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People with diabetes more likely to access educational programs that encourage better self-management of their illness if they are receiving regular primary care


A new study has found that people with diabetes who did not have access to a family physician were less likely to seek education and counseling aimed at helping them manage their condition more effectively compared to those who received regular primary care. Those who attended such special diabetes education programs were more likely to go for retinal screening which is aimed at detecting and preventing vision loss, a serious complication of poorly controlled diabetes.

The aim of the study, led by Dr. Baiju R. Shah, a scientist at the Institute for Clinical Evaluative Sciences (ICES), was to identify predictors of attendance at a diabetes education centre (DEC). These centres, located throughout the province, provide free classes and support designed to help people with diabetes learn more about their disease, including how best to manage their condition and thus prevent long-term complications such as cardiovascular and kidney disease, nerve damage and vision loss.

“We know that self-management, which is the purpose of DEC programs, is an essential component of care for people with diabetes,” says Dr. Shah, who conducted the study with ICES scientist Dr. Gillian Booth who is also a researcher at the Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto. “But we wanted to know whether attendance at DEC programs could be linked to better quality of care for people with diabetes.”

Previous clinical trials have found that attending such programs can lead to improvements in knowledge, dietary habits, weight, glucose monitoring frequency and better control of blood glucose levels. However, relatively little “real world” research has been done to see how diabetes self-management education changes quality of care, says. Dr. Shah, an endocrinologist at Sunnybrook Health Sciences Centre.

Between August 2003 and December 2004, 781 adults diagnosed with diabetes for at least two years were recruited by staff at participating pharmacies across the province. They were asked to complete a written survey about their health, including whether or not they had attended a DEC program in 2002. These data were linked with other provincial healthcare data—for example, whether they had been hospitalized for a diabetes-related problem, their use of emergency departments and any visits made to physicians and optometrists.

The study found that 30 percent of survey participants reported having attended DEC classes in 2002. Those most likely to attend classes were those with a shorter duration of diabetes, and those receiving regular primary care or care from a diabetes specialist. People with diabetes who had attended a DEC were more likely to receive a retinal screening examination in the following two years than those with diabetes did not attend.

”This suggests that DECs are not being used as a substitute provider of diabetes care by people lacking regular physicians,” says Dr. Shah. “It also suggests that there may be barriers to accessing DECs in parts of the province with lower physician supply, and that people with diabetes may not be self-referring to DECs. It might be possible to design community-based interventions aimed at promoting and increasing public awareness and use of these services.”

Drs. Shah and Booth add that more research is needed to determine whether self-management education in routine clinical care can lead to sustained improvements in quality of life, morbidity and mortality for people with diabetes.

The study was partially funded by a grant from the Canadian Diabetes Association.

”Predictors of effectiveness of diabetes self-management education in clinical practice” was published in the January, 2009 issue of Patient Education and Counseling (Volume 74, Issue 1, Pages 19-22).

  • About diabetes education centres (DECs)
  • There are approximately 220 diabetes education centres (DECs) in Ontario. The programs are largely government-funded and available to Ontarians free of charge. They are usually staffed by nurses and dietitians but may also include the services of physicians, social workers, clinical psychologists, chiropodists, pharmacists and/or physiotherapists. Most DECs allow patients to attend without a physician referral, although many attendees are referred by their family physicians or by a diabetes specialist. Most diabetes education is delivered through short-term, structured group programs which help people with diabetes effectively manage their disease. This includes advice on regular monitoring of blood glucose levels, advice about diet and exercise, and information on the importance of controlling other health problems such as high blood pressure and high blood lipids (cholesterol). The goal of effective self-management is to improve quality of life for people with diabetes and prevent serious complications associated with poorly controlled diabetes which include cardiovascular and kidney disease, nerve damage and vision loss.
  • About ICES
  • The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and is a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. ICES is supported by a core grant from the Ontario Ministry of Health and Long-Term Care.


  • Nadia Radovini
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