine care ( RC ) in an unbalanced ( 1:3:3 ) r and omisation . The remaining 27 practice s were r and omly allocated to IT and RC . A risk score incorporating routine practice data was used to identify people aged 40–69 years at high-risk of undiagnosed diabetes . In the screening practice s , high-risk individuals were invited to take part in a stepwise screening programme . In the IT group , diabetes treatment is optimised through guidelines , target-led multifactorial treatment , audit , feedback , and academic detailing for practice teams , alongside provision of educational material s for newly diagnosed participants . Primary endpoints are modelled cardiovascular risk at one year , and cardiovascular mortality and morbidity at five years after diagnosis of diabetes . Secondary endpoints include all-cause mortality , development of renal and visual impairment , peripheral neuropathy , health service costs , self-reported quality of life , functional status and health utility . Impact of the screening programme at the population level is also assessed through measures of mortality , cardiovascular morbidity , health status and health service use among high-risk individuals . Discussion ADDITION-Cambridge is conducted in a defined high-risk group accessible through primary care . It addresses the feasibility of population -based screening for diabetes , as well as the benefits and costs of screening and intensive multifactorial treatment early in the disease trajectory . The intensive treatment algorithm is based on evidence from studies including individuals with clinical ly diagnosed diabetes and the education material s are informed by psychological theory . ADDITION-Cambridge will provide timely evidence concerning the benefits of early intensive treatment and will inform policy decisions concerning screening for type 2 diabetes . Trial registration Current Controlled trials IS RCT BACKGROUND Group education for patients with suboptimally controlled diabetes has not been rigorously studied . METHODS A total of 623 adults from Minnesota and New Mexico with type 2 diabetes and glycosylated hemoglobin ( HbA(1c ) ) concentrations of 7 % or higher were r and omized to ( 1 ) group education ( using the US Diabetes Conversation Map program ) , ( 2 ) individual education , or ( 3 ) usual care ( UC ; ie , no assigned education ) . Both education methods covered content as needed to meet national st and ards for diabetes self-management education and were delivered through accredited programs from 2008 to 2009 . General linear mixed-model methods assessed patient-level changes between treatment groups in mean HbA(1c ) levels from baseline to follow-up at 6.8 months . Secondary outcomes included mean change in general health status ( Medical Outcomes Study 12-Item Short Form Health Survey [ SF-12 ] ) , Problem Areas in Diabetes ( PAID ) , Diabetes Self-Efficacy ( DES-SF ) , Recommended Food Score ( RFS ) , and Physical Activity ( PA , min/wk ) . RESULTS Mean HbA(1c ) concentration decreased in all groups but significantly more with individual ( -0.51 % ) than group education ( -0.27 % ) ( P = .01 ) and UC ( -0.24 % ) ( P = .01 ) . The proportion of subjects with follow-up HbA(1c ) concentration lower than 7 % was greater for individual education ( 21.2 % ) than for group ( 13.9 % ) and UC ( 12.8 % ) ( P = .03 ) . Compared with UC , individual education ( but not group ) improved SF-12 physical component score ( + 1.88 ) ( P = .04 ) , PA ( + 42.95 min/wk ) ( P = .03 ) , and RFS ( + 0.63 ) ( P = .05 ) . Compared with group education , individual education reduced PAID ( -3.62 ) ( P = .02 ) and increased self-efficacy ( + 0.1 ) ( P = .04 ) . CONCLUSIONS Individual education for patients with established suboptimally controlled diabetes result ed in better glucose control outcomes than did group education using Conversation Maps . There was also a trend toward better psychosocial and behavioral outcomes with individual education . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00652509 OBJECTIVE To evaluate the efficacy of two office-based treatments design ed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a r and omized clinical trial . An individualized , more intensive family teamwork Coping skills program was compared with a diabetes Education treatment . RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years . Families of 226 early adolescents ( ages 11–14 ) were r and omized to receive either individualized coping skills education or diabetes education as adjunctive treatment  to quarterly medical appointments . Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years . A post hoc Usual Care group facilitated comparisons of glycemic control . RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers — without a concomitant increase in diabetes-related or general family conflict . However , contrary to expectation , the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up . CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads . Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources DIABETES MELLITUS EXACTS AN ENORMOUS TOLL IN the United States by decreasing quality of life and causing death and disability , all at a huge economic cost . Yet simple diagnostic criteria and effective treatment choices that prevent or delay the onset of costly diabetes complications are readily available to health care professionals . It is time for health care professionals and patients with diabetes to take action together to reduce premature morbidity and mortality from diabetes-caused disease . The National Diabetes Education Program is the first joint diabetes initiative of the National Institutes of Health and the Centers for Disease Control and Prevention and involves public and private partnerships to promote early diagnosis and improve the treatment and outcomes for patients with type 1 and type 2 diabetes mellitus . It is estimated that in the United States , type 2 diabetes can be present for up to 9 to 12 years before initial clinical diagnosis . Microvasculardiseaseprogressesduringthis time , causing 15 % to 20 % of patients to have retinopathy and 5 % to 10%tohaveproteinuriaat the timeofdiagnosis . Patients with type 2 diabetes have high rates of hypertension , dyslipidemia , and obesity , major reasons for their 2to 4-fold higher rates ofcardiovasculardisease . Type2diabetes isoccurring increasingly in younger people . Although every patient can be expected to benefit from any increment in improved glycemic control , blood glucose control is more effective in preventing the initial development of microvascular complications than inpreventing theprogressionofcomplicationsonce theyhave become established . This finding underscores the need for aggressive treatment as soon as type 2 diabetes is diagnosed . Diabetes accounts for almost $ 100 billion in direct medical costs and indirect expenditures attributable to diabetes each year . Further , while patients with diabetes represented 4.5 % of the