Effectiveness of Education and Counselling Provided by a Multidisciplinary Team for Self-management in Patients with Diabetes Mellitus : A Case Study of a Tertiary-care Hospital in Thailand

Abstract

Objective: To determine the effect of patient education and counselling provided by a multidisciplinary team for patients with diabetes mellitus (DM) on control of blood glucose. Methods: A retrospective chart review was conducted. Patients who met the following inclusion criteria were included--1) patients diagnosed with DM type 2, 2) patients having a fasting blood glucose (FBG) > 300 mg/dL in the latest test along with FBG ≥ 170 mg/dL within 6 months before inclusion or hemoglobin A1C (HbA1C) ≥ 8% or estimated glomerular filtration rate (eGFR) at stage 3B, 3) patients having an ability to communicate in Thai, and 4) patients visiting an outpatient department at a tertiary hospital from February to May 2017. Experimental group received individual education and counseling for self-management of DM provided by a multidisciplinary team consisting of health educators, nutritionists and pharmacists. Control group received usual care. The outcomes were changes in HbA1C, proportion of patients with ≥ 1.0 mg% of HbA1C reduction at week 24, and complications occurred during the study, control of diet and coffee drinking, and medication adherence. Results: A total of 106 patients were include, with 48 in control and 58 in experimental group. HbA1C of control group was 0.67±2.19% lower than its baseline, while that for intervention group was 1.02 ± 1.58 % lower than its baseline. However, the difference was not statistically significant (P=0.353). The propensity score adjusted multiple linear regression indicated that intervention could decrease HbA1C level more than control (mean difference=-0.20% (95% confidence interval; -0.10 to 0.59) but not statistically significant. The proportion of patients with ≥ 1.0 mg% of HbA1C reduction at week 24 was similar among the groups (41.30% vs. 39.58%; P=0.851). Approximately 14.58% of patients in control group had hyperglycemia or diabetic ketoacidosis, while no patients in intervention group had adverse events. The patients in intervention group had lower amount of carbohydrate and coffee consumptions, and higher adherence rate compared to its baseline (P<0.05). However, we could not study the behavior changes in control group because of the nature of our study design. Conclusion: Patient education and counselling for DM self-management by a multidisciplinary team tends to improve blood glucose control compared to usual care, but with no statistically significant differences. However, the intervention tends to decrease adverse events, and improve patients’ behavior toward self-management in dietary control and medication adherence.