Education Helps Reduce Elevated Glycosylated Hemoglobin Levels

A trial comparing intensive and passive education in patients with diabetes.

Both intensive and passive education methods seem to work equally well in improving glycemic control in patients with elevated glycosylated haemoglobin [HbA(1C)] levels.

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 diabetic control.

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.

If your patients are having a problem paying for their medications go to www.diabetesmeds.org and download the application that will allow them to get all of their medications for 10 dollars or less for a 90 day supply.