Self-Management Education

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Helen Jones RN, MSN, CDE Lori D. Berard RN, CDE Gail MacNeill BNSc, RN, MEd, CDE Dana Whitham RD, MS, CDE Catherine Yu MD, FRCPC, MHSc

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • Offer collaborative and interactive self-management education (SME) interventions as they are more effective than didactic SME.
  • Incorporate problem-solving skills for ongoing self-management of medical, social and emotional aspects of care into the traditional knowledge and technical skills content of educational interventions.
  • Design patient-centred learning to empower individuals to make informed decisions toward achievement of patient-chosen goals.
  • Individualize SME interventions according to type of diabetes and recommended therapy, the patient's ability and motivation for learning and change, and his or her culture and literacy level.
  • Provide ongoing SME and comprehensive healthcare collaboratively to make SME most effective.

Recommendations

  1. People with diabetes should be offered timely diabetes education that is tailored to enhance self-care practices and behaviours [Grade A, Level 1A (1-3)].
  2. All people with diabetes who are able should be taught how to self-manage their diabetes [Grade A, Level 1A (3)].
  3. SME that incorporates cognitive-behavioural educational interventions, such as problem solving, goal setting, and self-monitoring of health parameters, should be implemented for all individuals with diabetes [Grade B, Level 2 (2,4-6)].
  4. 4.Interventions that increase patient participation and collaboration in healthcare decision making should be used by providers [Grade B, Level 2 (3)].
  5. For people with type 2 diabetes, SME interventions should be offered in small group and/or one-on-one settings, since both may be effective [Grade A, Level 1A (7,8)].
  6. In both type 1 and 2 diabetes, interventions that target families' ability to cope with stress or diabetes-related conflict should be included in educational interventions when indicated [Grade B, Level 2 (9)].
  7. Technologically based home blood glucose monitoring systems may be integrated into SME interventions in order to improve glycemic control [Grade C, Level 3 (10,11)].
  8. Culturally appropriate SME, which may include peer or lay educators, may be used to increase diabetes-related knowledge and self-care behaviours and to decrease A1C [Grade B, Level 2 (12,13,14)].
  9. Adding literacy- and numeracy-sensitive materials to a comprehensive diabetes management and education program may be used to improve knowledge, self-efficacy and A1C outcomes for patients with low literacy [Grade C, Level 3 (15)].

Highlights of Revisions

  • Less focus on didactic teaching and greater focus on patient-centred learning.
  • Recognition of the need for culturally appropriate, literacy- and numeracysensitive materials and education.
  • Acknowledgement of the role of technologically based home monitoring systems.

References

  1. Minet L, Moller S, Lach V, et al. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Educ Couns 2010;80:29e41.
  2. Ellis S, Speroff T, Dittus R, et al. Diabetes patient education: a meta analysis and meta-regression. Patient Educ Couns 2004;52:97e105.
  3. Norris SL, Engelgau MM, Narayan KMV. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001;24:561e87.
  4. Kulzer B, Hermanns N, Reinhecker H, et al. Effects of self-management training in type 2 diabetes: a randomized prospective trial. Diabet Med 2007;24: 415e23.
  5. Weinger K, Beverly E, Lee Y, et al. The effect of a structured behavioral intervention in poorly controlled diabetes. Arch Intern Med 2011;171: 1990e8.
  6. Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns 2003;51:5e15.
  7. Rickheim PL, Weaver TW, Flader JL, et al. Assessment of group versus individual diabetes education: a randomized study. Diabetes Care 2002;25: 269e74.
  8. Deakin T, McShane CE, Cade JE, et al. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database System Rev 2005;2:CD003417.
  9. Armour TA, Norris SL, Jack Jr L, et al. The effectiveness of family interventions in people with diabetes mellitus: a systematic review. Diabet Med 2005;22: 1295e305.
  10. Jaana M, Pare G. Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract 2007;13: 242e53.
  11. Tildesley HD, Mazanderani AB, Ross SA. Effect of internet therapeutic intervention on A1C levels in patients with type 2 diabetes treated with insulin. Diabetes Care 2010;33:1738e40.
  12. Whittemore R. Culturally competent interventions for Hispanic adults with type 2 diabetes: a systematic review. J Transcult Nurs 2007;18: 157e66.
  13. Hawthorne K, Robles Y, Cannings-John R, et al. Culturally appropriate health education for type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized control trials. Diabet Med 2010; 27:613e23.
  14. Babamato K, Sey KA, Karlan V, et al. Improving diabetes care and health measures among Hispanics using community health workers: results from a randomized controlled trial. Health Educ Behav 2009;36: 113e26.
  15. Van Scoyoc EF, deWalt DA. Interventions to Improve diabetes outcomes for people with low literacy and numeracy: a systematic literature review. Diabetes Spectrum 2010;23:228e37.

 

Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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