NEW YORK (Reuters Health) - Diabetics whose blood sugar is hard to rein in can be helped by self-management education and counseling, new research shows.
Experts say nearly half of all diabetics in the U.S. have poorly controlled blood sugar, putting them at higher risk for eye problems, kidney disease and other complications of the disease.
"The problem with diabetes is you can't just take the medication and say, 'OK, that's it,'" Katie Weinger, a scientist at the Joslin Diabetes Center in Boston, told Reuters Health.
"You have to also follow recommendations about what you eat and you have to exercise more -- there are a lot of lifestyle choices involved and that makes it tough."
Two studies in the Archives of Internal Medicine, however, show teaching patients skills to manage their disease can lower their blood sugar as measured by HbA1c, which doctors use to monitor average blood sugar levels.
In diabetes, doctors usually aim to get HbA1c below 7 percent.
Weinger and her colleagues designed a 10-hour program delivered over six weeks, during which nurses taught detailed management skills to patients and also helped them focus on positive ways to change their behavior.
The researchers randomly assigned 222 diabetes patients -- all with poorly controlled blood sugar -- to either this program or one of two comparison groups with less-intensive training.
After three months, HbA1c levels had dropped by 0.8 percent in the group getting the behavioral training, and only by half as much in the two other groups.
"It shows that any kind of education works, but for those with poor control the highly structured cognitive behavioral intervention was better," said Weinger, adding that the effect was sustained at least one year.
While the change may seem small, she said it is big enough to cut the risk of diabetes-related complications substantially.
Another study, led by Dr. JoAnn Sperl-Hillen of the Health Partners Research Foundation in Minneapolis, found that individual patient education works better than group education.
Finally, a third study found telephone coaching and a video teaching behavioral skills worked no better than a simple brochure.
Weinger said patients with poorly controlled blood sugar should seek out diabetes education, for instance by looking centers up at the website of the American Association of Diabetes Educators.
"It's the ones that are struggling that should use it," she said. "They have to get support from people who are trained to do this."
She could not say how much the training costs, but noted that her program had been developed to take just 10 hours, which is covered by Medicare and many insurance companies.
SOURCES: http://bit.ly/ng64yV, http://bit.ly/o1BL3t, and http://bit.ly/pFysJ4, Archives of Internal Medicine, online October 10, 2011.
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