ASSESSMENT OF GROUP VERSUS INDIVIDUAL DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT (DSMES) IN TYPE 2 DIABETES PATIENTS AT PRIMARY CARE UNIT AND DIABETES CLINIC, CHIANGRAI PRACHANUKHROH HOSPITAL

Abstract

ABSTRACT

BACKGROUND: Diabetes is a serious, chronic, common and costly disease. High glucose levels leads to multiple complications. One critical component of diabetes care is patient education. The effectiveness of Diabetes Self-Management Education and Support (DSMES) on patient outcomes has been well recognized.

OBJECTIVE: To compare the effectiveness of DSMES in either group or individual setting in ChiangraiPrachanukhroh Hospital.

METHODS: A retrospective cohort study ,of 98 subjects with poor controlled (HbA1C>9%) type 2 diabetes treated in DM Clinic and PCU during 2014-2016 was conducted. 49 DM2 patients in DM Clinic received individual DSMES until their HbA1C < 9% , 49 DM2 patients in PCU received three sequential sessions group DSMES every four months. Outcomes included changes in BMI, FBS, HbA1c, and medication regimen. Changes were assessed at baseline and after the 6-month, 12-month and 24 month DSMES sessions. Multivariate repeated measures analysis was used to control confounding baseline variables.

RESULTS: At baseline, patients in DM clinic compared to patients in PCU has higher HbA1C level (p=0.006), longer duration of diabetes (p=0.038) and used lesser number of oral hypoglycemic agents (p=0.017), significantly. Both educational settings had similar improvements in glycemic control. The difference in HbA1c improvement was marginally greater in subjects assigned to individual education versus individualized education (p =0.053).

CONCLUSIONS AND DISCUSSIONS: This study demonstrates that diabetes education delivered in an individual setting, when compared with a group setting, was equally effective at providing equivalent or slightly greater improvements in glycemic control