Structured diabetes education outcomes: looking beyond HbA_1c. A systematic review

Abstract

Diabetes education aims to equip people with diabetes with positive self‐care behaviours and management strategies to improve glycaemic control. The preferred outcome measure of education effectiveness is often HbA1c reduction. However, the move towards person‐centred education has led to renewed calls to capture associated behavioural and psychosocial change. The aim of this study was to review indicators of diabetes education efficacy in light of the growing emphasis on person‐centric care. A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus databases, from January 2006 to December 2016, was conducted. Studies meeting the inclusion criteria, focusing on diabetes education effectiveness primarily measured using HbA1c, were selected. Twenty‐three studies were included, comprising 6747 participants. They yielded mixed results, with 13 studies reporting significant reductions in HbA1c following intervention. Thirteen studies assessed multiple behavioural and psychosocial measures as secondary outcomes with significant, positive changes in these outcomes following intervention. Studies utilising diabetes‐specific measures yielded positive results. It was concluded successful diabetes education involves changing participant cognitions and behaviours. Changes in behavioural and psychosocial aspects should inform education effectiveness. Development of effective diabetes education programmes requires better understanding of how they affect behavioural and psychosocial change, facilitating glycaemic control. Copyright © 2019 John Wiley & Sons.

Improved blood glucose control, cardiovascular health and empowerment in people attending X‐PERT structured diabetes education

“…In the current analysis, empowerment score increased by 20%, indicating a greater degree of confidence in the participants' perceived ability to manage their own health. Other analyses of SDE have also seen improvements in empowerment-related outcomes, 9,16 supporting this finding. It is likely that increased feelings of empowerment are at least partly responsible for the observed improvements in a range of health markers, but, as noted in the limitations below, it is not possible to assess this directly within the current audit.…”

Overcoming Barriers to Injectable Therapies: Development of the ORBIT Intervention Within a Behavioural Change Framework

“…More specifically the review found that successful diabetes education relied on facilitating change in participant cognition and behaviours, with psychosocial and behavioural change central in successful interventions. The review also confirmed diabetes education was more effective when led by Health care professionals (HCPs), with peer input, delivered in a group setting (40).…”

“…The COM-B system allowed for clear As noted in the Results, the newly developed ORBIT intervention will allow for delivery of the identified behavioural change techniques to people with diabetes prior to commencing injectable treatment. In line with the translation of the behavioural change techniques, best practice guidelines and clinical guidelines will be used to guide same (20,33,40). Responding to this, the intervention should be delivered in a group setting, led by a trained HCP (Diabetes Specialist Dietitian), with opportunity for peer discussion and support.…”

The Effects of Diabetes Self-Management Education on Quality of Life for Persons With Type 1 Diabetes: A Systematic Review of Randomized Controlled Trials

“…23 Similarly, significant positive changes in behavioral and psychosocial outcomes such as diabetes knowledge, understanding, and condition management have also been reported. 24 Concerning cost-effectiveness, strong evidence exists in favor of DSMES compared to usual care. 25 Research has demonstrated that diabetes education significantly contributes to the reduction of risk for development of diabetes-related complications.…”