Learning Together: Group-Based Training for Diabetes Self-Management
by tony sheng
Self-management skills are vital for all patients with type 2 diabetes and are effective in helping individuals take control of their diabetes, but the most effective way to learn such skills remains unclear. In recent years, more and more patients turned to group-based programs for their diabetes education. In this article (published in the Cochrane Database of Systematic Reviews), entitled “Group based training for self-management strategies in people with type 2 diabetes mellitus,” Dr. Trudi Deakin and her colleagues sought to find out just how effective these programs are. Their study looked to see if the programs helped participants improve their lives in the short-term (four to six months) and long-term (more than 12 months) compared to traditional one-to-one visits with health professionals. They were also interested in learning what characteristics of group-based programs were most effective, specifically looking at the setting (primary/secondary care), the educator (physician, nurse, dietitian, other health professional, or peer educator), and the duration/intensity of the group-based program.
The authors analyzed the results of 14 previous publications describing 11 studies including 1,532 participants. Three types of outcomes were tracked: Clinical outcomes such as A1c and fasting blood glucose, lifestyle outcomes such as diabetes knowledge, and psychosocial outcomes such as quality of life and patient empowerment/self-effectiveness in care.
The analysis showed that participants in group-based diabetes education programs showed significant improvements in clinical, lifestyle, and psychosocial outcomes. Patients in such programs showed strong declines in A1c by 1.4% at four to six months, by 0.8% at 12-14 months, and by 1.0% at two years, as well as drops in fasting blood glucose levels by 21.6 mg/dL at 12 months. What’s more, patients lost weight, losing an average of 3.5 lbs at 12-14 months – systolic blood pressure improved as well at four to six months by 5 mmHg. Participants in the group-based diabetes programs demonstrated significant improvements in their knowledge of diabetes, and one in five patients could expect to reduce use of diabetes medications. Lastly, the authors suggested that patient self-empowerment improved for patients in group-based programs in both the short and long-term.
Overall, Dr. Deakin and her colleagues confirmed the benefits of group-based educational programs – participants improved on clinical, lifestyle, and psychosocial outcomes. However, the researchers were unable to determine which characteristics were most important in the programs. No evidence was found to suggest that programs delivered in either primary or secondary care were more effective; furthermore, the authors could not discern whether programs were more effective when delivered by a physician, dietitian, or nurse, as long as the health professional was trained to deliver the program. Lastly, the size of the program (4-6 versus 16-18 participants) or duration did not seem to alter the effectiveness of the education. We expect further research to shed some light on what makes a group-based program most effective, but for now it is good to know that in general, we can attend our group-based diabetes education programs with the confidence that their benefits are clinically proven.
