Diabetes & Metabolism Journal

Original Articles

Clinical Care/Education
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes: Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha; Diabetes Metab J. 2017;41(3):187-194. Published online May 12, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.187

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Background

When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels.

Methods

The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.

Results

Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024).

Conclusion

For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

Citations

Citations to this article as recorded by

Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
The Journal of Korean Diabetes.2022; 23(1): 64. CrossRef
Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial
Da Young Lee, Seung-Hyun Yoo, Kyong Pil Min, Cheol-Young Park
JMIR mHealth and uHealth.2020; 8(9): e19153. CrossRef
Developing a multi-center clinical data mart of ACEI and ARB for real-world evidence (RWE)
Hun-Sung Kim, Sue Hyun Lee, Tong Min Kim, Ju Han Kim
Clinical Hypertension.2018;[Epub] CrossRef

Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes: Yun-Mi Yong, Kyung-Mi Shin, Kang-Min Lee, Jae-Young Cho, Sun-Hye Ko, Min-Hyang Yoon, Tae-Won Kim, Jong-Hyun Jeong, Yong-Moon Park, Seung-Hyun Ko, Yu-Bae Ahn; Diabetes Metab J. 2015;39(2):154-163. Published online March 10, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.2.154

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Abstract PDF Supplementary Material PubReader

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±11.0 and 5.1±7.3 years, 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±6.5 in the CG and 2.58±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.

Citations

Citations to this article as recorded by

2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association
Jun Sung Moon, Shinae Kang, Jong Han Choi, Kyung Ae Lee, Joon Ho Moon, Suk Chon, Dae Jung Kim, Hyun Jin Kim, Ji A Seo, Mee Kyoung Kim, Jeong Hyun Lim, Yoon Ju Song, Ye Seul Yang, Jae Hyeon Kim, You-Bin Lee, Junghyun Noh, Kyu Yeon Hur, Jong Suk Park, Sang
Diabetes & Metabolism Journal.2024; 48(4): 546. CrossRef
Effectiveness of the SUGAR intervention on hypoglycaemia in elderly patients with type 2 diabetes: A pragmatic randomised controlled trial
Huda Y. Almomani, Carlos Rodriguez Pascual, Paul Grassby, Keivan Ahmadi
Research in Social and Administrative Pharmacy.2023; 19(2): 322. CrossRef
A Cross-Sectional study on risk factors for severe hypoglycemia among Insulin-Treated elderly type 2 diabetes Mellitus (T2DM) patients in Singapore
Michelle Shi Min Ko, Wai Kit Lee, Li Chang Ang, Su-Yen Goh, Yong Mong Bee, Ming Ming Teh
Diabetes Research and Clinical Practice.2022; 185: 109236. CrossRef
Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
The Journal of Korean Diabetes.2022; 23(1): 64. CrossRef
Anti-hyperglycemic Medication Compliance: A Quality Assurance Project
Rayan Mamoon, Md Y Mamoon, Debbie Hermanstyne, Issac Sachmechi
Cureus.2022;[Epub] CrossRef
Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention
Huda Y. Almomani, Carlos Rodriguez Pascual, Sayer I. Al-Azzam, Keivan Ahmadi
Research in Social and Administrative Pharmacy.2021; 17(5): 885. CrossRef
Severe hypoglycemia as a preventable risk factor for cardiovascular disease in patients with type 2 diabetes mellitus
Soo-Yeon Choi, Seung-Hyun Ko
The Korean Journal of Internal Medicine.2021; 36(2): 263. CrossRef
Type 2 diabetes patients’ views on prevention of hypoglycaemia – a mixed methods study investigating self-management issues and self-identified causes of hypoglycaemia
Stijn Crutzen, Tessa van den Born-Bondt, Petra Denig, Katja Taxis
BMC Family Practice.2021;[Epub] CrossRef
Cross‐sectional analysis of emergency hypoglycaemia and outcome predictors among people with diabetes in an urban population
Chukwuma Uduku, Valentina Pendolino, Ian Godsland, Nick Oliver, Monika Reddy, Rachael T. Fothergill
Diabetic Medicine.2021;[Epub] CrossRef
Short-term efficacy of high intensity group and individual education in patients with type 2 diabetes: a randomized single-center trial
R. Reale, A. Tumminia, L. Romeo, N. La Spina, R. Baratta, G. Padova, L. Tomaselli, L. Frittitta
Journal of Endocrinological Investigation.2019; 42(4): 403. CrossRef
The role of structured education in the management of hypoglycaemia
Ahmed Iqbal, Simon R. Heller
Diabetologia.2018; 61(4): 751. CrossRef
Association of diabetes therapy-related quality of life and physical activity levels in patients with type 2 diabetes receiving medication therapy: the Diabetes Distress and Care Registry at Tenri (DDCRT 17)
Yasuaki Hayashino, Satoru Tsujii, Hitoshi Ishii
Acta Diabetologica.2018; 55(2): 165. CrossRef
Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017
Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu-Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
Diabetes & Metabolism Journal.2017; 41(5): 367. CrossRef
Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association
Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
Diabetes & Metabolism Journal.2017; 41(5): 337. CrossRef
Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
The Korean Journal of Internal Medicine.2017; 32(6): 967. CrossRef
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes
Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha
Diabetes & Metabolism Journal.2017; 41(3): 187. CrossRef
Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association
Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
The Korean Journal of Internal Medicine.2017; 32(6): 947. CrossRef
Hypoglycemia and Health Costs
Yong-ho Lee, Gyuri Kim, Eun Seok Kang
The Journal of Korean Diabetes.2016; 17(1): 11. CrossRef
Association between estimated blood glucose levels and glycated hemoglobin levels
Seon-Ah Cha, Seung-Hyun Ko
The Korean Journal of Internal Medicine.2016; 31(3): 457. CrossRef
Characteristics of Hypoglycemia Pateints Visiting the Emergency Department of a University Hospital
Sang-Hyeon Choi, Deok-Ki Youn, Moon-Gi Choi, Ohk-Hyun Ryu
The Journal of Korean Diabetes.2016; 17(3): 202. CrossRef
Experiences of Diabetes Education among Educators of Diabetes : a content analysis approach
Soo Jin Kang, Soo Jung Chang
Journal of Korean Public Health Nursing.2016; 30(2): 221. CrossRef

