What is the impact of diabetes management education on patient confidence in assessing Hemoglobin A1c (HbA1c) levels, glucose management, dietary control, physical activity, and healthcare use?

From the Guidelines

Diabetes education is crucial for improving patient self-assessment of management skills, and it should be patient-centered, respecting and reflecting the patient's personal preferences, needs, and values, as emphasized by the standards of medical care for type 2 diabetes in China 2019 1. The study compared pre-education and post-education data on diabetes self-management among participants. After receiving diabetes education, participants showed improved confidence in assessing their HgA1C levels, with mean values improving from 8.8 to 7.4. Glucose management confidence increased from a mean of 6.6 to 7.4, and dietary control understanding significantly improved from 5.5 to 6.6. However, physical activity confidence slightly decreased (5.8 to 5.7), with a notable drop in mode from 7.7 to 4.4, possibly indicating participants realized they weren't exercising appropriately for diabetes management. Healthcare use confidence also declined post-education, with median values dropping from 8.3 to 6.6, suggesting participants recognized gaps in their self-care practices. Some key points to consider in diabetes management education include:

• The importance of self-monitoring of blood glucose (SMBG) in guiding treatment decisions and self-management, as highlighted in the standards of medical care in diabetes-2022 1 and 2020 1.
• The need for SMBG to be part of a comprehensive diabetes self-management education and support program, as it may help patients taking less-frequent insulin injections or altering diet, physical activity, and/or medications.
• The potential benefits of SMBG in reducing A1C levels, particularly when used in conjunction with a treatment adjustment program, as suggested by the 2022 standards of medical care in diabetes 1. Overall DSMQ scores showed mixed results, with median values increasing slightly from 6.3 to 7.0 but mode decreasing from 7.3 to 6.4. These findings suggest that while education improved participants' understanding in some areas, it also made them more aware of their knowledge gaps, potentially explaining the decreased confidence in certain domains. The results indicate that diabetes education impacts patient self-assessment of management skills, though more comprehensive education and larger sample sizes would be needed to fully validate these findings, as supported by the most recent and highest quality study on the topic 1.

From the Research

Comparison of Pre-Education and Post-Education HgA1C Levels

• The mean HgA1C levels decreased from 8.8 (retrospective) to 7.4 (post-education), indicating an improvement in glucose control 2.
• The standard deviation of HgA1C levels also decreased from 2.8 (retrospective) to 1.3 (post-education), suggesting a reduction in variability 2.
• However, the mode HgA1C levels increased from 6.6 (retrospective) to 7.4 (post-education), which may indicate that some participants had higher HgA1C levels post-education.

Analysis of DSMQ Areas

• Glucose Management: The mean glucose management confidence increased from 6.6 (retrospective) to 7.4 (post-education), indicating an improvement in glucose management skills 3.
• Dietary Control: The mean dietary control confidence increased from 5.5 (retrospective) to 6.6 (post-education), suggesting an improvement in dietary control skills 3.
• Physical Activity: The mean physical activity level remained stable at 5.8 (retrospective) and 5.7 (post-education), but the mode decreased from 7.7 (retrospective) to 4.4 (post-education), which may indicate a decline in physical activity confidence.
• Healthcare Use: The median healthcare management confidence decreased from 8.3 (retrospective) to 6.6 (post-education), suggesting a decline in healthcare management confidence.

Overall DSMQ

• The median DSMQ score increased slightly from 6.3 (retrospective) to 7.0 (post-education), but the mode decreased from 7.3 (retrospective) to 6.4 (post-education), indicating mixed results 4.
• The education provided to participants may have been just a small sample of what they needed to know, and more education may be necessary to increase overall DSMQ scores 5.
• Participation in structured diabetes self-management education programs has been shown to be associated with improved self-management behavior, including following a diet plan, self-monitoring of blood glucose, and foot self-examination 6.