Background

Diabetes is a chronic and progressive disorder that has an impact on almost every aspect of life. Type 2 diabetes is characterised by insulin resistance and relative insulin deficiency. It is commonly linked to being overweight or obese, and to physical inactivity. Type 2 diabetes primarily affects people over the age of 40 years and is becoming more common.

The basic targets in the treatment of diabetes are the normalisation of blood glucose levels, blood pressure control and lipid management, and studies have shown that good diabetic control is associated with a significant reduction in the risk of a number of complications. Control of diabetes is affected by both lifestyle factors and by pharmacological treatments and the management of diabetes is largely the responsibility of those affected. Supporting self-care is a crucial aspect of any diabetes service, and national guidance recommends structured education as fundamental to this.

The aim of patient education is to empower patients by improving knowledge, skills and confidence, enabling them to take increasing control of their condition. Structured educational programmes for diabetes self-management are often multifaceted interventions providing information and also management skills around diet, exercise, self-monitoring and medication use.

This review is an update of a previous systematic review which concluded that the diversity of the educational programmes for Type 2 diabetes did not yield consistent results. Some of the included trials reported significant improvements in metabolic control and/or quality of life or other psychological outcomes; however, many others did not report significant effects of educational interventions.

Objective

The objective was to examine the clinical effectiveness of patient-education models for adults with Type 2 diabetes.

Methods

A systematic review of the literature on educational methods in diabetes was undertaken. This was an update of a previous systematic review.

Results

Discussion

Overall, the results of educational interventions aimed at patients with Type 2 diabetes are difficult to interpret due to differences in the interventions, the populations, the study designs and the outcomes reported. There is little evidence to suggest whether and how educational programmes might currently be directed to achieve maximal benefit for patients with Type 2 diabetes. Multi-component educational interventions appear to have better effects on outcomes than those focused on particular aspects of diabetes self-care alone, and this is currently reflected in national guidance for diabetes education.

There are a number of issues around the complexity of the intervention, the possibility of confounding, and methodological issues around study designs which need to be taken into account in any interpretation of the results of this review.

The review has a number of strengths which should minimise bias: a research protocol defined the research question and the inclusion criteria; consistent methods of critical appraisal were applied; and the work was informed by an advisory group. Limitations of the review are that, owing to time and resource restrictions, authors of trials were not contacted for further information. Also, perhaps due to publishing word length limits in the primary literature, details of some trials were not reported. It is unlikely, however, that these limitations would have made a difference to the overall results of the review.

Conclusions

Publication

• Loveman E, Frampton GK, Clegg AJ. The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review. Health Technol Assess 2008;12(9). [PubMed: 18405469]

NIHR Health Technology Assessment Programme

The Health Technology Assessment (HTA) Programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.

The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'.

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The research reported in this issue of the journal was commissioned by the HTA Programme as project number 06/47/01. The contractual start date was in November 2006. The draft report began editorial review in May 2007 and was accepted for publication in October 2007. As the funder, by devising a commissioning brief, the HTA Programme specified the research question and study design. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the referees for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

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