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 with either diabetes type. At 12 months, A1C levels decreased by 0.72 percentage points for older patients in the highly structured behavior group and by 0.65 percentage points in the attention control group. For the younger cohort, A1C reductions were 0.55 and 0.43 percentage points, respectively. In addition, quality of life, distress, and frustration with self-care (among many other factors) improved in both older and younger groups at follow-up after receiving an intervention.
Structured Diabetes Education for Older Adults
There are several reasons why group settings can be beneficial for older patients. This educational strategy allows people to hear questions asked by others and to learn from their approaches. Older adults may also be more committed to the group about attendance and may enjoy the company. Our research adds to what is known about the positive impact of structured diabetes education. The key is to seize the opportunity by proactively partnering older adults who have the disease with diabetes educators.
Readings & Resources (click to view)
Beverly EA, Fitzgerald S, Sitnikov L, Ganda OP, Caballero AE, Weinger K. Do older adults aged 60 to 75 benefit from diabetes behavioral interventions? Diabetes Care. 2013 Jan 11[Epub ahead of print]. Available at: http://care.diabetesjournals.org/content/early/2013/01/08/dc12-2110.abstract.
Weinger K, Beverly EA, Lee Y, Sitnokov L, Ganda OP, Caballero AE. The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Arch Intern Med. 2011 Oct 10 [Epub ahead of print]. Available at: http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.502.
Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2:CD003417.
Suhl E, Bonsignore P. Diabetes self-management education for older adults: general principles and practical application. Diabetes Spectrum. 2006;19:234-240.
Weinger K. Keeping up with the elderly: implications for diabetes education. Diabetes Spectrum. 2006;19:194.
Miller CK, Edwards L, Kissling G, Sanville L. Nutrition education improves metabolic outcomes among older adults with diabetes mellitus: results from a randomized controlled trial. Prev Med. 2002;34:252-259.
Glasgow RE, Toobert DJ, Hampson SE, Brown JE, Lewinsohn PM, Donnelly J. Improving self-care among older patients with type II diabetes: the “Sixty Something…” Study. Patient Educ Couns. 1992;19:61-74.