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Patient Education Program Prevents Progression of Prediabetes to Diabetes

A 2-day in-hospital group program of diabetes education, followed by individual support sessions every 3 months, significantly helped prevent or delay progression to type 2 diabetes in patients with impaired glucose tolerance.

With the incidence of type 2 diabetes rising steadily around the world, the study’s goal was to identify a program that would be effective in preventing impaired glucose tolerance from progressing to type 2 diabetes, yet be relatively affordable for widespread use.

The community-based clinical trial drew a total of 426 participants from 11 outpatient practices and a health evaluation and promotion center. All patients (average age 51 years) were newly diagnosed with impaired glucose tolerance, defined according to the 2003 American Diabetes Association criteria.

The researchers, led by Dr. Tetsuya Kawahara of Niigata-Rousai Hospital in Joetsu, randomized the study participants into one of three groups: a short-term hospitalization group, a diabetes education and support group, and a control group.

During the 2-day in-hospital program, participants in the short-term hospitalization group received a nine-lesson curriculum that covered diet, exercise and other behavioral changes. Individual and group classes were presented by physicians, nutritionists, pharmacists, physical therapists, nurses and medical technicians. In addition, 20- to 30-minute individual follow-up sessions with nurses or nutritionists at 3-month intervals reinforced the behavioral changes.

Participants in the diabetes education and support group received written information, as well as similar follow-up sessions to those given to the short-term hospitalization group.

The control group received only general information about diabetes and impaired glucose tolerance, including brochures with information about diet and lifestyle improvements.

After an average follow-up of 3.1 years, the incidence of diabetes was 8.0 cases per 100 person-years in the short-term hospitalization group, 10.7 in the diabetes education and support group and 13.2 in the control group (p < 0.01 for all pair comparisons).

When weight loss was excluded from the analysis, however, the group differences became nonsignificant.

The estimated cost to prevent one case of diabetes was $21,800 in the short-term hospitalization group and $26,350 in the diabetes education and support group. Dr. Kawahara and colleagues note that under the Japanese national healthcare system, medications for impaired glucose tolerance are not covered, but the system will pay for educational hospitalization.
Diabetes Care 2008;31:1949-1954.

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http://www.diabetesincontrol.com/results.php?storyarticle=6177

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