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Can J Diabetes 37 (2013) S301

Canadian Journal of Diabetesjournal homepage:

www.canadianjournalofdiabetes.com

Executive Summary

Self-Management Education

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KEY MESSAGES

� Offer collaborative and interactive self-management education (SME)interventions as they are more effective than didactic SME.

� Incorporate problem-solving skills for ongoing self-management ofmedical, social and emotional aspects of care into the traditional knowl-edge and technical skills content of educational interventions.

� Design patient-centred learning to empower individuals to make informeddecisions toward achievement of patient-chosen goals.

� Individualize SME interventions according to type of diabetes and recom-mended therapy, the patient’s ability and motivation for learning andchange, and his or her culture and literacy level.

� Provide ongoing SME and comprehensive healthcare collaboratively tomake SME most effective.

RECOMMENDATIONS

1. People with diabetes should be offered timely diabetes education that istailored to enhance self-care practices and behaviours [Grade A, Level 1A(1e3)].

2. All people with diabetes who are able should be taught how to self-manage their diabetes [Grade A, Level 1A (3)].

3. SME that incorporates cognitive-behavioural educational interventions,such as problem solving, goal setting, and self-monitoring of healthparameters, should be implemented for all individuals with diabetes[Grade B, Level 2 (2,4e6)].

4. Interventions that increase patient participation and collaboration inhealthcare decision making should be used by providers [Grade B, Level 2(3)].

5. For people with type 2 diabetes, SME interventions should be offered insmall group and/or one-on-one settings, since both may be effective[Grade A, Level 1A (7,8)].

6. In both type 1 and 2 diabetes, interventions that target families’ ability tocope with stress or diabetes-related conflict should be included ineducational interventions when indicated [Grade B, Level 2 (9)].

7. Technologically based home blood glucose monitoring systems may beintegrated into SME interventions in order to improve glycemic control[Grade C, Level 3 (10,11)].

8. Culturally appropriate SME, which may include peer or lay educators, maybe used to increase diabetes-related knowledge and self-care behavioursand to decrease A1C [Grade B, Level 2 (12,13,14)].

9. Adding literacy- and numeracy-sensitive materials to a comprehensivediabetes management and education program may be used to improveknowledge, self-efficacy and A1C outcomes for patients with low literacy[Grade C, Level 3 (15)].

99-2671/$ e see front matter � 2013 Canadian Diabetes Associationp://dx.doi.org/10.1016/j.jcjd.2013.02.006

Highlights of Revisions

� Less focus on didactic teaching and greater focus on patient-centred learning.� Recognition of the need for culturally appropriate, literacy- and numeracy-

sensitive materials and education.� Acknowledgement of the role of technologically based home monitoring

systems.

References

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2. Ellis S, Speroff T, Dittus R, et al. Diabetes patient education: a meta analysis andmeta-regression. Patient Educ Couns 2004;52:97e105.

3. Norris SL, Engelgau MM, Narayan KMV. Effectiveness of self-managementtraining in type 2 diabetes: a systematic review of randomized controlledtrials. Diabetes Care 2001;24:561e87.

4. Kulzer B, Hermanns N, Reinhecker H, et al. Effects of self-management trainingin type 2 diabetes: a randomized prospective trial. Diabet Med 2007;24:415e23.

5. Weinger K, Beverly E, Lee Y, et al. The effect of a structured behavioralintervention in poorly controlled diabetes. Arch Intern Med 2011;171:1990e8.

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7. Rickheim PL, Weaver TW, Flader JL, et al. Assessment of group versusindividual diabetes education: a randomized study. Diabetes Care 2002;25:269e74.

8. Deakin T, McShane CE, Cade JE, et al. Group based training for self-managementstrategies in people with type 2 diabetes mellitus. Cochrane Database SystemRev 2005;2:CD003417.

9. Armour TA, Norris SL, Jack Jr L, et al. The effectiveness of family interventions inpeople with diabetes mellitus: a systematic review. Diabet Med 2005;22:1295e305.

10. Jaana M, Pare G. Home telemonitoring of patients with diabetes:a systematic assessment of observed effects. J Eval Clin Pract 2007;13:242e53.

11. Tildesley HD, Mazanderani AB, Ross SA. Effect of internet therapeutic inter-vention on A1C levels in patients with type 2 diabetes treated with insulin.Diabetes Care 2010;33:1738e40.

12. Whittemore R. Culturally competent interventions for Hispanic adultswith type 2 diabetes: a systematic review. J Transcult Nurs 2007;18:157e66.

13. Hawthorne K, Robles Y, Cannings-John R, et al. Culturally appropriatehealth education for type 2 diabetes in ethnic minority groups: a system-atic and narrative review of randomized control trials. Diabet Med 2010;27:613e23.

14. Babamato K, Sey KA, Karlan V, et al. Improving diabetes care andhealth measures among Hispanics using community health workers:results from a randomized controlled trial. Health Educ Behav 2009;36:113e26.

15. Van Scoyoc EF, deWalt DA. Interventions to Improve diabetes outcomes forpeople with low literacy and numeracy: a systematic literature review. Dia-betes Spectrum 2010;23:228e37.