Education on Type One Diabetes
The PRED 1 Research group:
André Luiz Cruzes¹
Cláudia Elaine Terensi²
Miguel Ângelo M. Hernandez¹
Regina C. Q. da Silva¹
Vera Saturnino³
Adriano Dias
Marilena F. Ninomya
Department of Endocrinology¹, Department of Nursery², Department of Psychology³ - Juvenile Diabetes Association (JDA) of Northwestern Region of Sao Paulo State, Birigui/SP.
Department of Public Health and Research Projects Coordinator of School of Medicine of Botucatu (Sao Paulo State University), Botucatu/SP .
Department of Preventive Medicine of Unimed Cooperative Association of Medical Work- Araçatuba/SP
1) OBJECTIVE
The objective of this study was to test if there was improvement of the glycemic control of the Type one Diabetic patients (T1D) followed in the JDA through learning activities (lectures, meetings and workshops).
2) METHODS
It was done a retrospective analysis of glycemic control through the Glycated Hemoglobin (HbA1c) of the 33 patients frequently followed the applied activities for T1D during the time of 2 years (1/1/2007 to 12/31/2008). The range of age of the patients was 7 to 59 years old.
During this time the participating group (intervention) was in events that approached several important issues in the context of the T1D treatment: general concepts about the disease, nutrition, physical exercises, special situations, self-monitoring of blood glucose, intensive treatment and some notions about pump therapy.
The main inclusion criteria were: participation in at least 50% of the activities and execution of at least 2 HbA1c test with minimum interval of 6 months in this period.
For comparison, 33 patients were analyzed all of them coming from the private office of the researchers physicians of the study but didn’t participate of the proposed activities, however presented at least 2 HbA1c tests with minimum interval of 6 months in the same time. All HbA1c tests of the elected patients were done by HPLC, with normal range of 4,0 to 6,0%.
3) RESULTS
Both groups were similar in age, time of duration of disease and previous levels of HbA1c. The results showed:
A)Average decrease of 0,96 ± 1,40 sd in the levels of HbA1c in the intervention group versus average increase of 0,32 ± 1,38 sd in the control group. This difference presented high statistical meaning (p = 0,00039).
B) There was a bigger number of patients that had important improvement of HbA1c (> 1,0%) in the intervention group than in the control group: 75,7% vs. 36,4%, respectively.
C) There was a bigger number of patients that reached the goal of HbA1c < 7,0% at the moment of the second evaluation in the intervention group than in the control: 36,0% vs. 21,2%. Analyzing the goal of HbA1c < 6,5% the difference kept itself: 27,2% vs. 12,0%.
4) CONCLUSION
The results above give strong evidences of the importance of the Education in T1D. The intervention group got a reduction of almost 1,0 in the HbA1c, which is corresponding to 35% reduction in the developing risk of microangiophaty complications .
It’s important to register that the number of the patients that reached the recommended goal of HbA1c < 7,0% was much bigger than the average national (10%) in both groups: intervention (36,0%) and control (21,2%). The most probable explanation is regarding to the conditions of the follow-up of all patients: in private office and by specialists in Diabetes.
The fact of the biggest number of patients of the intervention group reached at the end of the study the goal of HbA1c < 6,5% (27,2%) shows the power of learning activity in getting to change a part of the passive patients in active ones (self-management), that is considered to be the great achievement of the educational activity in T1D .
Besides these results besides giving credibility to JDA work, they are the base for the elaboration of a more audacious project: PRED 1 = Project of Education in Type one Diabetes, which should start on 2010.
There is in the medical literature, little studies related self-management in T1D. According to a recent review, in the most part of them, the T1D patients are minority and are mixed with T2D . Just one study approached only T1D, even so with limitations in number of patients and time of follow-up .
5) BIBLIOGRAPHY
1.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.
2.Fiocruz News Agency. www.fiocruz.br; visited in 12/20/2007
3. International Diabetes Federation (IDF). International Standards for
Diabetes Education. 2003. info@idf.org; www.idf.org.
4.Boren, SA et al. Costs and Benefits Associated with Diabetes
Education. The Diabetes Educator 2009;35(1):72-96.
5.Chase et al. Modern transmission of values reduces the cost and
Need to Clinic visits. Diabetes Care 2003;26:1475-79.
