August 15, 2014

Diabetes Education Better in a Group or Individually?

The Certified Diabetes Educators could learn from this study. I doubt they would see the value, as they like to work on an individual basis.

While the study was done in Ontario, Canada, it was carried out in a real-world situation and involved more than 75,000 patients. The only real flaw was they were unable to distinguish type 1 from type 2 diabetes, so the analyses could not be stratified by diabetes type. "However, the overwhelming majority of patients with diabetes in the population have type 2," they observe.

The study examining individual counseling for self-care in patients with diabetes vs. group education has found that the latter is associated with better outcomes. Senior author Baiju Shah, MD, PhD, of the Institute for Clinical Evaluative Sciences, Toronto, Ontario said, “We wanted to investigate in our population cohort what the differences were, based on individual appointments vs. the group-class approach, recognizing that the ministry of health and payers are pushing toward group programs because they're cheaper — you can treat more people with the same staff. We wanted to look at whether there was a clinical justification for that."

They were pleased to find that not only is group education more efficient in terms of resource utilization, it actually leads to better care and better patient outcomes, so it's a win-win situation: you can save money and improve care. "There's been a little bit of clinical-trial data that compare different ways of delivering diabetes education, but there really hasn't been very much literature published in this area," Dr. Shah explained.

The study did find that those patients participating in group classes were less likely to visit the emergency room, to be hospitalized for hypo- or hyperglycemia, or to develop foot ulcers. Those in group-therapy were also more likely to have adequate HbA1c and lipid testing. Unfortunately, they were more likely to use statins than those in one-on-one care.

The research is published by Jeremiah Hwee, MSc, also of the Institute for Clinical Evaluative Sciences, and colleagues in the May/June issue of the Canadian Journal of Public Health.

The researchers identified all patients in Ontario who attended diabetes education programs in 2006 and were grouped according to the type of program they attended. Individual appointment numbers = 55,761
Group appointment numbers = 12,234
Mixture of both = 9,829

The diabetes self-education was provided by nurses and dietitians. The size of the group classes was generally five to 10 patients plus family members. There were some centers in smaller towns where the group program would be run once a month and all patients in the town with diabetes would attend.

The study used secondary data and had no direct access to patients, but other studies have been published suggesting visits tend to be longer. Many of these group sessions were a full day or half a day compared to 20 to 30 minutes for individual counseling.

Previous research has shown that the information received from group classes is rated as more useful by patients than that received at individual classes. It is also known that discussing diabetes with others can be very important and peer-to-peer interaction can reinforce what is learned.

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