A randomized trial comparing intensive and passive education in patients with diabetes mellitus

Patient education is a cornerstone of treatment in diabetes mellitus, but there is not unanimity of opinion as to how it should be delivered.

To determine whether a single, intensive group educational program would improve glycosylated hemoglobin (HbA(1c)) levels when compared with passive education.

A total of 106 patients with HbA(1c) levels greater than 8.5% were randomized to either an intensive (n = 50) or a passive education (n = 56) group. The intensive education group received 3.5 days of a structured curriculum involving a physician, nurse, nutritionist, pharmacist, exercise physiologist, and a social worker. The passive education group received material sent by mail every 3 months providing basic information on topics related to diabetes management. Patients continued care with their diabetes care provider during the study period. Levels of HbA(1c) were measured at baseline and 3, 6, and 12 months after randomization. A matched control group of individuals who declined participation also had HbA(1c) levels measured at baseline and 12 months.

Mean +/- SD HbA(1c) levels fell significantly (P<.001) from baseline (9.9% +/- 1.3%) in both the intensive (-2.0%) and passive (-1.9%) education groups at 12 months, and there was no difference between the groups at any evaluation time. Both groups had significantly greater decline (P<.03) in HbA(1c) levels than a matched control group (-1.2%) with similar baseline HbA(1c) levels that did not receive education.

Patients with elevated HbA(1c) levels who were receptive to education had substantial improvement in HbA(1c) levels after receiving an educational intervention. In this population, intensive or passive methods of delivering patient education seemed to have similar effect on improving glycemic control.