Diabetes is a chronic illness that requires the active participation of patients in daily self-care for them to maintain control over their metabolism. Education about diabetes has become accepted as an integral part of care for the person with diabetes (1). Several groups (2–5) demonstrated the positive effects of diabetes education by documenting reduced hospitalizations for acute complications of diabetes or improvement in measures of metabolic control, for example, fasting blood glucose, GHb, and blood pressure. Although these reports demonstrate the benefits of some diabetes education programs, many other diabetes education programs have not achieved such favorable results. For instance, Miller et al. (6) found that 45% of patients who had attended diabetes education programs failed all aspects of an evaluation; of those without any training, 67% failed. Whitehouse et al. (7) reviewed medical records of 178 patients who attended an outpatient follow-up program. These patients did not experience a lower incidence of ketoacidosis, foot infections, or hypoglycemia—conditions usually considered closely related to poor self-care. Korhonen et al. (8) found a highly significant improvement of metabolic control in IDDM patients immediately after intensive education; however, a similar change also occurred in the control group. In a more recent study by Bloomgarden et al. (9) in 1987, patient education improved knowledge, but did not appear to offer a benefit in overall glycemic control.

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