US population in 1992 , they accounted for 15 % of total US health care expenditures and 27 % of Medicare expenditures . There is a marked correlation between glycemic control of diabetes as measured by glycosylated hemoglobin ( HbA1c ) testing and the cost of medical care . Medical care charges increase significantly for every 1 % increase in HbA1c level above 7 % . In 1994 , excess expenditures for patients with diabetes in a managed care setting totaled $ 282.7 million or $ 3494 per person—2.4 times the cost for control subjects . Nearly 38 % of the total excess was spent treating the long-term complications of diabetes , predominantly coronary heart disease and end-stage renal disease . Because of its high and increasing prevalence , type 2 diabetes contributes a significant portion of these costs . There is substantial evidence that the human and economic burden of diabetes can be reduced significantly by early , aggressive therapeutic intervention . The Diabetes Control and Complications Trial and the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) demonstrated that intensive blood glucose control for patients with type 1 and type 2 diabetes significantly reduced the risk for retinopathy , nephropathy , and neuropathy . Lowering blood pressure in a subset of UKPDS patients to a mean of 144/82 mm Hg reduced the risk of strokes , diabetes-related deaths , heart failure , microvascular complications , and vision Abstract Objectives : To evaluate integrated care for diabetes in clinical , psychosocial , and economic terms . Design : Pragmatic r and omised trial . Setting : Hospital diabetic clinic and three general practice groups in Grampian . Patients : 274 adult diabetic patients attending a hospital clinic and registered with one of three general practice s. Intervention - R and om allocation to conventional hospital clinic care or integrated care . Integrated care patients seen in general practice every three or four months and in the hospital clinic annually . General practitioners were given written guidelines for integrated care . Main outcome measures : Metabolic control , psychosocial status , knowledge of diabetes , beliefs about control of diabetes , satisfaction with treatment , disruption of normal activities , numbers of consultations and admissions , frequency of metabolic monitoring , costs to patients and NHS . Results - A higher proportion of patients defaulted from conventional care ( 14 ( 10 % ) ) than from integrated care ( 4 ( 3 % ) , 95 % confidence interval of difference 2 % to 13 % ) . After two years no significant differences were found between the groups in metabolic control , psychosocial status , knowledge , beliefs about control , satisfaction with treatment , unscheduled admissions , or disruption of normal activities .  Integrated care was as effective for insulin dependent as non-insulin dependent patients . Patients in integrated care had more visits and higher frequencies of examination . Costs to patients were lower in integrated care ( mean pounds sterling 1.70 ) than in conventional care ( pounds sterling 8) . 88 % of patients who experienced integrated care wished to continue with it . Conclusions : This model of integrated care for diabetes was at least as effective as conventional hospital clinic care A population -based study on the therapeutic effects of a diabetes teaching programme ( DTP ) based on problem oriented participatory education (POPE)--a method based on learner activity in group meetings -- was undertaken at the Primary Health Care Centre , Kisa , Sweden , in collaboration with educationalists . A control group was given conventional classroom teaching . To be included a patient had to be aged 55 - 73 years , to live in his own home , and to have non-insulin-treated type II diabetes mellitus . The therapeutic effects of the DTP were studied before , during , and after POPE with regard to three factors , diabetes related knowledge , behaviour assessed by dietary and exercise habits , and the quality of the anti-diabetic therapy as assessed by metabolic profile including Hb-A1 . Significant improvement in knowledge and transient improvement in Hb-A1 concentration were recorded among patients taking part in a DTP adjusted to their individual problems and needs . When improvement in metabolic control does not last , group meetings should be continued for more than the three months used in the present study . We believe that such improvement is intimately bound up with the psycho-social process that is involved in the group meetings and that helps the patient to cope with the disease in particular and life in general AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs Purpose The purpose of this study was to evaluate the effectiveness of integrative health ( IH ) coaching on psychosocial factors , behavior change , and glycemic control in patients with type 2 diabetes . Methods Fifty-six patients with type 2 diabetes were r and omized to either 6 months of IH coaching or usual care ( control group ) . Coaching was conducted by telephone for fourteen 30-minute sessions . Patients were guided in creating an individualized vision of health , and goals were self-chosen to align with personal values . The coaching agenda , discussion topics , and goals were those of the patient , not the provider . Preintervention and postintervention assessment s measured medication adherence , exercise frequency , patient engagement , psychosocial variables , and A1C . Results Perceived barriers to medication adherence decreased , while patient activation , perceived social support , and benefit finding all increased in the IH coaching group compared with those in the control group . Improvements in the coaching group alone were also observed for self-reported adherence , exercise frequency , stress , and perceived health status . Coaching participants with elevated baseline A1C ( ≥7 % ) significantly reduced their A1C . Conclusions A coaching intervention focused on patients ’ values and sense of purpose may provide added benefit to traditional diabetes education programs . Fundamentals of IH coaching may be applied by diabetes educators to improve patient self-efficacy , accountability , and clinical outcomes Asthma is a common , costly , and chronic disease that has a significant impact on children , their families , and the health care system . This study investigated whether formal asthma education can reduce asthma severity and morbidity and further question ed whether the method of education is an important factor in this process . Study subjects were recruited from the emergency department of the Royal Children 's Hospital , Melbourne ( RCHM ) , and controls were recruited from the neighboring Western Hospital , Sunshine ( WHS ) . Subject parents were r and omized to receive face-to-face education , group education , or home-based video education . Controls had similar medical treatment but received no formal asthma education .  