Issue 173 Item 11 Diabetes Education Lacks Focus on Cardiovascular Risk

Diabetes education doesn’t focus enough on reduction of cardiovascular risk factors.

Recent data overwhelmingly confirm the importance of controlling both blood pressure and lipids—in addition to normalization of glucose—in the reduction of cardiovascular risk in diabetic patients. Randomized trials have also shown the value of aspirin therapy, use of ACE inhibitors and angiotensin receptor blockers, and smoking cessation, said Ms. Giesler, a certified diabetes educator (CDE) at the Mayo Clinic, Rochester, Minn.

But diabetes education hasn’t kept pace. “As educators, we have traditionally, disproportionately emphasized glycemic control.”

Two analyses—one prospective and one retrospective—were conducted to see exactly what diabetes educators say during typical encounters with adult diabetic patients referred by their primary care or specialist physicians.

In the first analysis, three CDEs who were unaware of the study’s intent recorded all statements they made in 50 one-on-one encounters with 49 patients during a 2-week period.

Statements related to glycemic control made up 63% of the total, while 5% related to cardiovascular risk reduction.

The retrospective analysis evaluated 1,219 educational “modules” used in 1,043 individual and group education sessions. The modules cover curriculum content areas of the American Diabetes Association’s national standards for diabetes education.

Glycemic control was the focus of 62% of the modules that were used during the sessions. Only 10% were devoted to cardiovascular risk reduction; the other 28% dealt with the disease process and other general facts about diabetes.

Even though all of the data came from Mayo and another nearby clinic, they probably represent diabetes education around the country.

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Did YOU KNOW:
Retinopathy occurs more often among black than white participants (50 vs. 19%). Diabetes Care. 1999;22:779-783.