Diabetes and Metabolism Journal

Korean Diabetes Association (대한당뇨병학회)
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Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes

  • Yong, Yun-Mi (Diabetes Care Team, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Shin, Kyung-Mi (Diabetes Care Team, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kang-Min (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Cho, Jae-Young (Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ko, Sun-Hye (Diabetes Care Team, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yoon, Min-Hyang (Diabetes Care Team, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Tae-Won (Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Jong-Hyun (Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Yong-Moon (Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina) ;
  • Ko, Seung-Hyun (Diabetes Care Team, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Yu-Bae (Diabetes Care Team, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2014.04.15
  • Accepted : 2014.07.29
  • Published : 2015.04.18
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Abstract

Background: We investigated whether an intensive individualized reinforcement education program could influence the prevention of hypoglycemic events in patients with type 2 diabetes. Methods: From March 2013 to September 2013, patients aged 35 to 75 years with type 2 diabetes who had not previously participated in diabetes education, and treated with insulin or a sulfonylurea-containing regimen were included in the study. After structured group education, the patients assigned to the intensive individualized education group (IT) were requested to visit for reinforcement. All subjects in the IT were encouraged to self-manage dose adjustments. Participants in both groups (control group [CG, group education only; n=22] and IT [n=24]) attended follow-up visits at 2, 8, 12, and 24 weeks. At each visit, all patients were asked whether they had experienced hypoglycemia. Results: The total study population consisted of 20 men (43.5%; mean age and diabetic duration of $55.9{\pm}11.0$ and $5.1{\pm}7.3years$, respectively). At 24 weeks, there were no significant differences in hemoglobin A1c values between the CG and IT. The total number of hypoglycemic events per patient was $5.26{\pm}6.5$ in the CG and $2.58{\pm}2.3$ times in the IT (P=0.004). Adherence to lifestyle modification including frequency of exercise, self-monitoring of blood glucose, or dietary habit was not significantly different between the groups. However, adherence to hypoglycemia management, especially the dose adjustment of medication, was significantly higher in the IT compared with the CG. Conclusion: Compared with the structured group education, additional IT resulted in additional benefits in terms of avoidance of hypoglycemia and treating hypoglycemia in patients with type 2 diabetes.

