Group Education & Older Diabetics

Group Education & Older Diabetics

Studies suggest that group-based diabetes education efforts can improve short- and long-term disease control among younger patients, but few analyses have explored the effect of these programs on older adults. Unfortunately, older adults are often underrepresented in diabetes edu­cation interventions because subtle changes in functional, cognitive, and psychosocial status can affect diabetes self-care. Many clinicians are reluctant to refer older patients to group education because they believe they may require more individual attention. In a secondary analysis study published in Diabetes Care, we examined whether community-dwelling older adults aged 60 to 75 with type 1 or type 2 diabetes would benefit from self-management interventions similarly to younger and middle-aged adults. We also tested if older adults benefited from group versus individual self-management interventions. Comparing Benefits of Diabetes Intervention In our analysis, patients were randomly assigned to one of three self-management interventions from diabetes educators that were delivered separately to those with type 1 or type 2 disease: 1. Highly structured group: Five group sessions were conducted over 6 weeks. Patients were taught how food, medication, and exercise affected A1C and actions they could take when levels were out of range. Between classes, patients set daily goals and practiced problem solving 2. Attention control group: Five group sessions were conducted over 6 weeks, but the sessions followed a manual-based standard diabetes education program. 3. Control group: One-on-one sessions were delivered for 6 months. During sessions, patients could receive any type of information they requested. According to our results, A1C levels improved equally in the older and younger groups at 3, 6, and 12 months with all interventions and for those...

Structuring Behavioral Interventions for Diabetes

Approximately 45% of patients with diabetes have not achieved an A1C level of less than 7%. Studies show that improved glycemia helps delay or prevent serious diabetes complications. However, poor adherence to medication prescriptions and selfmanagement and lifestyle recommendations can negatively impact glycemic control. Numerous adherence and lifestyle interventions for diabetes are available, but few have been effectively adopted in clinical practice. Testing a Novel Intervention In the December 12, 2011 Archives of Internal Medicine, my colleagues and I had a study published that assessed the efficacy of a 5-week, highly structured behavioral diabetes education program aimed at helping patients with poorly controlled diabetes improve glycemic control. Those who received this care (Arm 1) were compared with those who received curriculum-based standard group diabetes education without as much structure (Arm 2) and with those who received one-on-one education with diabetes educators for 6 months (Arm 3). All patients received supplies to check glucose levels, but those in Arm 1 were instructed to do so 6 to 8 times per day, write their levels in a log, and make notes about what they ate, if they exercised, and medications they took and when. Each week, Arm 1 diabetes educators reviewed the logs with the group to help patients understand the impact of these factors on glucose levels. Significant Benefits for Patients Findings from our study revealed that patients valued the approach of Arm 1 and reported that it helped them gain a better understanding of how the disease affected their body. Arm 1 patients were discouraged from using negative language and instructed to focus on problem-solving, planning ahead, and using...