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Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: A population-based cohort study

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Abstract

OBJECTIVE: Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling.

METHODS: With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups.

RESULTS: Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42–0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32–0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50–0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05–1.15) and lipid testing (OR 1.25, CI: 1.19–1.32), and were more likely to receive statins (OR 1.22, CI: 1.07–1.39).

CONCLUSION: Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care.

Résumé

OBJECTIF: Une éducation à l’auto-prise en charge, appuyée par une équipe de soins de santé multidisciplinaire, est essentielle à une prise en charge optimale du diabète. Nous avons cherché à déterminer si les complications aiguës du diabète ou la qualité des soins diffèrent chez les patients recevant les soins cliniques habituels lorsque leur éducation à l’auto-prise en charge leur est offerte en groupe dans des classes d’éducation au diabète, plutôt que sous forme de counseling individuel.

MÉTHODE: À l’aide de données primaires et administratives populationnelles, nous avons identifié tous les patients diabétiques de l’Ontario ayant assisté à un programme d’éducation à l’auto-prise en charge en 2006 et nous les avons regroupés selon qu’ils ont assisté à des classes en groupe (n=12 234), reçu du counseling individuel (n=55 761) ou un mélange des deux (n=9 829). Nous avons comparé les complications aiguës et la qualité des soins au cours de l’année suivante dans ces trois groupes.

RÉSULTATS: Comparativement à ceux qui ont reçu du counseling individuel, les patients ayant assisté à des classes en groupe étaient moins susceptibles de s’être rendus à l’urgence pour cause d’hypo- ou d’hyperglycémie (rapport de cotes 0,54, intervalle de confiance de 95 % [IC]: 0,42–0,68), d’être hospitalisés pour hypo- ou hyperglycémie (RC 0,49, IC: 0,32–0,75) ou de souffrir de plaies du pied ou de cellulite (RC 0,64, IC: 0,50–0,81). Ils étaient aussi plus susceptibles d’avoir fait faire un test d’HbA1c (RC 1,10, IC: 1,05–1,15) et un bilan lipidique (RC 1,25, IC: 1,19–1,32), et plus susceptibles de recevoir des statines (RC 1,22, IC: 1,07–1,39).

CONCLUSION: L’éducation à l’auto-prise en charge reçue en groupe était associée à un moindre nombre de complications aiguës et à certaines améliorations du processus de soins. Les séances en groupe permettent de servir davantage de patients et exigent moins de ressources humaines. Étant donné les pressions accrues pour réaliser des économies dans la prestation des soins de santé, l’éducation au diabète en groupe peut être l’occasion d’offrir des services avec moins de ressources tout en améliorant les soins aux patients.

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Authors and Affiliations

  1. Institute for Clinical Evaluative Sciences, G106-2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

    Jeremiah Hwee MSc, Karen Cauch-Dudek BA, J. Charles Victor MSc, Ryan Ng MSc &  Baiju R. Shah MD, PhD

  2. University of Toronto, G106–2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

    J. Charles Victor MSc &  Baiju R. Shah MD, PhD

  3. Department of Medicine, Sunnybrook Health Sciences Centre, G106–2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada

    Baiju R. Shah MD, PhD

Authors
  1. Jeremiah Hwee MSc
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  2. Karen Cauch-Dudek BA
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  3. J. Charles Victor MSc
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  4. Ryan Ng MSc
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  5. Baiju R. Shah MD, PhD
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Corresponding author

Correspondence to Baiju R. Shah MD, PhD.

Additional information

Acknowledgements: This research was funded by an operating grant from the Physicians’ Services Incorporated Foundation of Ontario and by the Chronic Diseases division of the Ontario Ministry of Health and Long-Term Care (MOHLTC). Dr. Shah receives salary support from the Canadian Institutes of Health Research. The Institute for Clinical Evaluative Sciences (ICES) is a non-profit research institute funded by the MOHLTC. The opinions, results and conclusions reported in this study are those of the authors and are independent of the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred.

Conflict of Interest: None to declare.

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Hwee, J., Cauch-Dudek, K., Victor, J.C. et al. Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: A population-based cohort study. Can J Public Health 105, e192–e197 (2014). https://doi.org/10.17269/cjph.105.4309

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  • DOI: https://doi.org/10.17269/cjph.105.4309

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