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

group” if their pretest score was Ͼ40%.
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:
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 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 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 hereby marked “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 randomized controlled trials. Diabetes References
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terol levels: subgroup analyses in the cho- lesterol and recurrent events (CARE) trial.
4. Selvin E, Marinopoulos S, Berkenblit G, 21. Hovland CI, Lumsdaine AA, Sheffield FD: control of risk factors for vascular disease age change. In Experiments on Mass Com- bin and cardiovascular disease in diabetes munication. Princeton, NJ, Princeton mellitus. Ann Intern Med 141:421– 431, diabetes. JAMA 291:335–342, 2004 12. Chuang LM, Tsai ST, Huang BY, Tai TY: 22. Rothman RL, DeWalt DA, Malone R, Bry- 5. Gaede P, Vedel P, Larsen N, Jensen GV, The status of diabetes control in Asia: a cross-sectional survey of 24 317 patients M, Pignone M: Influence of patient liter- intervention and cardiovascular disease in with diabetes mellitus in 1998. Diabet patients with type 2 diabetes. N Engl J Med program. JAMA 292:1711–1716, 2004 DIABETES CARE, VOLUME 30, NUMBER 6, JUNE 2007


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