Diabetes Metab J.  2012 Jun;36(3):222-229. 10.4093/dmj.2012.36.3.222.

Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program

Affiliations
  • 1Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea. ybahn@catholic.ac.kr
  • 2Department of Preventive Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Diabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes.
METHODS
Two hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program (< or =1 year [< or =1Y] vs. > or =3 years [> or =3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint.
RESULTS
The mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the < or =1Y group. Self-care behaviors, measured by scores for dietary habits (P=0.004) and physical activity (P<0.001), were higher at the endpoint in the < or =1Y group than in the > or =3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol).
CONCLUSION
Diabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes.

Keyword

Blood glucose; Diabetes mellitus, type 2; Education; Lifestyle modification

MeSH Terms

Behavior Therapy
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 2
Follow-Up Studies
Food Habits
Hemoglobins
Humans
Life Style
Logistic Models
Motor Activity
Reinforcement (Psychology)
Self Care
Surveys and Questionnaires
Blood Glucose
Hemoglobins

Figure

  • Fig. 1 Enrollment of patients with type 2 diabetes mellitus and the study design. Data represent the number (%) of patients.

  • Fig. 2 Changes in the scores of lifestyle behaviors during the study period with respect to the duration of diabetes before education. (A) Before education. (B) After education. Diet habit: Score 1, irregular diet with unlimited snacks; 2, irregular with intermittent snacks; 3, appropriate meal calories, regular diet with some snacks (>2 times/day or >300 kcal/day of excess intake; 4, appropriate meal calories, but a few snacks (≤1 time/day, or 100 to 300 kcal/day of excess calorie); 5, tightly controlled, with no intermittent snacks. Self-monitoring of blood glucose (SMBG): Score 1, never; 2, monthly; 3, weekly; 4, 3 to 4 times/wk; 5, ≥ daily. Physical activity: 1, never; 2, <30 min/wk (weekly); 3, <60 min/wk (1 to 2 times per week); 4, <120 min/wk (3 to 4 times per week); 5, daily, >150 min/wk. The P values denote the differences between the groups (≤1Y vs. ≥3Y) at the given time point.

  • Fig. 3 Mean hemoglobin A1c (A1C) levels in both groups. (A) Mean values during the study period. (B) Changes in A1C levels in both groups. Data are presented as the mean±standard deviation. ≤1Y, diabetes duration of less than 1 year before diabetes education or in recently diagnosed patients; ≥3Y, diabetes duration of more than 3 years before education. aP<0.05 vs. ≤1Y group.


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