One on One Teaching is the Best for Diabetic Care

“Know your enemy,” said Chinese military tactician Sun Tzu, and diabetics who put this into practice do better than those who know little about their condition.  Two recent studies have shown intensive education about diabetes management can help diabetic patients lower their blood glucose levels and minimize the risk of the deadly side effects of the disease.  Education is especially important in the case of diabetics who are not good at controlling their blood sugar by themselves.

However, although they can all have a positive effect, some educational interventions are better than others at producing results.  Best of all is one on one teaching of a patient by a trained nurse who gives him individual attention.

Diabetes can be a tricky disease to manage, with patients needing to take a lot of information on board in order to do all the right things to improve their condition.  As well as learning about how to calculate their insulin medication, they have to be aware about the nutritional content of the food they eat and the effect it can have on their blood sugar levels.  Without this knowledge they have far less chance of lowering their HbA1c glucose test results, which they should ideally aim to get below 7%.

Doctors know this, and encourage diabetic patients to accept coaching by attending courses at local health centers and hospitals, or at least taking home literature to read.

Recent studies of how well educational help can assist diabetics to manage their disease have included comparing intensive mobile phone coaching with an instructional video with a simple brochure.  The first group of diabetics, who were from poor and disadvantaged backgrounds and had poorly controlled blood sugar, received five telephone calls from a trained nurse and a film to watch.  However, surprisingly these people hardly did any better than a control group who were just given the 20-page brochure, without any other help. The study was carried out inCaliforniaby a team at Palo Alto Medical Foundation Research Institute.

Another recent study carried out inBostoncompared the results of a structured program of diabetes skills education involving 10 hours of coaching over three months with two programs involving less help.  The 222 diabetic patients were divided between the three programs and the results examined.  Sure enough, the group who got the intensive coaching showed the best improvements.  The team noted that coaching may have produced better results at the time, but that educational intervention did not seem to produce better results in the long term, and they felt that the social support side of the classes was probably important in motivating the patients.

One kind of education has did produce good results was individual teaching, which almost doubled the number of patients taking part who reduced their blood sugar HbA1c test results below the target 7%.  The study atMinneapolisdivided the patients into three groups, with one group getting individual one on one attention from a trained nurse, one getting group sessions with an educator and one receiving the usual care package.  In the group getting individual help the number scoring below 7% with their tests was 21%, compared to 13% and 12% in the other two groups.

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