Diabetes self-management education is not associated with a reduction in long-term diabetes complications: an effectiveness study in an elderly population

Rationale, Aims and Objectives — The efficacy of diabetes self-management education on glycaemic control, self-care behaviour and knowledge has been established by short-term studies in experimental settings. The objective of this study was to assess its effectiveness to improve quality of care and reduce the risk of long-term diabetes complications in unselected older patients with recently diagnosed diabetes in routine clinical care.

Methods — Using population-level healthcare administrative databases and registries, all patients aged ≥66 years in Ontario, Canada with diabetes for <5 years were identified. Self-management education programme attendees (n = 8485) in 2006 were matched with non-attendees using high-dimensional propensity scores, creating extremely well-balanced study arms. Quality of care measures and the long-term risk of diabetes complications were compared.

Results — Self-management programme attendees were more likely than non-attendees to achieve process measures of quality of care such as retinal screening examinations (75.3% versus 70.3%, adjusted relative risk 1.05, 99% confidence interval 1.03–1.08), and ≥2 glycated haemoglobin tests (57.5% versus 53.3%, adjusted relative risk 1.08, 99% confidence interval 1.05–1.11). However, with a median follow-up of 5.3 years, diabetes complications and mortality were not different between arms.

Conclusions — In real-world clinical care, self-management education for older patients with recently diagnosed diabetes was associated with modest improvements in quality of care, but no reductions in long-term clinical events.