Diabetes Education Seems to Help Improve Blood Sugar Control

Behavioral interventions, such as changing negative thinking, may offer even greater benefits

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MONDAY, Oct. 10 (HealthDay News) -- Three new studies show that diabetes education and behavioral interventions can help lower blood sugar levels in people who are having trouble managing their diabetes.

Each study looked at different types of educational and behavioral interventions and found some improvement in long-term blood sugar control. The results are published in the Oct. 10 online edition of the Archives of Internal Medicine.

"Diabetes education is fundamental. And, the time and effort spent with patients relates nicely to better outcomes," said Dr. Joel Zonszein, director of the clinical diabetes program at Montefiore Medical Center in New York City. "In these studies, the strategy is a little bit different in each, but it shows that education works."

But, he added, it's important to tailor the education strategy used to the patient population. What works for people with type 1 diabetes won't necessarily work well for people living with type 2 diabetes. People who already have complications from diabetes likely need more intensive education and follow-up than would people who have relatively well-controlled diabetes, said Zonszein.

One study compared an intervention that combined aspects of cognitive behavioral strategies with standard diabetes education in both group and individual settings. Cognitive behavioral strategies help identify and change negative thinking that can lead to bad outcomes.

For example, in diabetes education, a behavioral strategy might be to get people to stop thinking of blood glucose levels as either 'good' or 'bad.' "We don't allow labeling. Those numbers are information, and all information is valuable," said the study's lead author, Katie Weinger, an investigator in behavioral research at the Joslin Diabetes Center in Boston.

Instead of thinking you've been bad if you get a high reading, Weinger suggests thinking about what might have contributed to that number, what you can do to get the number down now and what you can do differently in the future to keep that from happening again.

Her study included 222 adults who'd been struggling with their diabetes management for years. Fifty-one percent of the study volunteers had type 2 diabetes and 49 percent had type 1 diabetes.

At the start of the study, the average hemoglobin A1C (HbA1C) was 9 percent. HbA1C, or A1C, is a long-term measure of blood sugar levels. It measures about two to three months of average blood sugar levels. In general, the target for people with diabetes is to get below 7 percent.

People in the structured behavioral group had an A1C reduction of 0.8 percent, while the A1C of those in standard group education dropped by 0.4 percent. People in the individual standard education group also saw a 0.4 percent reduction.

The second study compared group education, individual education and no assigned education. The study included 623 people with type 2 diabetes from Minnesota and New Mexico. At the start of the study, the average A1C was above 7 percent.

After the study intervention, more people in the individual education group -- 21.2 percent -- had an A1C below 7 percent, compared with 13.9 percent in those in group education and 12.8 percent for those with no specific education.

The final study included 201 people -- mostly black or Latino, and most living in poverty -- having trouble with diabetes management. The average A1C at the start of the study was 9.6 percent.

Study participants received a 24-minute video with a workbook and five sessions of telephone coaching from a diabetes nurse, or a 20-page brochure from the U.S. National Diabetes Education Program. The average A1C dropped by 0.5 percent, but the researchers found no difference between the two groups.

The bottom line, said Weinger, is "for people who are struggling with self-management, help is available from your medical team. There are people trained and able to support and help you. Diabetes is difficult to manage alone."

Zonszein added that education shouldn't just occur at one time. There needs to be reinforcement of education from time to time.

Both Weinger and Zonszein said that Medicare generally approves up to 10 hours of diabetes education, and that many insurers follow Medicare guidelines.

SOURCES: Katie Weinger, Ed.D., investigator, behavioral research, director, Center of Innovation in Diabetes Education, Joslin Diabetes Center, and assistant professor, Harvard Medical School, Boston; Joel Zonszein, M.D., director, clinical diabetes program, Montefiore Medical Center, New York City; Oct. 10, 2011, Archives of Internal Medicine, online

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