Perception of Clinicians and Diabetic Patients on the Importance of Postprandial Glucose Control and Diabetes Education Status: A Cross Sectional Survey: Ji Hun Choi, Cheol Young Park, Bong Soo Cha, In Joo Kim, Tae Sun Park, Joong Yeol Park, Kyung Soo Park, Kun Ho Yoon, In Kyu Lee, Sung Woo Park; Diabetes Metab J. 2012;36(2):120-127. Published online April 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.2.120

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Abstract PDF PubReader

Background

Recent studies have shown the importance of postprandial glucose (PPG) in the development of diabetes complications. This study was conducted in order to survey the perceptions of clinicians and diabetic patients with respect to PPG management and the current status of diabetes education.

Methods

This was a cross-sectional study involving face-to-face interviews and an open questionnaire survey conducted in Korea. A total of 300 patients and 130 clinicians completed questionnaires, which included current education status, self monitoring of blood glucose (SMBG), criteria of diagnosis and management, and perceptions relating to PPG management.

Results

While there was a significantly higher perceived need for diabetes education, the sufficiency of the current education was considered to be severely lacking. Fasting plasma glucose (FPG), PPG, and glycosylated hemoglobin (HbA1c) were all important considerations for clinicians when making a diagnosis of diabetes, although PPG was considered less important than FPG or HbA1c in the treatment of diabetes. Most clinicians and patients were aware of the importance of PPG, but actual education on the importance of PPG was not actively being delivered.

Conclusion

Our study showed that the current status of diabetes education is insufficient to meet the needs of the Korean population. A considerable gap was found to exist between awareness and what was actually taught in the current education program in regard to the importance of PPG. These results suggest that clinicians need to be more active in patient education, especially in regard to the importance of PPG.

Citations

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Addressing Overbasalization to Achieve Glycemic Targets
Kevin Cowart, Rachel Franks, Olivia Pane, Ellen Murphy, Kelly Oldziej
ADCES in Practice.2022; 10(2): 30. CrossRef
Post hoc efficacy and safety analysis of insulin glargine/lixisenatide fixed- ratio combination in North American patients compared with the rest of world
George Dailey, Harpreet S Bajaj, Terry Dex, Melanie Groleau, William Stager, Aaron Vinik
BMJ Open Diabetes Research & Care.2019; 7(1): e000581. CrossRef
Experiences of Diabetes Education among Educators of Diabetes : a content analysis approach
Soo Jin Kang, Soo Jung Chang
Journal of Korean Public Health Nursing.2016; 30(2): 221. CrossRef
BeAM value: an indicator of the need to initiate and intensify prandial therapy in patients with type 2 diabetes mellitus receiving basal insulin
Ariel Zisman, Francienid Morales, John Stewart, Andreas Stuhr, Aleksandra Vlajnic, Rong Zhou
BMJ Open Diabetes Research & Care.2016; 4(1): e000171. CrossRef
Does Availability of Reliable Home Blood Glucose Data at Diabetes Appointments Improve Glycemia?
Gillian S. Boyd-Woschinko, David L. Kaiser, Michael Diefenbach, Ronald Tamler
Endocrine Practice.2014; 20(4): 299. CrossRef
Safety and effectiveness of insulin aspart in type 2 diabetic patients: Results from the ASEAN cohort of the A1chieve study
Wan Mohamad Wan Bebakar, Mary Anne Lim-Abrahan, Ananá B. Jain, Darren Seah, Pradana Soewondo
Diabetes Research and Clinical Practice.2013; 100: S17. CrossRef

