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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR20

The importance of patient education and patient involvement in the treatment of diabetes

By M. T. McClean, J. C. McElnay and J. Andrews*

Introduction Previous research has shown that patient education adds value to diabetes management1 and that specific interventions aimed at improving patient knowledge can improve diabetes control.2
The aim of the present cross-sectional study was to examine whether patients who reported receiving education as part of routine practice at a diabetic clinic, had increased diabetes knowledge, and how this has impacted on the control of their diabetes. A further aim was to examine the impact of patient involvement in treatment decisions on their knowledge of diabetes.

Method Patients with type I (n=90) and type II (n=200) diabetes, attending a hospital diabetic outpatient clinic, were interviewed using a structured questionnaire which included the following parameters:

  • diabetes knowledge (validated instrument1)
  • demography
  • self-monitoring of blood glucose
  • whether patients had received diabetes education from a health care professional
  • patient rating of quality of information given to them by health professionals (doctor, diabetic nurse, dietician, chiropodist, pharmacist)
  • frequency of daily home blood glucose monitoring

Information was also collected from the patients' medical charts, including:

  • details on diabetic vascular complications
  • duration of diabetes
  • HbA1c levels

The sample consisted of 124 females and 166 males with an age range of 23-85 years (mean age 56.98; SD=15.44). The data collected were entered into SPSS and analysed using logistic regression analyses, controlling throughout for age, gender and diabetes type.

Focal points

  • Diabetes education contributes to patient satisfaction and patient willingness to become involved in treatment decisions
  • Diabetes education by practitioners enhances patient knowledge and may contribute to reduced complications
  • The community pharmacist has contributed significantly in encouraging patients to self-monitor their blood glucose

Results It was shown that patients who reported receiving diabetes education rated the quality of information provided to them by health care professionals more highly (P<0.01) and had greater diabetes knowledge (P<0.01). Such patients also tended to have had diabetes for a longer period of time (P=0.07). Furthermore, patients who rated the quality of information given to them by their pharmacist as higher, tested their blood glucose more frequently (P<0.05). Patients who were more involved in treatment decisions relating to their diabetes also had greater diabetes knowledge (P=0.05). Finally, although no significant relationship was evident between knowledge and HbA1c levels, it was shown that patients with higher diabetes knowledge had a decreased incidence of diabetic complications (P<0.008).

Discussion The results of this cross-sectional study indicate clearly that diabetic education and increased patient participation in their disease management lead to increased diabetes knowledge. Such increased knowledge is associated with a decreased incidence of diabetic complications.
Home blood glucose monitoring, a recognised prerequisite to good diabetic control, can be influenced by the provision of quality information to patients by their pharmacist. There is therefore much scope for comprehensive pharmaceutical care provision to diabetic patients in the community setting.

Pharmacy practice research group, school of pharmacy, Queen's University of Belfast; *Whiteabbey Hospital, Belfast

References

1. Assal JP, Jacquemet S, Morel Y. The added value of therapy in diabetes: the education of patients for self-management of their disease. Metabolism 1997; 46 Suppl 1:61-4.
2. Fitzgerald JT et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 1998;10:706-10.