Chronic Disease

Empowerment approach to diabetes education works better than the traditional didactic approach

Patient education is an integral component of high-quality diabetes care. Diabetes educators place particular emphasis on patients understanding the clinical importance of three key metabolic markers: hemoglobin A1c (a measure of average blood-sugar levels over time), systolic blood pressure, and low density lipoprotein (LDL) cholesterol values (the diabetes "ABCs"). Diabetes education related to the diabetes ABCs remains wedded to traditional didactic approaches in which experts "teach" the relevant information and provide recommendations to patients about their self-care. This is contrasted to an empowerment approach that places knowledge and understanding of the ABCs within the context of personalized goal-setting, skill-building, and one's daily roles.

In a comparative effectiveness study of these two methods of diabetes education, a team of Houston-based researchers discovered that participants in the empowerment group were significantly more likely to accurately recall the clinical meaning of the diabetes ABCs than were patients in the traditional education group. Three months later, they were also more likely to recall accurately their personal ABC values and a clinically reasonable target level for their ABC values than those in the traditional education group.

The empowerment intervention consisted of 4 group clinic sessions (8-10 patients per group) led by an internist, which focused on participant awareness of the diabetes ABCs, goal setting, action planning, and active communication with one's physician. The participants also received 10 minutes of one-on-one time with a study clinician after each hour-long session. A key strategy involved introducing the diabetes ABCs by mapping it to a weather prediction concept, presenting various levels of A1c, systolic blood pressure, and LDL cholesterol as being consistent with a "sunny," "partly sunny," or "stormy" diabetes "forecast."

Another strategy, drawing from team-based learning methods, aimed to give participants active hands-on practice in applying ABC values to cases that simulated real-world complexity. The 41 participants in the traditional diabetes education group received a 2-hour didactic group session on diabetes self-management followed by a 5-10 minute individual review of each participant's current diabetes ABCs. Both group and individual sessions were conducted by a nurse educator and followed American Diabetes Association patient education guidelines. All participants in the study were patients receiving diabetes care from various primary care clinics in a single regional Veterans Affairs Medical Center. This study was supported by the Agency for Healthcare Research and Quality (HS16093).

See "Knowing the ABCs: A comparative effectiveness study of two methods of diabetes education," by Aanand D. Naik, M.D., Cayla R. Teal, Ph.D., Elisa Rodriguez, B.S., and Paul Haidet, M.D., in the February 5, 2011 Patient Education and Counseling (epub ahead of print).

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