Knowledge improvement and metabolic control in diabetes education: approaching the limits?

Evaluation of diabetes education programs (DEPs) has provided minimal empirical support for a relationship between improved knowledge and better metabolic control. We hypothesized that improved knowledge in specific areas is predictive of changes in specific measures of diabetes control. Patients (n = 558) attending one of five DEPs completed a diabetes knowledge questionnaire at baseline and post-DEP. Glycosylated hemoglobin (GHb) was measured at baseline and at 3 months follow-up. Total diabetes knowledge (DKN) scores increased significantly by 18%, but improvement was uncorrelated with changes in GHb (r = 0.03). Improvement in nine specific content areas failed to predict changes in GHb (all P greater than 0.05) and improvement in knowledge of the causes of hypoglycemia did not predict changes in frequency of hypoglycemia (chi 2 = 1.54; P greater than 0.05). We conclude that neither global nor specific knowledge improvement predicts metabolic control in diabetes and suggest that evaluation of diabetes education should focus more intensively on behavioral and attitudinal outcomes.