The importance of education in people with type 2 diabetes
A patient-centred approach to medicine is becoming an integral part of general practice, particularly
in areas such as diabetes care – Dr Roger Gadsby continues the Diabetes Initiative - Take Control, by discussing good education techniques and the benefits of supporting patients' personal care plans
The diabetes national standards framework (NSF) emphasises the need to develop a patient-centred diabetes service in which health professionals working together in teams, educate and empower people with diabetes to care for their condition1.
Specifically standard 3 states:
"All children, young people and adults with diabetes will receive a service which encourages partnership in decision making, supports them in managing their diabetes and helps them adopt and maintain a healthy lifestyle. This will be reflected in an agreed and shared plan in an appropriate format and language. Where appropriate, parents and carers should be fully engaged in this process."
NICE has recently published a review on education in diabetes. It recommends that structured patient education is made available to all people with diabetes at the time of initial diagnosis, and then as required on an ongoing basis, based on a formal, regular assessment of need.
The document says there is insufficient evidence currently available to recommend a specific type of education or provide guidance on the setting for, or frequency of, sessions. But it does say that to achieve maximum effectiveness, educational interventions should reflect established principles of adult learning2.
Benefits of education
Research has shown patient satisfaction and knowledge improve when lifestyle interventions in type 2 diabetes are delivered by primary care staff who have been trained to take a patient-centred approach3.
The NSF says there is good evidence that structured education can improve knowledge, blood glucose control, weight and dietary management, physical activity and psychological well-being, particularly when this is tailored to the needs of the individual1.
It also states that personal care plans and patient-held or patient-accessed records can facilitate self-care.
Education in the practice
Education and empowerment are beginning to take a much more pivotal role in diabetes care. This means that education, often given by practice nurses, will need to become more formalised and documented.
It also needs to be supported by suitable literature to give to the person with diabetes.
The level and pace of learning varies between individuals and supplying too little information or inundating the person with too much information are equally disastrous. Good education techniques include:
lFocusing on the person's experience and previous knowledge
lLinking specific knowledge or skill with general therapeutic objectives
lTrying to enhance the person's understanding.
Education is enhanced if verbal education is backed up by written information.
In my practice we give people newly diagnosed with type 2 diabetes the Diabetes UK publication Diabetes for beginners, living with type 2 diabetes which offers a comprehensive overview of their condition and helps to introduce them to Diabetes UK.
It is vital that people living with diabetes receive continuing education and information about new developments in diabetes care. An educational update should therefore be part of the annual review process. Some practices have run open evenings or Saturday-morning events to which all people with diabetes and their carers are invited.
These events include talks, demonstrations, and information stands. Others have organised lunchtime meetings for small group education sessions on specific topics.
There are plans for significant investment and development of information technology by the NHS for chronic disease management. Such investment is needed to enable the ideas of electronic patient-care plans and electronic patient records to be turned into reality. They have huge potential as aids to education and empowerment
and could have a significant impact on care.
Our current paper-based systems seem to be of limited use as they are frequently lost or forgotten by people with diabetes when they attend for review.
Education and empowerment
Education and empowerment are key means of optimising the care of people with type 2 diabetes. If people know their role and responsibility in monitoring their care, if they appreciate the importance of reaching diabetes targets, and attend regularly for review, they are more likely to stay healthy and avoid the complications associated with poor control of this condition.
Roger Gadsby is a GP in Nuneaton and senior lecturer in primary care at the University of Warwick – he was an adviser to
NICE on its diabetes guidelines
1 Department of Health. National service framework for diabetes: standards. DOH: London, 2002
2 NICE Technology appraisal 60. Guidance on the use of patient education models for diabetes. NICE: London, April 2003
3 Kinmonth AL, Woodcock A, Griffen S, Spiegal N, Campbell MJ. Randomised controlled trial of patient-centred care of diabetes in general practice: impact on current well-being and future disease risk. Br Med J 1998; 317: 1202-08
Further information and patient information leaflets are available
from Diabetes UK Careline
Telephone: 020 7636 6112