Issue 118 Item 2 Patient Education Programs Often Fail!

Formal patient education programs often fail because of low levels of motivation and compliance from the patient or reluctance from the physicians to respond to information provided by patients. In a randomized prospective study of 165 patients with type 2 diabetes, hypertension and hyperlipidemia patients were randomly allocated to standard annual consultation or to a patient participation program. After 4 years, patients in the participation program had lower blood pressure, low-density-lipoprotein (LDL) cholesterol levels and mean glycosylated hemoglobin HbA1c levels compared with the other group.

This highlights the impact that patients being informed and motivated may have on their cooperation with healthcare professionals, and therefore on clinical targets (See Item 2 below).

In a similar way, although most providers recognize the importance of aspirin for patients with diabetes and known cardiovascular disease, it is imperative that clinicians include counseling about aspirin therapy as a care priority for all of their patients with diabetes (See Item 3 below).

Teaching Patients to Monitor Their Risks Retards the Progression of Complications

Intensive management of risk parameters in diabetic patients may retard the progression of both micro- and macrovascular complications.

Intensified care requires expert staff and is expensive. The aim of the present study was to examine whether sharing the therapeutic responsibility with the patients will improve the outcome.

A randomized prospective study of 165 patients with diabetes mellitus Type 2, hypertension (> 140/90 mmHg) and hyperlipidaemia (LDL-C > 120 mg/dl). Patients were randomly allocated to standard annual consultation (SC) or to a patient participation program (PP). The medical care for both groups was administered by primary care physicians, who were unaware of the nature of the intervention.

At 4 years the mean blood pressure was 148/88 (± 6.1/1.7) mmHg in the SC patients vs. 142/84 (± 5.8/1.8) mmHg in the PP group (P = 0.02). The mean LDL-C was 124 ± 8 and 114 ± 6 mg/dl (P = 0.01) and the mean HbA1c was 8.9 ± 1.2% and 8.2 ± 1.5% (P = 0.04) in the SC and PP groups, respectively. The average annual fall in estimated glomerular filtration rate was 3.5 ml/min per year in the SC group vs. 2.25 in the PP group (P < 0.05). Albumin/creatinine ratio > 300 mg/g developed in four SC patients vs. none of the PP patients. There was a total of 36 cardiovascular events in the SC group vs. 23 in the PP group (P = 0.04).

All patients in the PP group received ACE inhibitors (or AII blockers) and statins vs. 52% and 43%, respectively, in the SC group. Glucose-lowering regimens were similar.

Conclusions. Well-informed and motivated patients were more insistent to reach and maintain target values of the main risk factors of diabetic complications. The differences between the PP and SC groups were of the same order of magnitude as those between intensive and standard care groups in other studies albeit with, comparatively, a very modest cost.

Diabetic Medicine: 2002 19/5 (385-392)