Keywords

Acknowledgement

Supported by : Korean Diabetes Association

References

  1. American Diabetes Association. Standards of medical care in diabetes: 2014. Diabetes Care 2014;37 Suppl 1:S14-80. https://doi.org/10.2337/dc14-S014
  2. Rickheim PL, Weaver TW, Flader JL, Kendall DM. Assessment of group versus individual diabetes education: a randomized study. Diabetes Care 2002;25:269-74. https://doi.org/10.2337/diacare.25.2.269
  3. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Selfmanagement education for adults with type 2 diabetes: a metaanalysis of the effect on glycemic control. Diabetes Care 2002;25:1159-71. https://doi.org/10.2337/diacare.25.7.1159
  4. Ko SH, Song KH, Kim SR, Lee JM, Kim JS, Shin JH, Cho YK, Park YM, Jeong JH, Yoon KH, Cha BY, Son HY, Ahn YB. Longterm effects of a structured intensive diabetes education programme (SIDEP) in patients with type 2 diabetes mellitus: a 4-year follow-up study. Diabet Med 2007;24:55-62. https://doi.org/10.1111/j.1464-5491.2007.02013.x
  5. Dinneen SF, O’Hara MC, Byrne M, Smith D, Courtney CH, Mc- Gurk C, Heller SR, Newell J, Coffey N, Breen C, O’Scannail M, O’Shea D; Irish DAFNE Study Group. Group follow-up compared to individual clinic visits after structured education for type 1 diabetes: a cluster randomised controlled trial. Diabetes Res Clin Pract 2013;100:29-38. https://doi.org/10.1016/j.diabres.2013.01.017
  6. Deakin T, McShane CE, Cade JE, Williams RD. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005;2:CD003417.
  7. Ko SH, Kim SR, Kim DJ, Oh SJ, Lee HJ, Shim KH, Woo MH, Kim JY, Kim NH, Kim JT, Kim CH, Kim HJ, Jeong IK, Hong EK, Cho JH, Mok JO, Yoon KH; Committee of Clinical Practice Guidelines Korean Diabetes Association. 2011 Clinical practice guidelines for type 2 diabetes in Korea. Diabetes Metab J 2011;35:431-6. https://doi.org/10.4093/dmj.2011.35.5.431
  8. Zwar N, Hasan I, Hermiz O, Vagholkar S, Comino E, Harris M. Multidisciplinary care plans and diabetes: benefits for patients with poor glycaemic control. Aust Fam Physician 2008;37:960-2.
  9. Abraira C, Duckworth W, McCarren M, Emanuele N, Arca D, Reda D, Henderson W; VA Cooperative Study of Glycemic Control and Complications in Diabetes Mellitus Type 2. Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2: Veterans Affairs Diabetes Trial. J Diabetes Complications 2003;17:314-22. https://doi.org/10.1016/S1056-8727(02)00277-5
  10. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2545-59. https://doi.org/10.1056/NEJMoa0802743
  11. ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-72. https://doi.org/10.1056/NEJMoa0802987
  12. Kim JT, Oh TJ, Lee YA, Bae JH, Kim HJ, Jung HS, Cho YM, Park KS, Lim S, Jang HC, Lee HK. Increasing trend in the number of severe hypoglycemia patients in Korea. Diabetes Metab J 2011;35:166-72. https://doi.org/10.4093/dmj.2011.35.2.166
  13. Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient Educ Couns 2007;68:10-5. https://doi.org/10.1016/j.pec.2007.05.003
  14. Muhlhauser I, Bruckner I, Berger M, Cheta D, Jorgens V, Iones-cu-Tirgoviste C, Scholz V, Mincu I. Evaluation of an intensified insulin treatment and teaching programme as routine management of type 1 (insulin-dependent) diabetes. The Bucharest- Dusseldorf Study. Diabetologia 1987;30:681-90. https://doi.org/10.1007/BF00296989
  15. The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care 1999;22:623-34. https://doi.org/10.2337/diacare.22.4.623
  16. Hermanns N, Kulzer B, Kubiak T, Krichbaum M, Haak T. The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes. Diabetes Metab Res Rev 2007;23:528-38. https://doi.org/10.1002/dmrr.710
  17. Davies M, Storms F, Shutler S, Bianchi-Biscay M, Gomis R; ATLANTUS Study Group. Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care 2005;28:1282-8. https://doi.org/10.2337/diacare.28.6.1282
  18. Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care 2005;28:1245-9. https://doi.org/10.2337/diacare.28.5.1245
  19. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364-79. https://doi.org/10.2337/dc12-0413
  20. Alsahli M, Gerich JE. Hypoglycemia. Endocrinol Metab Clin North Am 2013;42:657-76. https://doi.org/10.1016/j.ecl.2013.07.002
  21. Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes. Diabetologia 2002;45:937-48. https://doi.org/10.1007/s00125-002-0822-9
  22. Ha WC, Oh SJ, Kim JH, Lee JM, Chang SA, Sohn TS, Son HS. Severe hypoglycemia is a serious complication and becoming an economic burden in diabetes. Diabetes Metab J 2012;36:280-4. https://doi.org/10.4093/dmj.2012.36.4.280
  23. Akram K, Pedersen-Bjergaard U, Carstensen B, Borch-Johnsen K, Thorsteinsson B. Frequency and risk factors of severe hypoglycaemia in insulin-treated type 2 diabetes: a cross-sectional survey. Diabet Med 2006;23:750-6. https://doi.org/10.1111/j.1464-5491.2006.01880.x
  24. Yun JS, Ko SH, Ko SH, Song KH, Ahn YB, Yoon KH, Park YM, Ko SH. Presence of macroalbuminuria predicts severe hypoglycemia in patients with type 2 diabetes: a 10-year follow-up study. Diabetes Care 2013;36:1283-9. https://doi.org/10.2337/dc12-1408
  25. Cox DJ, Gonder-Frederick L, Polonsky W, Schlundt D, Kovatchev B, Clarke W. Blood glucose awareness training (BGAT-2): longterm benefits. Diabetes Care 2001;24:637-42. https://doi.org/10.2337/diacare.24.4.637
  26. Lawton J, Rankin D, Cooke D, Elliott J, Amiel S, Heller S; UK NIHR DAFNE Study Group. Patients’ experiences of adjusting insulin doses when implementing flexible intensive insulin therapy: a longitudinal, qualitative investigation. Diabetes Res Clin Pract 2012;98:236-42. https://doi.org/10.1016/j.diabres.2012.09.024

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