Modeling The Effect of Diabetes Education on Glycemic Control

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Abstract
The objective of this study was to identify the mechanisms by which diabetes education improves glycemic control. Study participants were 82 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program and again 6 to 12 months later. The research protocol included a glycosylated hemoglobin assay and self-reported frequency of two insulin administration events (shot skipping and dosage adjustment), self-monitoring of blood glucose (SMBG), and exercise. Those who did not improve any aspect of self-care reduced their mean glycohernoglobin frorn 9.7 to 9.0. Those who improved exercise or SMBG (but not both) reduced their glycohemoglobirt from 10.9 to 9.6. Those who improved both exercise and SMBG and those who improved insulin adntinistratiort had the lat-gest irttprovemertt in glycemic control, from 12.5 to 9.6. These findings suggest that if diabetes education can help patients improve self-care behanior, it cart bring about dramatic improvements in glycentic control. Improved insulin administration is the single most powerful way to improve glycemia, but improving other aspects of self-care also can produce substantial gains.