Patient diabetes education in the management of adult type 2 diabetes

102 Pages·2001·10.9 MB·English

by  Corabian, Paula, 1958-

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Alberta Heritage Foundation
for Medical Research
Patient Diabetes Education
in the Management
of Adult Type 2 D iabetes
Paula Corabian and Christa Harstall
February 2001
National Library Bibliotheque nationale
of Canada du Canada
HTA 23: Series A
Patient Diabetes Education
in the Management
of Adult Type 2 D iabetes
Paula Corabian and Christa Harstall
February 2001
© C opyright Alberta Heritage Foundation for Medical Research, 2000
This Health Technology Assessment Report has been prepared on the basis of available
information of which the Foundation is aware from public literature and expert opinion
and attempts to be current to the date of p ublication. It has been externally reviewed.
Additional information and comments relative to the report are welcome and should be
sent to:
Director, Health Technology Assessment
Alberta Heritage Foundation for Medical Research
3125 Manulife Place, 10180 - 1 01 Street
Edmonton, Alberta T5J 3S4
CANADA
Tel: [phone], Fax: [phone]
ISBN 1-896956-39-4
Alberta's Health Technology Assessment program has been established under the
Health Research Collaboration Agreement between the Alberta Heritage Foundation for
Medical Research and the Alberta Health Ministry.
Acknowledgments
The Alberta Heritage Foundation for Medical Research is most grateful to the following
persons for their comments on the draft report and for provision of information.
Ms. Peggy Dunbar, Coordinator, Diabetes Care Program of Nova Scotia, Halifax,
Nova Scotia
Dr. Alun Edwards, Colonel Belcher Hospital, Calgary, Alberta
Ms. Ann Fox, Director, Tri-Diabetes Education Centre, Toronto, Ontario
Dr. Heather Maclean, The Centre for Research in Women's Health, Toronto,
Ontario
Dr. Brucie McLeod, Georgetown, Ontario
Dr. Sam Sheps, Professor, Faculty of Medicine, University of British Columbia,
Vancouver, B.C.
Alberta Heritage Foundation for Medical Research l
Digitized by the Internet Archive
in 2016
https://archive.org/details/patientdiabeteseOOcora
Summary
• Formal patient education in diabetes self-management (referred to here as
patient diabetes education or PDE) at different levels of complexity and
comprehensiveness, has emerged from instruction by physicians, nurses, and
dieticians in physician's offices and hospitals.
• The past decade witnessed a s hift from traditional approaches of PDE to a
focus on patient-centered perspectives, self-efficacy, and empowerment
issues.
• The published reports on the effectiveness of PDE as a t ool to promote self-
management ina dults with type 2 d iabetes produced mixed results in terms
of improved metabolic control and reduced risks for diabetes-associated
complications in the long-term. The results are not directly comparable since
investigators have used different designs, PDE programs, patient
populations, sample sizes, follow-up periods, types of outcome and outcome
measures. Also, the inadequate data presentation limited the interpretation
of the available evidence.
• The long-term diabetes control outcomes of formal PDE when used to
promote self-management in adults with type 2 d iabetes have yet to be
defined and appropriate measures established.
• The available evidence did not permit to draw reliable conclusions on:
> which types of programs or what components are most effective in
improving the ability of adults with type 2 d iabetes to self-manage their
disease; or
> which category of patients might benefit most.
• This review confirmed results of p revious ones:
> there is no consistent pattern of effect across outcomes based on type of
intervention, length of educational intervention, core team composition or
type of educational setting; and
> there is no standard method to describe formal PDE programs and
interventions, thus making it difficult to replicate studies.
• Findings from qualitative research studies were useful in illuminating the
findings from quantitative research studies, by helping to understand better
the context in which formal PDE should be applied to be successful in
promoting self-management behaviors in adults with type 2 d iabetes.
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Patient diabetes education in the management of type 2 d iabetes in adults
• The administrators of formal PDE programs need to consider that the trends
in formal PDE delivery call for:
> an ongoing patient-centered PDE approach, described as a step-by-step
process which involves the diabetes care and education providers, the
patients and their caregivers;
> focus on meeting the patient's needs and overcoming patient's barriers to
self-management behaviors, and continuous reinforcement of p atient's
positive behaviors, besides transmission of knowledge and skills;
> the development of trustful patient-educator relationships and the
existence of g ood partnership with the other members of the diabetes
management team;
> measurement of PDE success in terms of both long-term outcomes and
short-term outcomes, regardless of PDE approach.
> data collected for each outcome by using a more standardized set of
validated instruments.
• None of the Canadian studies published over the last ten years met the
criteria in the working definitions and inclusion criteria for review. Canadian
investigators can build upon the research described in this report and should
attempt to overcome the methodological limitations of the reviewed studies.
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Contents
Acknowledgments i
Summary ii
Introduction . 1
Scope of the Report 3
SECTION 1:
Formal Patient Diabetes Education (PDE) 8
Evolution 8
Theories of learning and behavior 8
PDE programs 10
Available Evidence on the Effectiveness of Formal PDE 12
Meta analyses ..12
Primary quantitative studies 1 4
Systematic reviews and critical appraisals 17
Critical Appraisal of the Primary Research Studies 17
Limitations and data presentation 19
Discussion 20
Canadian Studies 20
SECTION 2:
Issues Associated with Diabetes Self-management 24
Patient compliance and regimen adherence 24
Barriers to diabetes self-management behaviors 25
PDE and behavioral change 30
Implications for the PDE Process 30
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Patient diabetes education in the management of adult type 2 d iabetes
SECTION 3:
Discussion 36
Quantitative research studies.. 36
Qualitative research studies 38
Conclusions 39
APPENDIXES:
Appendix A: Methodology 41
Appendix B: Methodological Quality of Critically Appraised Studies ....42
Appendix C: Meta analyses 45
Appendix D: Primary Quantitative Studies 49
Appendix E: Systematic Reviews 58
Appendix F: Canadian Studies 63
Appendix G: Details on Canadian Studies 67
Appendix H: Qualitative Research Studies 73
Discussion 8 2
References 83
TABLES:
Table 1: Meta analyses of educational interventions studies 48
Table 2: Primary studies on effectiveness of PDE 53
Table 3: Comprehensive and systematic reviews 61
Table 4: Canadian Studies.. 65
Table 5: Qualitative research studies 74
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