Modeling the effect of diabetes education on glycemic control.

The objective of this study was to identify the mechanisms by which diabetes education improves glycemic control. Study participants were 82 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program and again 6 to 12 months later. The research protocol included a glycosylated hemoglobin assay and self-reported frequency of two insulin administration events (shot skipping and dosage adjustment), self-monitoring of blood glucose (SMBG), and exercise. Those who did not improve any aspect of self-care reduced their mean glycohemoglobin from 9.7 to 9.0. Those who improved exercise or SMBG (but not both) reduced their glycohemoglobin from 10.9 to 9.6. Those who improved both exercise and SMBG and those who improved insulin administration had the largest improvement in glycemic control, from 12.5 to 9.6. These findings suggest that if diabetes education can help patients improve self-care behavior, it can bring about dramatic improvements in glycemic control. Improved insulin administration is the single most powerful way to improve glycemia, but improving other aspects of self-care also can produce substantial gains.