Abstract
The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent (type 2) diabetic patients. The programme was aimed at improving the overall treatment quality in these patients through measures involving self-care, diet, exercise and weight reduction. Four theoretical-practical teaching units were given once a week to group of 5–8 ambulatory patients by previously trained general practitioners. Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment, but receiving no structured teaching before or during the survey period (control group). The drop-out percentage in the intervention group (25%) was significantly lower than in the control group (45%),P<0.05, suggesting an incentive toward greater compliance in the former. At the end of the 1-year follow-up, the mean differences observed in the control and in the intervention groups were: body weight loss −2.4±0.5 kg vs −0.4±0.5 (P<0.001); haemoglobin HbA1 −0.2%±0.4% vs +0.8±0.4% (NS); number of daily oral hypoglycaemic agent intake −1.4±0.2 vs +0.9±0.2 tablets (P<0.001). Our results strongly suggest that this programme, applied through family doctors, may constitute an efficient tool to improve the compliance and clinico-metabolic control of type 2 patients at the primary health care level.
Similar content being viewed by others
References
De Fronzo R, The trimuvirate: β-cell, muscle, liver: a collusion responsible for NIDDM. Diabetes 37:667–698, 1988
Campbell P, Carlson MC, Impact of obesity on insulin action in NIDDM. Diabetes 42:405–410, 1993
Bjorntorp P, Abdominal obesity and the metabolic syndrome. Ann Med 24:465–468, 1994
Kahn CR, Insulin action, diabetogenes and the cause of type II diabetes. Diabetes 43:1066–1084, 1993
Berger M, Grüsser M, Jörgens V, Standl E, Mehnert H, and Boehringer Mannheim, Diabetes Treatment in our Practice: Education and Treatment Program for Non-insulin-treated Type II Diabetic Patients. Deutscher Ärzte-Verlag, Köln; 1987
European NIDDM Policy Group, Desktop guide for the management of non-insulin-dependent diabetes mellitus (NIDDM). Bull Int Diabetes Fed 35:2–23, 1990
Kronsbein P, Jorgens V, Mülhauser I, Scholz V, Venhaus A, Berger M, Evaluation of structured treatment and teaching programmes on non-insulin dependent diabetes. Lancet 2:1407–1410, 1988
Savage PJ, Bennion LJ, Flock EV, Nagulesparan M, Mott D, Roth J, Unger RH, Bennett PH, Diet-induced improvement of abnormalities in insulin and glucagon secretion and in insulin receptor binding in diabetes mellitus. J Clin Endocrinol Metab 48:999–1007, 1979
Beck-Nielsen H, Pedersen O, Sorensen NS, Effects of dietary changes on cellular insulin binding and in vivo insulin sensitivity. Metabolism 29:482–487, 1980
Wales JK, Treatment of type 2 (NID) diabetic patients with diet alone. Diabetologia 23:240–245, 1982
Henry RR, Wallace P, Olefsky JM, Effect of weight loss on mechanisms of hyperglycemia in obese non-insulin dependent diabetes mellitus. Diabetes 35:990–998, 1986
Bitzén PO, Melander A, Scherstén M, Svensson M, Efficacy of dietary regulation in primary health care patients with hyperglycaemia detected by screening. Diabetic Med 5:640–647, 1988
UKPDS Group, Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients. Metabolism 39:905–912, 1990
Taboulet F, Comparaison Internationale de Consommations Pharmaceutiques (These). Université Claude Bernard, Lyon; 1991 (No. 17, 91)
Groop L, Sulfonylureas in NIDDM. Diabetes Care 15:737–753, 1992
Asplund K, Wiholm BE, Lithner F, Glibenclamide associated hypoglycaemia: a report on 57 cases. Diabetologia 24:412–417, 1983
Gruesser M, Bott U, Ellermann P, Kronsbein P, Jorgens V, Evaluation of a structured treatment and teaching program for noninsulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians. Diabetes Care 16:1268–1275, 1993
Gagliardino JJ, Olivera EM, Barragán H, Puppo RA, A simple economic evaluation model for selecting diabetes health care strategies. Diabetic Med 10:351–354, 1993
Olivera EM, Perez Duhalde E, Gagliardino JJ, Cost of temporary and permanent disability induced by diabetes. Diabetes Care 14:593–596, 1991
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Domenech, M.I., Assad, D., Mazzei, M.E. et al. Evaluation of the effectiveness of an ambulatory teaching/treatment programme for non-insulin dependent (type 2) diabetic patients. Acta Diabetol 32, 143–147 (1995). https://doi.org/10.1007/BF00838482
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00838482