Subject and control parents were asked to complete question naires before the intervention and at 1 , 6 , and 12 months . These question naires measured demographics , the levels of parent asthma knowledge , anxiety , child asthma severity , and morbidity . Results showed that any method of education increased parent asthma knowledge and immediately decreased their anxiety and child asthma morbidity scores . Despite this , asthma severity was reduced only when knowledge was imparted in an interactive , face-to-face setting . When this happened , asthma severity scores were significantly reduced in both the short- and long-term . These findings call into question mass asthma education campaigns and have important implication s for the design of future asthma education programs AIMS To evaluate the effectiveness of a family-centred group education programme , in adolescents with Type 1 diabetes . METHODS Three hundred and five adolescents with Type 1 diabetes ; age 13.1 ± 1.9 years , diabetes duration 5.6 ± 3.3 years , BMI 20.9 ± 3.7 kg/m(2 ) , HbA(1c ) 78 ± 6 mmol/mol ( 9.3 ± 1.9 % ) were r and omly allocated to the Families and Adolescents Communication and Teamwork Study ( FACTS ) diabetes education programme ; ( six 90-min monthly sessions attended by parents and adolescents incorporating skills training and family teamwork ) or conventional clinical care . Primary outcome was HbA(1c ) at 18 months ( 12 months post-intervention ) . Secondary outcomes were HbA(1c ) at 9 months , psychosocial outcomes , adolescent quality of life , well-being , family responsibility and insulin dose adjustment behaviours at 12 months ( 6 months post-intervention ) and episodes of severe hypoglycaemia and diabetic ketoacidois during the 12 months post-intervention . All analyses are intention to treat . RESULTS Session attendance was poor with 48/158 families ( 30.4 % ) not attending any sessions and only 75/158 ( 47.5 % ) families attending ≥ 4 group education sessions . All biomedical and psychosocial outcomes were comparable between groups . At 18 months there was no significant difference in HbA(1c ) in either group and no between-group differences over time : intervention group 75 mmol/mol ( 9.0 % ) to 78 mmol/mol ( 9.3 % ) , control group 77 mmol/mol ( 9.2 % ) to 80 mmol/mol ( 9.5 % ) . Adolescents perceived no changes in parental input at 12 months . CONCLUSION Poor attendance of group education sessions delivered in routine clinics was a major challenge . More personalized educational approaches may be required to support and motivate families who are struggling to integrate the dem and s of intensive insulin regimens into their daily lives OBJECTIVE To determine whether a 6-month home-based intervention program in adolescents with poorly controlled diabetes improves metabolic control and whether benefits are maintained after the intervention . RESEARCH DESIGN AND METHODS Adolescents with a mean HbA1c of > 9.0 % over the preceding 12 months received either  routine care in a diabetes clinic and an ambulatory intervention for 6 months ( n = 37 ) or routine care only ( n = 32 ) . A diabetes educator provided monthly home visits and weekly phone contact to educate and support the adolescents in setting goals for insulin adjustment , blood glucose monitoring , and target blood glucose range . There was no systematic change in the frequency of insulin injections . After the intervention , there was a 12-month follow-up when the intervention and control groups both received only routine care . Outcome measures were HbA1c and Diabetes Knowledge Assessment ( DKN ) . RESULTS During the intervention , mean HbA1c fell ( baseline : 11.1 + /- 1.3 % , 6 months : 9.7 + /- 1.6 % ; P = 0.0001 ) and mean knowledge scores increased ( P = 0.0001 ) in the intervention group but not in control subjects . However , this improvement in HbA1c and increase in knowledge was not maintained in the intervention group at 12- and 18-month follow-up assessment s. Parents ' knowledge scores also improved significantly from baseline levels in the intervention group at 6 and 12 months ( P = 0.001 , P = 0.005 , respectively ) . CONCLUSIONS An ambulatory program improves metabolic control and knowledge in adolescents with poorly controlled type 1 diabetes ; however , it is effective only while the intervention is maintained OBJECTIVES The current study was conducted to compare the effectiveness of delivering diabetes education in either a group or individual setting using a consistent , evidence -based curriculum . RESEARCH DESIGN AND METHODS A total of 170 subjects with type 2 diabetes were r and omly assigned to either group ( n = 87 ) or individual ( n = 83 ) educational setting s. Subjects received education in four sequential sessions delivered at consistent time intervals over a 6-month period . Outcomes included changes in knowledge , self-management behaviors , weight , BMI , HbA(1c ) , health-related quality of life , patient attitudes , and medication regimen . Changes were assessed at baseline and after the 2-week , 3-month , and 6-month education sessions . RESULTS Both educational setting s had similar improvements in knowledge , BMI , health-related quality of life , attitudes , and all other measured indicators . HbA(1c ) decreased from 8.5 + /- 1.8 % at baseline to 6.5 + /- 0.8 % at 6 months ( P < 0.01 ) in the study population as a whole . Subjects assigned to the individual setting had a 1.7 + /- 1.9 % reduction in HbA(1c ) ( P < 0.01 ) , whereas subjects assigned to the group setting had a 2.5 + /- 1.8 % reduction in HbA(1c ) ( P < 0.01 ) . The difference in HbA(1c ) improvement was marginally greater in subjects assigned to group education versus individualized education ( P = 0.05 ) . CONCLUSIONS This study demonstrates that diabetes education delivered in a group setting , when compared with an individual setting , was equally effective at providing equivalent or slightly greater improvements in glycemic control . Group diabetes education was similarly effective in delivering key educational components and may allow for more efficient and cost-effective methods in the delivery of diabetes education programs AIMS Scarcity of re sources , expertise and evidence -based models have so far limited delivery of patient-centred diabetes education . We have developed and vali date d a group care approach that is applicable to everyday clinical practice and cost-effective in improving metabolic control , knowledge of diabetes , health behaviours , and quality of life in Type 2 diabetes . A clinical trial ( ROMEO ) was planned to evaluate applicability and reproducibility of group care in other out patients facilities and assess its impact on a larger patient population . METHODS Multicentre , r and omized , controlled clinical trial of group vs. individual care in the routine management of Type 2 diabetes . Nine hundred patient aged < 80 , with diabetes of > or = 1 year known duration , treated by either diet alone or diet and oral agents , will be recruited in 15 centres and followed for 4 years .  