André Luiz Cruzes¹
Cláudia Elaine Terensi²
Miguel Ângelo M. Hernandez¹
Regina C. Q. da Silva¹
Vera Saturnino³
Adriano Dias
Marilena F. Ninomya
Department of Endocrinology¹, Department of Nursery², Department of Psychology³ - Juvenile Diabetes Association (JDA) of Northwestern Region of Sao Paulo State, Birigui/SP.
Department of Public Health and Research Projects Coordinator of School of Medicine of Botucatu (Sao Paulo State University), Botucatu/SP .
Department of Preventive Medicine of Unimed Cooperative Association of Medical Work- Araçatuba/SP
1) OBJECTIVE
The objective of this study was to test if there was improvement of the glycemic control of the Type one Diabetic patients (T1D) followed in the JDA through learning activities (lectures, meetings and workshops).
2) METHODS
It was done a retrospective analysis of glycemic control through the Glycated Hemoglobin (HbA1c) of the 33 patients frequently followed the applied activities for T1D during the time of 2 years (1/1/2007 to 12/31/2008). The range of age of the patients was 7 to 59 years old.
During this time the participating group (intervention) was in events that approached several important issues in the context of the T1D treatment: general concepts about the disease, nutrition, physical exercises, special situations, self-monitoring of blood glucose, intensive treatment and some notions about pump therapy.
The main inclusion criteria were: participation in at least 50% of the activities and execution of at least 2 HbA1c test with minimum interval of 6 months in this period.
For comparison, 33 patients were analyzed all of them coming from the private office of the researchers physicians of the study but didn’t participate of the proposed activities, however presented at least 2 HbA1c tests with minimum interval of 6 months in the same time. All HbA1c tests of the elected patients were done by HPLC, with normal range of 4,0 to 6,0%.
3) RESULTS
Both groups were similar in age, time of duration of disease and previous levels of HbA1c. The results showed:
A)Average decrease of 0,96 ± 1,40 sd in the levels of HbA1c in the intervention group versus average increase of 0,32 ± 1,38 sd in the control group. This difference presented high statistical meaning (p = 0,00039).
B) There was a bigger number of patients that had important improvement of HbA1c (> 1,0%) in the intervention group than in the control group: 75,7% vs. 36,4%, respectively.
C) There was a bigger number of patients that reached the goal of HbA1c < 7,0% at the moment of the second evaluation in the intervention group than in the control: 36,0% vs. 21,2%. Analyzing the goal of HbA1c < 6,5% the difference kept itself: 27,2% vs. 12,0%.
4) CONCLUSION
The results above give strong evidences of the importance of the Education in T1D. The intervention group got a reduction of almost 1,0 in the HbA1c, which is corresponding to 35% reduction in the developing risk of microangiophaty complications .
It’s important to register that the number of the patients that reached the recommended goal of HbA1c < 7,0% was much bigger than the average national (10%) in both groups: intervention (36,0%) and control (21,2%). The most probable explanation is regarding to the conditions of the follow-up of all patients: in private office and by specialists in Diabetes.
The fact of the biggest number of patients of the intervention group reached at the end of the study the goal of HbA1c < 6,5% (27,2%) shows the power of learning activity in getting to change a part of the passive patients in active ones (self-management), that is considered to be the great achievement of the educational activity in T1D .
Besides these results besides giving credibility to JDA work, they are the base for the elaboration of a more audacious project: PRED 1 = Project of Education in Type one Diabetes, which should start on 2010.
There is in the medical literature, little studies related self-management in T1D. According to a recent review, in the most part of them, the T1D patients are minority and are mixed with T2D . Just one study approached only T1D, even so with limitations in number of patients and time of follow-up .
5) BIBLIOGRAPHY
1.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86.
2.Fiocruz News Agency. www.fiocruz.br; visited in 12/20/2007
3. International Diabetes Federation (IDF). International Standards for
Diabetes Education. 2003. info@idf.org; www.idf.org.
4.Boren, SA et al. Costs and Benefits Associated with Diabetes
Education. The Diabetes Educator 2009;35(1):72-96.
5.Chase et al. Modern transmission of values reduces the cost and
Need to Clinic visits. Diabetes Care 2003;26:1475-79.
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Centro - Birigui - SP
16.200-071
Tel.: (18) 3642 1929
(18) 3642 7207
Centro - Birigui - SP
16.200-071
Tel.: (18) 3642 1929
(18) 3642 7207
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