Treatment--education.

The educational model which proposed knowledge improvement as a necessary condition for behaviour change (or increased compliance!) is wrong. It ignores the reality that patients fail to comply for many reasons, the least of which is insufficient information. This is not to say that group programmes, or certain types of individual intervention, are not effective in producing change in variables other than factual knowledge, particularly psychosocial factors. There is increasing evidence that formal education programmes are associated with changes in attitude, which may be more a result of the interaction between participants than a response to educational content, and that it is these attitudinal changes which are the precursors to behavioural change. The initial enthusiasm of the medical community for diabetes education as the solution to the major problem of non-compliance has now been replaced by a healthy skepticism. Diabetes education, by itself, has little to offer the patient whose metabolic control is inadequate. The effectiveness of formal education programmes in patients with compromised metabolic control is limited to the few cases where specific information, or a general understanding of diabetes in a newly-diagnosed patient, is lacking. Information deficit is a specific diagnosis with a specific remedy and in many cases the most efficient treatment may be formal education. For the vast majority of patients, however, the information gained from attending traditional diabetes education programmes has very limited implications for behaviour change.