Structured diabetes education outcomes: looking beyond HbA1c. A systematic review

Abstract

Diabetes education aims to equip people with diabetes with positive self-care behaviours and management strategies to improve glycaemic control. The preferred outcome measure of education effectiveness is often HbA1c reduction. However, the move towards person-centred education has led to renewed calls to capture associated behavioural and psychosocial change. The aim of this study was to review indicators of diabetes education efficacy in light of the growing emphasis on person-centric care. A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus databases, from January 2006 to December 2016, was conducted. Studies meeting the inclusion criteria, focusing on diabetes education effectiveness primarily measured using HbA1c, were selected. Twenty-three studies were included, comprising 6747 participants. They yielded mixed results, with 13 studies reporting significant reductions in HbA1c following intervention. Thirteen studies assessed multiple behavioural and psychosocial measures as secondary outcomes with significant, positive changes in these outcomes following intervention. Studies utilising diabetes-specific measures yielded positive results. It was concluded successful diabetes education involves changing participant cognitions and behaviours. Changes in behavioural and psychosocial aspects should inform education effectiveness. Development of effective diabetes education programmes requires better understanding of how they affect behavioural and psychosocial change, facilitating glycaemic control. Copyright © 2019 John Wiley & Sons.