Both intensive and passive education methods seem to work equally well in improving
glycemic control in patients with elevated glycosylated haemoglobin [HbA(1C)]
Patients who are receptive to education can substantially improve their levels
after either type of educational intervention, say researchers from the Veterans
Affairs Healthcare System and Brigham and Women's Hospital, Harvard Medical
School in Boston, Massachusetts, United States.
They found a decrease in HbA(1C) level of approximately 2.0 percent after one
year in 106 patients randomised to either intensive or passive education groups.
Such a decrease is significant, investigators add. "Maintaining this mean
decrease in HbA(1C) level would represent a significantly reduced lifetime risk
for microalbuminuria, retinopathy and neuropathy."
They concluded that the results reinforce the need for and benefits of incorporating
educational interventions into the management of diabetic patients: "Any
educational method that provides instruction in the core content areas, particularly
when delivered to patients who are interested and receiving ongoing care, can
be an effective means for reducing HbA(1C) levels."
The investigators say they were surprised to find no significant difference
in the metabolic control achieved in the two educational intervention groups.
They suggest participants who enrolled were highly motivated. Regardless of
their group assignment, these patients were prepared to make change in their
Because of this, the researchers compared the outcomes in both groups of participants
with those of patients who refused to participate. The patients who refused
also had a decline in HbA(1C) level, but that it was significantly less than
that of the intervention groups.
Participants had HbA(1C) levels greater than 8.5 percent. A total of 50 were
randomised to intensive education and 56 to passive education.
Intensive education included 3.5 days of structured curriculum taught by five
staff: a doctor, a nurse, a pharmacist, an exercise physiologist and a social
worker. Passive education participants received basic diabetes information by
mail every three months.
Participants in both groups continued to see their primary care providers.
Investigators measured their levels of HbA(1C) at three, six and 12 months.
Patients who declined participation were measured at baseline and 12 months.
Researchers found intensive-education participants had a mean decline of 2.0
percent in HbA(1C) level at 12 months. The mean decline for passive-education
participants was 1.9 percent.
Archives of Internal Medicine, 2002; 162: 1301-1304.