Training of physicians , nurses and dietitians included preparation of operating manual and videos , interactive sessions , and evaluation of local facilities and re sources . RESULTS PRIMARY MEASUREMENTS 3-monthly HbA1c , fasting blood glucose , body weight , waist-hip ratio , yearly blood lipids , and bi-yearly assessment of knowledge of diabetes , health behaviours and quality of life . SECONDARY OUTCOMES systolic and diastolic blood pressure , evaluation of ECG for ischaemia and QT interval , hypoglycaemic and anti-hypertensive medication and cardiovascular events . Analysis will be by intention-to-treat . DISCUSSION If ROMEO confirms that group care can be successfully implemented in different clinics , a novel clinico-pedagogic tool will have been acquired to support patient-centred education , improve lifestyle and outcomes , support team work , enhance providers ' attitudes and competencies and ameliorate diabetes care organization OBJECTIVE To determine the effects of a culturally competent diabetes self-management intervention in Mexican Americans with type 2 diabetes . RESEARCH DESIGN AND METHODS A prospect i ve , r and omized , repeated measures study was conducted on the Texas-Mexico border in Starr County . A total of 256 r and omly selected individuals with type 2 diabetes between 35 and 70 years of age , diagnosed with type 2 diabetes after 35 years of age , and accompanied by a family member or friend were included . The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses , dietitians , and community workers . The intervention involved 3 months of weekly instructional sessions on nutrition , self-monitoring of blood glucose , exercise , and other self-care topics and 6 months of biweekly support group sessions to promote behavior changes . The approach was culturally competent in terms of language , diet , social emphasis , family participation , and incorporation of cultural health beliefs . Outcomes included indicators of metabolic control ( HbA(1c ) and fasting blood glucose ) , diabetes knowledge , and diabetes-related health beliefs . RESULTS Experimental groups showed significantly lower levels of HbA(1c ) and fasting blood glucose at 6 and 12 months and higher diabetes knowledge scores . At 6 months , the mean HbA(1c ) of the experimental subjects was 1.4 % below the mean of the control group ; however , the mean level of the experimental subjects was still high ( > 10 % ) . CONCLUSIONS This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans , particularly for those individuals with HbA(1c ) levels > 10 % & NA ; Low health literacy is more prevalent in persons with limited education , members of ethnic minorities , and those who speak English as a second language , and is associated with multiple adverse diabetes‐related health outcomes . This study examined the effectiveness of a low health literacy and culturally sensitive diabetes education program for economically and socially disadvantaged adult patients with type 2 diabetes . A pre – post prospect i ve study design was used to examine outcomes over 12 months . Outcome measures included diabetes knowledge , self‐efficacy , and self‐care , measured using reliable and valid survey tools , and A1C . Over this period of time 277 patients were enrolled in the program , with 106 participants completing survey data . At the completion of the program patients had significant improvements in diabetes knowledge ( p < .001 ) , self‐efficacy ( p < .001 ) , and three domains of self‐care including diet ( p < .001 ) , foot care ( p < .001 ) , and exercise ( p < .001 ) . There were no significant improvements in the frequency of blood glucose testing ( p = .345 ) . Additionally , A1C values significantly improved 3 months after completing the program ( p = .007 ) . In conclusion , a diabetes education program design ed to be culturally sensitive and meet the needs of individuals with low health literacy improves short‐term outcomes To determine the feasibility and efficacy of structured education in intensive insulin therapy ( IIT ) in patients with Type 1 diabetes mellitus commonly attended by primary care physicians , a prospect i ve case‐control study was carried out in co‐operation with 26 general practitioners in rural Alpine region and the diabetes service at the University of Vienna , Medical School , Austria . From 89 rural Type 1 diabetic patients on conventional insulin therapy ( CIT ) , those volunteering for better diabetes care ( n = 52 ) were trained in IIT in the diabetes education centre  and subsequently received their outpatient service by their general practitioners , as did those remaining on CIT ( n = 37 ) . Patients were matched as case‐controls ( n = 36 in each therapy group ) for metabolic control at baseline ( IIT/CIT : HbA1c 8.2 ± 1.8 vs 8.1 ± 2.0 % , ns ) , age , duration of diabetes , incidence of retinopathy and nephropathy . Analysing an observation period of > 4.5 years , patients trained in IIT presented with improved metabolic control as compared to those on CIT ( Mean HbA1c : IIT , 6.9 ± 1.0 % ; CIT , 7.9 ± 1.3 % , p < 0.05 , ANOVA ) . No difference between groups was , however , observed at the end‐point of the study in HbA1c ( IIT , 7.3 ± 1.3 % ; CIT , 7.8 ± 1.4 % ; IIT vs CIT , p = 0.14 ) and in the development of diabetic microangiopathy , frequency of reported severe hypoglycaemic episodes , and increase in body weight . Structured in‐hospital education of self‐selected Type 1 diabetic patients in intensive insulin therapy permits improvement of metabolic control in the setting of a rural general practice without striking drawbacks compared to conventional insulin therapy over a period of > 4.5 years . The deterioration in metabolic control at the end‐point of the study suggests the need for periodic reinforcement of transferred knowledge to continuously maintain better diabetes care OBJECTIVE To evaluate an educational intervention about the food label design ed specifically for women with type 2 diabetes mellitus . DESIGN A pretest-posttest control group design . Participants received r and om group assignment . SUBJECTS/ SETTING Forty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated . Forty participants ( 93 % ) completed the program . INTERVENTION Nine weekly group sessions were developed on the basis of findings from previous research among this sample . Principles from Ausubel 's learning theory were also incorporated into program design and evaluation . MAIN OUTCOME MEASURES The effectiveness of the food label education program on participants ' knowledge was determined using a multiple-choice test design ed to measure declarative and procedural knowledge . A skills inventory assessed participants ' perceived confidence in using the food label . The validity and reliability of the instruments had been established previously . STATISTICAL ANALYSES Analysis of variance was performed to compare groups . Paired t tests compared pretest and posttest results . RESULTS The experimental group showed a greater gain than the control group in total knowledge ( P < .001 ) , declarative knowledge ( P < .001 ) , and procedural knowledge ( P < .01 ) at posttest . Posttest data showed a significant increase ( P < .01 ) in experimental participants ' perceived confidence in using the food label . CONCLUSIONS Women with diabetes need more education about the food label . This intervention is an effective outpatient education program . Participant knowledge and perceived confidence in using the food label improved significantly as a result of the intervention . Future research should assess retention of knowledge gained and the impact of the intervention on metabolic measures of diabetes management and control Background The benefit of self-monitoring of blood glucose ( SMBG ) in people with type 2 diabetes on diet or oral agents other than sulphonylureas  remains uncertain . Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results . A recent systematic review concluded that SMBG was not cost-effective . However , what was unclear was whether a cheaper method of self-monitoring ( such as urine glucose monitoring ) could produce comparable benefit and patient acceptability for less cost . Methods / Design The DESMOND SMBG trial is comparing two monitoring strategies ( blood glucose monitoring and urine testing ) over 18 months when incorporated into a comprehensive self-management structured education programme . It is a multi-site cluster r and omised controlled trial , conducted across 8 sites ( 7 primary care trusts ) in Engl and , UK involving individuals with newly diagnosed Type 2 diabetes . The trial has 80 % power to demonstrate equivalence in mean HbA1c ( the primary end-point ) at 18 months of within ± 0.5 % assuming 20 % drop out and 20 % non-consent . Secondary end-points include blood pressure , lipids , body weight and psychosocial measures as well as a qualitative sub- study . Practice s were r and omised to one of two arms : participants attend a  DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose . The programme is delivered by accredited educators who received specific training about equipoise . Biomedical data are collected and psychosocial scales completed at baseline , and 6 , 12 , and 18 months post programme . Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring . Discussion The DESMOND SMBG trial is design ed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes . Strengths include a setting in primary care , a cluster design , a health economic analysis , a comparison of different methods of monitoring while controlling for other components of training within the context of a quality assured structured education programme and a qualitative sub- study .Trial registration IS RCT N : IS RCT N95696668 Background The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world . One such national education programme in the United Kingdom is the DESMOND Programme , which has been shown to be robust and effective for patients in general . However , these programmes are not generally targeted to people with intellectual disabilities ( ID ) , and robust evidence on their effects for this population is lacking . We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID.This protocol is for a pilot trial to determine whether a large-scale r and omised trial is feasible , to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes , in particular as a means to reduce glycated haemoglobin ( Hb1Ac ) , improve psychological wellbeing and quality of life and promote a healthier lifestyle . This protocol describes the rationale , methods , proposed analysis plan and organisational and administrative details . Methods / Design This trial is a two arm , individually r and omised , pilot trial for adults with ID and type 2 diabetes , and their family and /or paid carers . It compares the DESMOND-ID programme with usual care .  Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom . Family and /or paid carers may also participate in the study . Participants will be r and omly assigned to one of two conditions using a secure computerised system with robust allocation concealment . A range of data will be collected from the adults with ID ( biomedical , psychosocial and self-management strategies ) and from their carers . Focus groups with all the participants will assess the acceptability of the intervention and the trial . Discussion The lack of appropriate structured education programmes and educational material s for this population leads to secondary health conditions and may lead to premature deaths . There are significant benefits to be gained globally , if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments . Trial registration Registered with International St and ard R and omised Controlled Trial ( identifier : IS RCT N93185560 ) on 10 November 2014 Introduction Diabetes self-management education interventions in community gathering places have been moderately effective , but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes . This paper describes a church-based diabetes self-management education intervention for African Americans , a r and omized controlled trial to evaluate the intervention , and baseline characteristics of study participants . Methods A New DAWN : Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina . Each church recruited congregants with type 2 diabetes and design ated a diabetes advisor , or peer counselor , to be part of the intervention team . Participants were enrolled at each church and r and omized as a unit to either the special intervention or the minimal intervention . The special intervention included one individual counseling visit , twelve group sessions , three postcard messages from the participant 's diabetes care provider , and twelve monthly telephone calls from a diabetes advisor . Baseline data included measures of weight , hemoglobin A1c , blood pressure , physical activity , dietary and diabetes self-care practice s , and psychosocial factors . The study to evaluate the intervention ( from enrollment visit to last follow-up ) began in February 2001 and ended in August 2003 . Results Twenty-four churches ( with 201 total participants ) were r and omized . Sixty-four percent of the participants were women . On average , the participants were aged 59 years and sedentary . They had an average of 12 years of education , had been diagnosed with diabetes for 9 years , had a body mass index of 35 , had a  hemoglobin  A1c level of 7.8 % , and had a reported dietary intake of 39 % of calories from fat . Conclusion A New DAWN is a culturally sensitive , church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a r and omized controlled trial . The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority population s and help to inform the selection of approaches to improve diabetes care in this population Background African Americans with Type 2 diabetes ( T2DM ) have higher prevalence of diabetes , poorer metabolic