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Short-term efficacy of high intensity group and individual education in patients with type 2 diabetes: a randomized single-center trial

  • R. Reale
  • A. Tumminia
  • L. Romeo
  • N. La Spina
  • R. Baratta
  • G. Padova
  • L. Tomaselli
  • L. Frittitta
Original Article
  • 12 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

Type 2 diabetes Conversation map Individual education Treatment satisfaction 

Abbreviations

CM™

Conversation Map

IE

Individual education

UC

Usual care

BMI

Body mass index

HbA1c

Glycated hemoglobin

DTSQ

Diabetes Treatment Satisfaction Questionnaire

GICR-IACPR

Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology

ATT19

Diabetes Integration Scale-19

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    American Diabetes A (2018) 4. Lifestyle management: standards of medical care in diabetes—2018. Diabetes Care 41(Suppl 1):S38–S50.  https://doi.org/10.2337/dc18-s004 CrossRefGoogle Scholar
  2. 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. 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 Google Scholar
  4. 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
  5. 5.
    Gary TL, Genkinger JM, Guallar E, Peyrot M, Brancati FL (2003) Meta-analysis of randomized educational and behavioral interventions in type 2 diabetes. Diabetes Educ 29(3):488–501.  https://doi.org/10.1177/014572170302900313 CrossRefPubMedGoogle Scholar
  6. 6.
    Ellis SE, Speroff T, Dittus RS, Brown A, Pichert JW, Elasy TA (2004) Diabetes patient education: a meta-analysis and meta-regression. Patient Educ Couns 52(1):97–105CrossRefPubMedGoogle Scholar
  7. 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
  8. 8.
    Norris SL, Engelgau MM, Narayan KM (2001) Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 24(3):561–587CrossRefPubMedGoogle Scholar
  9. 9.
    Tang TS, Gillard ML, Funnell MM, Nwankwo R, Parker E, Spurlock D, Anderson RM (2005) Developing a new generation of ongoing: diabetes self-management support interventions: a preliminary report. Diabetes Educ 31(1):91–97.  https://doi.org/10.1177/0145721704273231 CrossRefPubMedGoogle Scholar
  10. 10.
    Funnell MM, Nwankwo R, Gillard ML, Anderson RM, Tang TS (2005) Implementing an empowerment-based diabetes self-management education program. Diabetes Educ 31(1):53.  https://doi.org/10.1177/0145721704273166 CrossRefPubMedGoogle Scholar
  11. 11.
    Trento M, Passera P, Borgo E, Tomalino M, Bajardi M, Cavallo F, Porta M (2004) A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care 27(3):670–675CrossRefPubMedGoogle Scholar
  12. 12.
    Izquierdo RE, Knudson PE, Meyer S, Kearns J, Ploutz-Snyder R, Weinstock RS (2003) A comparison of diabetes education administered through telemedicine versus in person. Diabetes Care 26(4):1002–1007CrossRefPubMedGoogle Scholar
  13. 13.
    Heinrich E, Candel MJ, Schaper NC, de Vries NK (2010) Effect evaluation of a Motivational Interviewing based counselling strategy in diabetes care. Diabetes Res Clin Pract 90(3):270–278.  https://doi.org/10.1016/j.diabres.2010.09.012 CrossRefPubMedGoogle Scholar
  14. 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. 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. 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
  17. 17.
    Li F, Yao P, Hsue C, Xu J, Lou Q (2016) Impact of “Conversation Maps” on diabetes distress and self-efficacy of Chinese adult patients with type 2 diabetes: a pilot study. Patient Prefer Adherence 10:901–908.  https://doi.org/10.2147/PPA.S95449 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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. 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. 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
  21. 21.
    Chinenye S, Young EE (2013) Diabetes conversation map in Nigeria: a new socioeducational tool in diabetes care. Indian J Endocrinol Metab 17(6):1009–1011.  https://doi.org/10.4103/2230-8210.122613 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ciardullo AV, Daghio MM, Fattori G, Giudici G, Rossii L, Vagnini C (2010) Effectiveness of the kit Conversation Map in the therapeutic education of diabetic people attending the Diabetes Unit in Carpi, Italy. Recenti Prog Med 101(12):471–474PubMedGoogle Scholar
  23. 23.
    Yang YS, Wu YC, Lu YL, Kornelius E, Lin YT, Chen YJ, Li CL, Hsiao HW, Peng CH, Huang CN (2015) Adherence to self-care behavior and glycemic effects using structured education. J Diabetes Investig 6(6):662–669.  https://doi.org/10.1111/jdi.12343 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Roza AM, Shizgal HM (1984) The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass. Am J Clin Nutr 40(1):168–182CrossRefPubMedGoogle Scholar
  25. 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
  26. 26.
    Torres HC, Virginia AH, Schall VT (2005) Validation of diabetes mellitus knowledge (DKN-A) and attitude (ATT-19) questionnaires. Rev Saude Publica 39(6):906–911.  https://doi.org/10.1590/S0034-89102005000600006 CrossRefPubMedGoogle Scholar
  27. 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 PubMedGoogle Scholar
  28. 28.
    Petterson T, Lee P, Hollis S, Young B, Newton P, Dornan T (1998) Well-being and treatment satisfaction in older people with diabetes. Diabetes Care 21(6):930–935CrossRefPubMedGoogle Scholar
  29. 29.
    Wredling R, Stalhammar J, Adamson U, Berne C, Larsson Y, Ostman J (1995) Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 4(6):515–522CrossRefGoogle Scholar
  30. 30.
    Shobhana R, Rao PR, Lavanya A, Padma C, Vijay V, Ramachandran A (2003) Quality of life and diabetes integration among subjects with type 2 diabetes. J Assoc Physicians India 51:363–365PubMedGoogle Scholar
  31. 31.
    Eigenmann CA, Colagiuri R, Skinner TC, Trevena L (2009) Are current psychometric tools suitable for measuring outcomes of diabetes education? Diabet Med J Br Diabet Assoc 26(4):425–436.  https://doi.org/10.1111/j.1464-5491.2009.02697.x CrossRefGoogle Scholar
  32. 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 PubMedGoogle Scholar
  33. 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. 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. 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. 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

Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  • R. Reale
    • 1
  • A. Tumminia
    • 1
  • L. Romeo
    • 1
  • N. La Spina
    • 1
  • R. Baratta
    • 2
  • G. Padova
    • 2
  • L. Tomaselli
    • 2
  • L. Frittitta
    • 1
    • 3
  1. 1.Endocrinology, Department of Clinical and Experimental MedicineUniversity of Catania, Garibaldi HospitalCataniaItaly
  2. 2.Endocrinology UnitGaribaldi HospitalCataniaItaly
  3. 3.Diabetes, Obesity and Dietetic CenterGaribaldi HospitalCataniaItaly

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