Diabetes Metab J.  2012 Dec;36(6):452-459. 10.4093/dmj.2012.36.6.452.

Education as Prescription for Patients with Type 2 Diabetes Mellitus: Compliance and Efficacy in Clinical Practice

• Kim MY
• Suh S
• Jin SM
• Kim SW
• Bae JC
• Hur KY
• Kim SH
• Rha MY
• Cho YY
• Lee MS
• Lee MK
• Kim KW
• Kim JH

• KMID: 2174371
• DOI: http://doi.org/10.4093/dmj.2012.36.6.452

Abstract

BACKGROUND
Diabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription.
METHODS
We retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis.
RESULTS
Among the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001) or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037). The hemoglobin A1c decreased greater in the compliant group (from 7.84+/-1.54 at baseline to 6.79+/-1.06 at 3 months and 6.97+/-1.20 at 12 months after prescription in the compliant group vs. from 7.74+/-1.25 to 7.14+/-1.02 and 7.24+/-1.24 in the non-compliant group; P=0.001). The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032).
CONCLUSION
In our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

Keyword

Diabetes mellitus, type 2; Education; Self care

MeSH Terms

Compliance
Diabetes Mellitus, Type 2
Disulfiram
Hemoglobins
Humans
Korea
Patient Compliance
Prescriptions
Retrospective Studies
Self Care
Disulfiram
Hemoglobins

Figure

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  Fig. 1 Enrollment of patients and the study design. Data represent the number of patients.

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  Fig. 2 Change in hemoglobin A1c levels over 1 year after education prescription. (A) Differences in hemoglobin A1c change according to the education completion (P=0.0013). The continuous line refers to the subjects who obeyed the physicians' prescription to get the education. The dotted line refers to the subjects who refused to get the education in spite of their physicians' prescription. (B) The change in hemoglobin A1c levels according to type of education after education prescription (P=0.605). (C) The hemoglobin A1c change according to number of years after education (P=0.565).

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  Fig. 3 (A) Differences in hemoglobin A1c change between the short duration group (P=0.032) and long duration group (P=0.183). (B) Change in hemoglobin A1c after education according to the duration of diabetes (P=0.002).

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