control , and greater risk for complications and death compared to American Whites . Poor outcomes in African Americans with T2DM can be attributed to patient , provider , and health systems level factors . Provider and health system factors account for < 10 % of variance in major diabetes outcomes including hemoglobin A1c ( HbA1c ) , lipid control , and re source use . Key differences appear to be at the patient level . Of the patient level factors , consistent differences between African Americans and American Whites with T2DM have been found in diabetes knowledge , self-management skills , empowerment , and perceived control . A variety of interventions to improve diabetes self-management have been tested including : 1 ) knowledge interventions ; 2 ) lifestyle interventions ; 3 ) skills training interventions ; and 4 ) patient activation and empowerment interventions . Most of these interventions have been tested individually , but rarely have they been tested in combination , especially among African Americans who have the greatest burden of diabetes related complications . This study provides a unique opportunity to address this gap in the literature . Methods / Design We describe an ongoing four-year r and omized clinical trial , using a 2 × 2 factorial design , which will test the efficacy of separate and combined telephone-delivered , diabetes knowledge/information and motivation/behavioral skills training interventions in high risk African Americans with poorly controlled T2DM ( HbA1c ≥ 9 % ) . Two-hundred thirty-two ( 232 ) male and female African-American participants , 18 years of age or older and with an HbA1c ≥ 9 % , will be r and omized into one of four groups for 12-weeks of phone interventions : ( 1 ) an education group , ( 2 ) a motivation/skills group , ( 3 ) a combined group or ( 4 ) a usual care/general health education group . Participants will be followed for 12-months to ascertain the effect of the interventions on glycemic control . Our primary hypothesis is that among African Americans with poorly controlled T2DM , patients r and omized to the combined diabetes knowledge/information and motivation/behavioral skills training intervention will have significantly greater reduction in HbA1c at 12 months of follow-up compared to the usual care/general health education group . Discussion Results from this study will provide important insight into how best to deliver diabetes education and skills training in ethnic minorities and whether combined knowledge/information and motivation/behavioral skills training is superior to the usual method of delivering diabetes education for African Americans with poorly controlled T2DM.Trial registration National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier # NCT00929838 ) OBJECTIVE : to compare the effectiveness of two educational interventions used by a healthcare provider in the monitoring of individuals with type 2 diabetes mellitus ( T2DM ) , regarding knowledge of the disease , impact on quality of life and adoption of self-care actions . METHODS : comparative , longitudinal , prospect i ve study performed with 150 subjects with type 2 diabetes , analyzed according to the type of participation in the program ( individual and /or group ) . Participants of the individual intervention ( II ) received nursing consultations every six months and those of the group intervention ( GI ) took part in weekly meetings for three months . Data were collected through four question naires : Identification question naire , Problem Areas in Diabetes Question naire ( PAID ) , Summary of Diabetes Self-Care Activities Question naire ( SDSCA ) and the Diabetes Knowledge Scale ( DKN-A ) . Data were analyzed using the Friedman and Mann Whitney tests , considering a statistical significance of p ≤ 0.05 . RESULTS : there was an increase in knowledge about the disease in the II ( p<0.003 ) and GI ( p<0.007 ) , with reduction of the impact on the quality of life in the II ( p<0.007 ) and improvement in self-care actions in the GI ( p<0.001 ) . CONCLUSION : in both intervention models improvements were observed in the indicators , over the six month monitoring period Background Type 2 diabetes mellitus ( DM2 ) is a disease with high prevalence and significant impact in terms of mortality and morbidity . The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management . The Spanish Diabetes Self-Management Program ( SDSMP ) has proven to be effective in other setting s. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care setting s within the Basque Health Service – Osakidetza ( Spain ) . Method / Design This is a r and omised clinical trial in which patients diagnosed with DM2 , 18–79 years of age , from four health regions within the Basque Health Service will be r and omised into two groups : an intervention group , who will follow the SDSMP , and a control group , who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region . The intervention consists of 2,5 hour-group sessions once a week for six weeks . The sessions cover target setting and problem solving techniques , promotion of physical exercise , basic knowledge of nutrition , proper use of medication , effective communication with relatives and health professionals , and basic knowledge about DM2 and its complications . This content is complemented by educational material : books , leaflets and CDs . The primary outcome measure will be the change in glycated haemoglobin ( HbA1c ) , and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables , cardiovascular risk , quality of life , self-efficacy , number of consultations and drug prescriptions . The results will be analysed 6 , 12 and 24 months after the intervention . Discussion If the intervention were to be effective , the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases . Trial registration Clinical Trials.gov identifier Background . Newly diagnosed insulin-dependent diabetic children are most often admitted to hospital for education and insulin management and subsequently followed in outpatient clinics or office setting s. However , most could be managed at home , given adequate family and health care team support and subsequent follow-up facilitated by home-based nursing intervention . We conducted a r and omized trial of clinical , psychosocial , and cost effects of home-based management in a 2-year follow-up study of newly diagnosed diabetic children . Methods . Sixty three patients were r and omly assigned to  traditional hospitalization and outpatient follow-up ( hospital-based group ) or home management ( home-based group ) . Treatment differences between the two groups consisted of duration of initial hospital stay , site and timing of initial teaching , and nature and extent of subsequent nursing follow-up . Metabolic control was assessed by means of quarterly glycosylated hemoglobin measurements for 24 months and then at 36 months . Diabetes-related adverse events , knowledge of diabetes , adherence to the diabetes regimen , psychosocial impact , and social ( total ) costs incurred were assessed for 24 months . Findings . Glycosylated hemoglobin concentrations were significantly lower in the home-based group at 12 to 24 months and at 36 months . Both groups had comparable numbers of diabetes-related adverse events . There were no significant group differences in psychosocial impact . Parents in the home-based group spent significantly fewer hours on diabetes care and incurred significantly lower out-of-pocket expenses during the 1st month . Health care sector costs were significantly higher . Hospital costs were $ 889 higher , and government costs $ 890 higher per child . Social ( total ) costs were only $ 48 higher per case ( NS ) with home care when parents ' time was valued at $ 11.88 per hour . Interpretation . Home-based management for newly diagnosed diabetic children can result in better metabolic control and similar psychosocial outcomes compared with traditional hospital- and clinic-based care without notable effects on social ( total ) costs Control of diabetes mellitus is a high priority for primary health care systems . One innovative method of diabetes care delivery is the use of structured diabetes care in primary care . This includes the use of chronic care diabetes clinics or mini-clinics operated by general practitioners in primary care . There is limited experience with this model in non-Western setting s. This study sought to evaluate a multi-component structured approach to diabetes care in primary care including chronic care diabetes clinics in a newly developed country in the Arabian Gulf . The study design used was a controlled before-after methodology . Three primary health centers were chosen for the intervention with six of the remaining clinics in a Health District being used as controls . A multifaceted intervention was initiated in the intervention clinics composed of chronic care diabetes clinics , a diabetic flow chart , and educational programs for clinic nurses and doctors and patients . The study intervention took place over a period of 18 months with three diabetic outcomes ( fasting blood glucose , blood pressure and cholesterol ) and adherence to seven diabetes guidelines being compared for the year prior to the intervention and during the last 12 months of the intervention period . Knowledge and satisfaction question naires were also administered to intervention and control subjects at the end of the study . In this study , 219 subjects were enrolled ( 130 males and 89 females ) . They had a mean age of 51.6 years and a mean of 3.1 years of formal education . Of these 109 were enrolled in one of three clinics that had a chronic care diabetes clinic and 110 were enrolled in one of the six control clinics . Subjects had diabetes for a mean of 7.8 ± 4.8 years and the majority was treated with pharmacological therapy . Baseline characteristics in the intervention and the control clinics were similar with the exception of younger age ( p = 0.01 ) and a trend for more males ( p = 0.06 ) in the intervention clinics . There was a statistically insignificant change noted with the intervention in the three clinical outcomes studied ( fasting blood glucose , blood pressure and cholesterol ) both in comparison to the control group before and after and within the intervention group . However most changes noted were in the expected direction of improvement ; six of the seven guidelines were statistically improved in the intervention group when compared with the control group . Within the intervention group , adherence with five of seven guidelines was also statistically significantly increased with the remaining guidelines showing a trend in favor of improvement ( fasting blood glucose measurements ( p = 0.07 ) and urine determinations for protein ( p = 0.07 ) ) . Knowledge question naire scores were similar between the intervention and control groups on completion of the study but 2 of 4 items on a satisfaction scale were statistically significantly higher in the intervention group . The intervention described in this setting was successful in improving adherence to diabetes guidelines and increased some aspects of satisfaction with diabetes care . The intervention did not result in a statistically significant improvement in clinical outcomes but changes noted were in the expected direction of improvement . The significant improvement in adherence to diabetes guidelines suggests that this intervention is a promising model for diabetes care for newly developed countries OBJECTIVES This study aim ed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes . RESEARCH DESIGN AND METHODS The Finnish Diabetic Nephropathy ( FinnDiane ) study is a national multicenter prospect i ve follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals , 33 district hospitals , and 26 primary health care centers across Finl and . RESULTS During a median 7 years of follow-up , there were 291 deaths ( 7 % ) , 3.6-fold ( 95 % CI 3.2–4.0 ) more than that observed in the age- and sex-matched general population . Excess mortality was only observed in individuals with chronic kidney disease . Individuals with normoalbuminuria showed no excess mortality beyond the general population ( st and ardized mortality ratio [ SMR ] 0.8 , 95 % CI 0.5–1.1 ) , independent of the duration of diabetes . The presence of microalbuminuria , macroalbuminuria , and end-stage kidney disease was associated with 2.8 , 9.2 , and 18.3 times higher SMR , respectively . The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease . In addition , the glomerular filtration rate was independently associated with mortality , such that individuals with impaired kidney function , as well as those demonstrating hyperfiltration , had an increased risk of death . CONCLUSIONS An independent grade d association was observed between the presence and severity of kidney disease and mortality in a large contemporary cohort of individuals with type 1 diabetes . These findings highlight the clinical and public health importance of chronic kidney disease and its prevention in the management of type 1 diabetes Background The prevalence of type 2 diabetes is rising internationally . Patients with diabetes have a higher risk of cardiovascular events accounting for substantial premature morbidity and mortality , and health care expenditure . Given healthcare workforce limitations , there is a need to improve interventions that promote positive self-management behaviours that enable patients to manage their chronic conditions effectively , across different cultural context s. Previous studies have evaluated the feasibility of including telephone and Short Message Service ( SMS ) follow up in chronic disease self-management programs , but only for single diseases or in one specific population . Therefore , the aim of this study is to evaluate the feasibility and short-term efficacy of incorporating telephone and text messaging to support the care of patients with diabetes and cardiac disease , in Australia and in Taiwan . Methods / design A r and omised controlled trial design will be used to evaluate a self-management program for people with diabetes and cardiac disease that incorporates the use of simple remote-access communication technologies .  