C l i n i c a l C a r e / E d u c a t i o n / N u t r i t i o n Gain in Patients’ Knowledge of Diabetes Management Targets Is Associated With Better Glycemic Control ADMALATHA BERIKAI, MD, MS BARBARA SAVOY, MS, RD, CDE
group” if their pretest score was Ͼ40%. ETER M. MEYER, PHD KELLY KOZIK, RD, CDE ASA KAZLAUSKAITE, MD, MS LEON FOGELFELD, MD
ers of a posttest score of Ն80 and 100%for the low and high baseline knowledgegroups, respectively. Patients with lower
Optimal glycemic, lipid, and blood Ն7%measuredwithin1monthofreceiv- thantheseposttestscoreswereclassified
as nongainers. The posttest score cutoff,
crovascular complications of diabetes (1–
these cardiovascular risk factors in indi-
the posttest score of 100% was chosen for
viduals with diabetes is far from optimal
(11,12). Lack of patients’ knowledge of
gain in the score. Patients with a pretest
the targets of diabetes care might be one of
ter the educational sessions, patients re-
score of 100% were classified as nongain-
the reasons for the low level of control of
ers if their posttest score was lower.
only 23–25% of individuals with diabetes
know what the target A1C level is (Ͻ7%),
(found in an online appendix, “ABC test,”
RESULTS — A total of 155 subjects
met the eligibility criteria, 94% had the
tients before (pretest) and after (posttest)
and 97% had type 2 diabetes. A total of 93
tion carried a score of 20%. The test was
classified as nongainers. Patient charac-
teristics including demographic variables,
ment from pretest to posttest was not the
same for all individuals. It was higher for
number of follow-up visits to the diabetes
RESEARCH DESIGN AND
patients with lower pretest scores and vice
METHODS — This is a retrospective
versa, as was also noted in other training
Association– certified Diabetes Center of
in relation to the baseline score. Subjects
new to diabetes therapy during the study,
were classified into “low baseline knowl-
Յ40% and “high baseline knowledge plus insulin (13.5 vs. 16.8%) at follow-
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
From the 1Division of Endocrinology, Rush University Medical Center, Chicago, Illinois; the 2Department of
Preventative Medicine, Rush University Medical Center, Chicago, Illinois; and the 3Division of Endocrinol-
ogy, John H. Stroger, Jr. Hospital, Chicago, Illinois.
Address correspondence and reprint requests to Leon Fogelfeld, MD, 1900 W. Polk St., Room 812,
Chicago, IL 60612. E-mail: [email protected].
at baseline (P ϭ 0.47) or at follow-up
Received for publication 3 October 2006 and accepted in revised form 12 March 2007.
(P ϭ 0.74), as shown in Table 1. Further-
Published ahead of print at http://care.diabetesjournals.org on 19 March 2007. DOI: 10.2337/dc06-2026.
more, there was no difference in the num-
Additional information for this article can be found in an online appendix at http://dx.doi.org.10.2337/
Abbreviations: DSME, diabetes self-management education.
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
87.5 vs. 86.4%; dual therapy 12.5 vs.
2007 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be herebymarked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
DIABETES CARE, VOLUME 30, NUMBER 6, JUNE 2007
Patients’ diabetes knowledge and glycemic control Table 1—Comparison of baseline and follow-up characteristics in knowledge gainers and
an odds ratio of 2.3 (95% CI of 1.1–5.0%,
nongainers P ϭ 0.028) after adjusting for baselineA1C, duration of diabetes, sex, ethnicity,BMI, and the number of visits to the dia-
than nongainers (20%, P ϭ 0.021). In the
the difference was not statistically signifi-
CONCLUSIONS — Our results showed
that the gain in the knowledge of the tar-
gets of diabetes care after receiving DSME
of target A1C levels. The difference in the
significant in the low baseline knowledge
group but not in the high baseline knowl-
results with their multidisciplinary diabe-
tervention patients achieved significantly
higher target A1C rates than control sub-
jects in the low literacy group but not in
be a good indicator of the impact of dia-
proved patients’ understanding of the im-
study is limited in that we did not evaluate
result of a combination of factors—the ef-
fect of the multidisciplinary intervention,
abetes care. In addition, about one-half of
Data are % or means Ϯ SD. *Pearson’s 2 (categorical variables). †Two-sample t test (normally distributed).
‡Mann-Whitney analysis (nonparametric). §Paired Wilcoxon analysis. ʈSubjects with a pretest score of
Յ40%. ¶Subjects with a pretest score of Ͼ40%. **Logistic regression.
low baseline knowledge should receive spe-cial attention in DSME programs, as knowl-
2.3% at baseline to 7.7 Ϯ 1.9% at 6.4 Ϯ
edge gain in this group can significantly
2.1 months follow-up (P Ͻ 0.001) with
gainers (46 vs. 29%, P ϭ 0.032). Knowl-
tional interventions need to be considered
Ͻ7%. The target A1C achievement was predictor of target A1C achievement with for individuals who do not gain adequate
DIABETES CARE, VOLUME 30, NUMBER 6, JUNE 2007
Berikai and Associates
tion by simple pre- and posttests may help
plications in type 2 diabetes: UKPDS 38.
number? Diabetes Educ 28:99 –105, 2002
14. Agrawal V, Korb P, Cole R, Barnes CS, Rhee
7. Collins R, Armitage J, Parish S, Sleigh P,
Acknowledgments — The members of the
Peto R, Heart Protection Study Collabora-
Diabetes Center of John H. Stroger, Jr. Hospi-
tal, and the faculty of the Masters of Science in
goal have better glycemic control. (Abstract)
Study of cholesterol-lowering with simva-
Clinical Research Program at Rush University
Diabetes 54 (Suppl. 1):298-OR, 2004
are gratefully acknowledged for their contri-
randomised placebo-controlled trial. Lan-
bution and suggestions. We thank Lucia Free-
Effectiveness of self-management training
in type 2 diabetes: a systematic review of
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FUSING & ATROPHY 1. HOW FUSING TAKES PLACE 2. FUSING VS. ATROPHY HOW FUSING TAKES PLACE Normally the mucous membranes are made to slide back and forth without sticking to one another, (such as in the mouth, even our internal organs) they have a 'slickness' to them, (a coating or covering,) without pulling on each other. Rub your tongue over the inside of your cheek and you'll