Evaluation of a 5-day education programme in Type 1 diabetes: achieving individual targets with a patient-centred approach

• Published in: Diabetic medicine Vol. 31; no. 4; pp. 500 - 503
• Main Authors: Halbron, M., Sachon, C., Simon, D., Obadia, T., Grimaldi, A., Hartemann, A.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01-04-2014; Blackwell; Wiley Subscription Services, Inc; Wiley
• Subjects: Adult; Biological and medical sciences; Cohort Studies; Diabetes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - therapy; Diabetes. Impaired glucose tolerance; Education; Endocrine pancreas. Apud cells (diseases); Endocrinology and metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glycated Hemoglobin A; Glycated Hemoglobin A - analysis; Human health and pathology; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - prevention & control; Hypoglycemic Agents; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; Life Sciences; Male; Medical sciences; Middle Aged; Patient Care Planning; Patient Education as Topic; Patient Education as Topic - methods; Patient Satisfaction; Patient-Centered Care; Patient-Centered Care - methods; Patients; Prospective Studies; Quality of Life; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Young Adult; France; Endocrinopathy; Human; Immunopathology; Patient-centered approach; Evaluation; Obesity; Nutrition; Nutrition disorder; Autoimmune disease; Metabolic diseases; Teaching; Target; Type 1 diabetes; Education; Endocrinology; Nutritional status
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12372

Aims
To evaluate if a single inpatient education training programme can achieve individualized therapeutic targets.
Methods
Patients with Type 1 diabetes participating in a flexible intensive therapy programme were consecutively included in a prospective monocentric study. They all participated in the same education programme which had a patient‐centred approach. Before the intervention, patients were divided into three groups according to their main therapeutic target: Group 1, to decrease HbA1c concentration in patients with baseline HbA1c ≥ 58 mmol/mol (7.5%); Group 2, to improve quality of life and satisfaction with treatment in patients with baseline HbA1c < 58 mmol/mol (7.5%); and Group 3, to decrease the frequency of hypoglycaemic episodes in patients with severe or frequent hypoglycaemic episodes. Therapeutic targets were evaluated at 12 months. Quality of life and treatment satisfaction were evaluated with validated questionnaires completed at baseline and 6 months.
Results
In Group 1 (n = 74), the mean ± sd HbA1c concentration decreased from 75 ± 15 mmol/mol (9.0 ±1.4%) to 68 ±15 mmol/mol (8.4 ± 1.4%; P < 0.001), with 53% of patients experiencing a decrease in HbA1c concentration of at least 6 mmol/mol (0.5%), without weight gain or more frequent hypoglycaemia. In Group 2 (n = 12), patient satisfaction with treatment improved significantly (P < 0.0001). In Group 3 (n = 35), minor hypoglycaemia significantly decreased from a mean ± sd of 6.6 ± 4.7 to 3.2 ± 3.0 hypoglycaemic episodes/week (P < 0.001) and the incidence of severe hypoglycaemia dropped significantly from a mean ± sd of 2.31 ± 3.07 to 0.86 ± 2.46 episodes/patient/year (P < 0.001).
Conclusions
Many patients with different needs, who attended the same flexible intensive therapy education programme, which had a patient‐centred approach, were able to achieve their individual therapeutic targets.
What's new?
Education programmes for patients with Type 1 diabetes are of major importance in routine hospital care but patients have differing requirements. Not all patients have poor glycaemic control; some have good glycaemic control but experience severe or frequent hypoglycaemia, and some have none of these problems but would like to enlarge their food choice without increasing their HbA1c levels.
Our results suggest that a single inpatient education training programme, using a patient‐centred approach, could achieve patients' individual therapeutic targets.