Short-term efficacy of high intensity group and individual education in patients with type 2 diabetes: a randomized single-center trial
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The aim of this randomized study was to examine the efficacy of two high intensity educational programs: the conversation maps-based (CM™) education and the individual education (IE), compared to usual care (UC) in a cohort of type 2 diabetic (T2DM) patients.
Ninety T2DM outpatients (30 per group) were randomized and 79 finished the study and were analyzed. The CM™ and IE groups received four educational sessions at 0, 4, 8 and 12 weeks, while the UC group received two brief individual sessions at 0 and 12 weeks. We evaluated glycemic control (HbA1c), diabetes treatment, body mass index (BMI) and carried out a questionnaire survey at three time points (before intervention, at 12 and at 32 weeks) to assess patients’ satisfaction, attitudes toward diabetes and dietary knowledge.
All the three groups showed a significant and comparable reduction of both HbA1c and BMI. Diabetes therapy needed to be reinforced in a higher percentage of cases (39.3%) among UC patients compared to the IE (14.8%; p = 0.04) and the CM™ (8.3%; p = 0.01) groups. At 32 weeks Diabetes Treatment Satisfaction (DTSQ Q1 + Q4–8) significantly improved in the CM™ group (25.8 ± 4.5 vs. 22.4 ± 6.0; p < 0.01) and attitudes toward diabetes (ATT19) significantly improved in the IE group (58.0 ± 4.7 vs. 55.3 ± 5.1; p = 0.02).
Our trial provides preliminary data regarding the efficacy of structured group and individual education on achieving better glyco-metabolic control without drug therapy reinforcement and with positive effects on patients’ attitude and treatment satisfaction.
KeywordsType 2 diabetes Conversation map Individual education Treatment satisfaction
Body mass index
Diabetes Treatment Satisfaction Questionnaire
Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology
Diabetes Integration Scale-19
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- 2.Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR, American Diabetes A, European Association for the Study of D (2012) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35(6):1364–1379. https://doi.org/10.2337/dc12-0413 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Look ARG, Wing RR (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 170(17):1566–1575. https://doi.org/10.1001/archinternmed.2010.334 CrossRefGoogle Scholar
- 4.Trento M, Passera P, Bajardi M, Tomalino M, Grassi G, Borgo E, Donnola C, Cavallo F, Bondonio P, Porta M (2002) Lifestyle intervention by group care prevents deterioration of type II diabetes: a 4-year randomized controlled clinical trial. Diabetologia 45(9):1231–1239. https://doi.org/10.1007/s00125-002-0904-8 CrossRefPubMedGoogle Scholar
- 7.Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JT, Assendelft WJ (2001) Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev (1):CD001481. https://doi.org/10.1002/14651858.cd001481
- 14.Trento M, Gamba S, Gentile L, Grassi G, Miselli V, Morone G, Passera P, Tonutti L, Tomalino M, Bondonio P, Cavallo F, Porta M, Investigators R (2010) Rethink Organization to iMprove Education and Outcomes (ROMEO): a multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care 33(4):745–747. https://doi.org/10.2337/dc09-2024 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Duke SA, Colagiuri S, Colagiuri R (2009) Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev (1):CD005268. https://doi.org/10.1002/14651858.cd005268.pub2
- 16.Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, Hanson A, Lavin-Tompkins J, Glasrud P, Davis H, Adams K, Parsons W, Spain CV (2011) Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Arch Intern Med 171(22):2001–2010. https://doi.org/10.1001/archinternmed.2011.507 CrossRefPubMedGoogle Scholar
- 18.Deakin T, McShane CE, Cade JE, Williams RD (2005) Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev (2):CD003417. https://doi.org/10.1002/14651858.cd003417.pub2
- 19.Penalba M, Moreno L, Cobo A, Reviriego J, Rodriguez A, Cleall S, Reaney M (2014) Impact of the ≪Conversation Map≫ tools on understanding of diabetes by Spanish patients with type 2 diabetes mellitus: a randomized, comparative study. Endocrinologia y nutricion organo de la Sociedad Espanola de Endocrinologia y Nutricion 61(10):505–515. https://doi.org/10.1016/j.endonu.2014.06.001 CrossRefPubMedGoogle Scholar
- 20.Steinsbekk A, Rygg LO, Lisulo M, Rise MB, Fretheim A (2012) Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res 12:213. https://doi.org/10.1186/1472-6963-12-213 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Nicolucci A, Giorgino R, Cucinotta D, Zoppini G, Muggeo M, Squatrito S, Corsi A, Lostia S, Pappalardo L, Benaduce E, Girelli A, Galeone F, Maldonato A, Perriello G, Pata P, Marra G, Coronel GA (2004) Validation of the Italian version of the WHO-Well-Being Questionnaire (WHO-WBQ) and the WHO-Diabetes Treatment Satisfaction Questionnaire (WHO-DTSQ). Diabetes Nutr Metab 17(4):235–243PubMedGoogle Scholar
- 27.da Vico L, Biffi B, Agostini S, Brazzo S, Masini ML, Fattirolli F, Mannucci E (2010) Validation of the Italian version of the questionnaire on nutrition knowledge by Moynihan. Monaldi Arch Chest Dis = Archivio Monaldi per le malattie del torace 74(3):140–146. https://doi.org/10.4081/monaldi.2010.263 PubMedCrossRefGoogle Scholar
- 32.Tramarin R, Ambrosetti M, De Feo S, Piepoli M, Riccio C, Griffo R, Isyde-208 Investigators of the Italian Association for Cardiovascular Prevention R, Prevention (2008) The Italian Survey on Cardiac Rehabilitation-2008 (ISYDE-2008). Part 3. National availability and organization of cardiac rehabilitation facilities. Official report of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (IACPR-GICR). Monaldi Arch Chest Dis = Archivio Monaldi per le malattie del torace 70(4):175–205. https://doi.org/10.4081/monaldi.2008.413 PubMedCrossRefGoogle Scholar
- 33.Yong YM, Shin KM, Lee KM, Cho JY, Ko SH, Yoon MH, Kim TW, Jeong JH, Park YM, Ko SH, Ahn YB (2015) Intensive individualized reinforcement education is important for the prevention of hypoglycemia in patients with type 2 diabetes. Diabetes Metab J 39(2):154–163. https://doi.org/10.4093/dmj.2015.39.2.154 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Beverly EA, Fitzgerald SM, Brooks KM, Hultgren BA, Ganda OP, Munshi M, Weinger K (2013) Impact of reinforcement of diabetes self-care on poorly controlled diabetes: a randomized controlled trial. Diabetes Educ 39(4):504–514. https://doi.org/10.1177/0145721713486837 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Tumminia A, Crimi S, Sciacca L, Buscema M, Frittitta L, Squatrito S, Vigneri R, Tomaselli L (2015) Efficacy of real-time continuous glucose monitoring on glycaemic control and glucose variability in type 1 diabetic patients treated with either insulin pumps or multiple insulin injection therapy: a randomized controlled crossover trial. Diabetes Metab Res Rev 31(1):61–68. https://doi.org/10.1002/dmrr.2557 CrossRefPubMedGoogle Scholar
- 36.Hemmati Maslakpak M, Razmara S, Niazkhani Z (2017) Effects of face-to-face and telephone-based family-oriented education on self-care behavior and patient outcomes in type 2 diabetes: a randomized controlled trial. J Diabetes Res 2017:8404328. https://doi.org/10.1155/2017/8404328 CrossRefPubMedPubMedCentralGoogle Scholar