A sample size of 180 participants from Australia and Taiwan will be recruited and r and omised in a one-to-one ratio to receive either the intervention in addition to usual care ( intervention ) or usual care alone ( control ) . The intervention will consist of in-hospital education as well as follow up utilising personal telephone calls and SMS reminders . Primary short term outcomes of interest include self-care behaviours and self-efficacy assessed at baseline and four weeks . Discussion If the results of this investigation substantiate the feasibility and efficacy of the telephone and SMS intervention for promoting self management among patients with diabetes and cardiac disease in Australia and Taiwan , it will support the external validity of the intervention . It is anticipated that empirical data from this investigation will provide valuable information to inform future international collaborations , while providing a platform for further enhancements of the program , which has potential to benefit patients internationally . Trial registration ACTRN 12611001196932 The purpose of this study was to evaluate the efficacy and feasibility of a newly developed diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for patients with mild type 2 diabetes or impaired glucose tolerance ( IGT ) by a r and omized controlled trial ( RCT ) method . Fifty-two patients with mild type 2 diabetes or IGT ( HbAlc<8 ) were r and omly assigned to either an intervention group or a control group . The current care was continued for the control group and the new education program was provided in addition to the current care for the intervention group . Changes in weight , blood glucose in a 75g-oral glucose tolerance test ( 75g-OGTT ) , and HbAlc were measured in June 1997 as baseline data and again in Dec. 1997 . Scores for knowledge of diabetes , dietary habits , physical activity , health practice index , diabetes quality of life ( DQOL ) , and self-efficacy were also obtained . After six months , the intervention group showed a statistically significant weight loss and blood glucose reduction in the 75g-OGTT test , but the control group did not . A significant improvement in lifestyle was observed in the intervention group , especially in terms of dietary habits and physical activity . The knowledge test scores increased in both groups . There were no significant differences in HbAlc , DQOL , or self-efficacy between the two groups . The results of this study show that the combination of a three-day hospitalization and a six-month follow-up by telephone counseling is effective in metabolic control and improvement of lifestyle for patients with mild type 2 diabetes or IGT . The reasons for the effectiveness were considered to be that l)changes in lifestyle were based on autonomous decision-making ; 2)regular , consistent counseling was provided by the nurse in charge of each patient ; 3)extended follow-up is more effective than initial education in preventing a rebound of weight or metabolic control The aim of the present study was to evaluate the impact of empowerment group education on  type 2 diabetes patients '  confidence in diabetes knowledge , self-efficacy , satisfaction with daily life , BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up . In this r and omized controlled trial , conducted at 7 primary care centres in central Sweden , 101 patients were r and omly assigned either to  empowerment group education ( intervention group )  or to  routine diabetes care ( control group )  . Out of these , 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up . Before the intervention and at the 1-year follow-up , the patients answered a 27-item question naire , and weight , BMI and HbA1c were measured . The question naire comprised three domains : confidence in diabetes knowledge , self-efficacy and satisfaction with daily life . At 1-year follow-up , the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group ( p<0.05 ) . No significant differences were found in self-efficacy , satisfaction with daily life , BMI and HbA1c between the intervention and control group . The empowerment group education did improve  patients ' confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease BACKGROUND AND AIMS We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually . Group care was cost-effective in improving quality of life , knowledge of diabetes , health behaviours and clinical outcomes in people with type 2 diabetes . The aim of this study was to verify if group care can also be applied to type 1 diabetes . METHODS AND RESULTS R and omized , controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care .  A syllabus was built and later remodulated with the patients in a series of focus-group meetings . The primary end-point was changes in quality of life . Secondary end-points were : knowledge of diabetes , health behaviours , HbA1c and circulating lipids . Differential costs to the Italian National Health System and to the patients were also calculated . After 3 years , quality of life improved among patients on group care , along with knowledge and health behaviours ( p<0.001 , all ) . Knowledge added its effects to those of group care by independently influencing behaviours ( p=0.004 ) while quality of life changed independently of either ( p<0.001 ) . Among controls , quality of life worsened ( p<0.001 ) whereas knowledge and behaviours remained unchanged . HDL cholesterol increased among patients on group care ( p=0.027 ) and total cholesterol decreased in the controls ( p<0.05 ) . HbA1c decreased , though not significantly , in both . Direct costs for group and one-to-one care were Euros 933.19 and Euros 697.10 per patient , respectively , giving a cost-effectiveness ratio of Euros 19.42 spent per point gained in the quality of life scale . CONCLUSIONS Group care is applicable and also cost-effective in type 1 diabetes . It improves quality of life , knowledge and behaviours . Future programme adjustments should strive to impact more on metabolic control
However , overall there did not appear to be a significant difference between individual education and usual care .
In the small number of studies comparing group and individual education , there was an equal impact on HbA1c at 12 to 18 months .
BACKGROUND Type 2 diabetes is a common and costly chronic disease which is associated with significant premature mortality and morbidity .
Although patient education is an integral component of diabetes care , there remain uncertainties regarding the effectiveness of different methods and modes of education .
OBJECTIVES To evaluate the effectiveness of individual patient education  on metabolic control , diabetes knowledge and psychosocial outcomes .