Background: A number of diabetics do not meet targets for metabolic control, with high morbidity, mortality, and costs. Prevention is of fundamental importance to reduce the burden. Various approaches are used including patient self-management education program. Aim was to assess reproducibility and homogeneity of significant effect on metabolic control improvement in pilot high-quality standardized structured group education program implemented in education centers countrywide within 2 subsequent years.
Methods: An out-patient program including 4x2 hours of structured education lessons (self-monitoring; diet; exercise; foot care) was realized in 9 centers in 2016 and 10 centers in 2017. Overall 62 type 2 diabetics on insulin in 2016 and 58 in 2017 were included (comparable in age, gender, BMI). Metabolic parameters were measured at baseline and 6 months later. Reproducibility of group education effect on diabetes control between 2016 and 2017 as well as homogeneity of outcomes among centers were assessed by standardized statistical analysis.
Results: Proportion of individuals with comparably well controlled diabetes (HbA1c<60 mmol/mol) 6 months after the program increased significantly both in 2016 (26 to 45%, p=0.007) and 2017 (36 to 67%, p=0.001) in comparison with baseline. Mean HbA1c declined from 70.0±16.2 at baseline to 63.1±12.6 mmol/mol at 6 months (p=0.001) in 2016 and from 65.0±15.8 to 58.3±13.0 mmol/mol (p=0.001) in 2017. Likewise, for both years we observed significant decline in fasting plasma glucose, body weight reduction and decrease in systolic blood pressure as well as assessed homogeneity in diabetes improvement among centers.
Conclusion: Project demonstrated good reproducibility of significantly improved metabolic control and homogeneity among centers in 2 consecutive years. The model is helpful in discussion with health insurance companies on adequate reimbursement.
J. Jirkovska: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care, Lilly Diabetes, Novo Nordisk Inc.
Czech Diabetes Society