Development of Two Parallel Diabetes Knowledge Tests.: Wan Sub Shim, Seong Bin Hong, Yeon Sil Choi, Yun Jin Choi, Sook Hee Ahn, Kee Young Min, Eun Joo Kim, Ie Byung Park, Moonsuk Nam, Yong Seong Kim; Korean Diabetes J. 2006;30(6):476-486. Published online November 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.6.476

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Abstract PDF

BACKGROUND
Knowledge evaluation about diabetes mellitus is necessary to self-manage diabetes effectively. We developed two parallel diabetes knowledge tests to meet a need for reliable knowledge assessment in diabetic patients. MATERIALS AND METHODS: The 75-items (59 items for general knowledge test, 16 items for insulin use subscale) were administered to 102 diabetic patients who visited Inha University Hospital. The items which had the appropriate difficulty (0.25~0.80) and good discrimination index (above 0.25) were selected. However, the items which are thought to be an important item for education were also selected even though they did not meet the criteria of reliability and discrimination index. Two parallel diabetes knowledge tests were developed after matching the selected appropriate items for similar contents. RESULTS: 102 patients fulfilled the tests and their mean age was 54.1 +/- 11.5 years. Mean percentage of correct questionnaires was 60.9 +/- 12.5% for general test and 45.9 +/- 19.5% for insulin use subscale. There were significant differences of scores between patients with high and low education level, between patients with high income per household and low income level per household, between patients with the history of diabetes education and without history of diabetes education, and between the old (> or = 50 yrs) and the young (< 50 yrs) age group. However, there was no significant difference of scores according to diabetes duration and complication or not. The selected two tests had a similar score. And their Cronbach alpha was appropriate (> 0.70) in both tests. CONCLUSIONS: We developed two parallel diabetes knowledge tests. These tests can be used as an important means in evaluating the diabetes knowledge and effect of education in diabetic patients.

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Comparative Study of Diabetes Knowledge, Attitudes, Family Support, Self-efficacy, and Self-management Behaviors Between Cancer Survivors With Diabetes and Diabetes Patients Without Cancer
Eun Jeong Ko, Su Jung Lee
Cancer Nursing.2024;[Epub] CrossRef
Health literacy and diabetes self‐care activities: The mediating effect of knowledge and patient activation
Su Hyun Kim
International Journal of Nursing Practice.2021;[Epub] CrossRef
Factors influencing psychological insulin resistance in type 2 diabetes patients
Ji Hyeon Yu, Hye Young Kim, Sung Reul Kim, Eun Ko, Heung Yong Jin
International Journal of Nursing Practice.2019;[Epub] CrossRef
A new comprehensive diabetes health literacy scale: Development and psychometric evaluation
Eun-Hyun Lee, Young Whee Lee, Kwan-Woo Lee, Moonsuk Nam, So Hun Kim
International Journal of Nursing Studies.2018; 88: 1. CrossRef
Effect of a Simulated Education-based Hypoglycemia Scenario Using a High-fidelity Simulator on Acquisition and Retention of Diabetes Knowledge and Academic Self-efficacy in Nursing Students
Jiyoung Kim, Narae Heo
Journal of Korean Academic Society of Nursing Education.2017; 23(3): 319. CrossRef
Clinical Evaluation of OneTouch Diabetes Management Software System in Patients with Type 2 Diabetes Mellitus
Jung Min Kim, Hey Jean Lee, Keum Ok Kim, Jong Chul Won, Kyung Soo Ko, Byung Doo Rhee
Diabetes & Metabolism Journal.2016; 40(2): 129. CrossRef
Relationship Between Duration of Type 2 Diabetes and Self-Reported Participation in Diabetes Education in Korea
Jongnam Hwang, Jeffrey A. Johnson
Asia Pacific Journal of Public Health.2015; 27(2): NP311. CrossRef
Factors Influencing Diabetes Educational Needs in Patients with Diabetes Mellitus
Seon-Yeong Park, Pok-Ja Oh
Journal of the Korea Academia-Industrial cooperation Society.2014; 15(7): 4301. CrossRef
The Effect of the Experience of Diabetes Education on Knowledge, Self-Care Behavior and Glycosylated Hemoglobin in Type 2 Diabetic Patients
Seung Hei Moon, Young Whee Lee, Ok-Kyung Ham, Soo-Hyun Kim
The Journal of Korean Academic Society of Nursing Education.2014; 20(1): 81. CrossRef
Factors Affecting Highly Educated Elders' Diabetic Health Leader Attitude
Kiwol Sung, Jiran Nam, Mijin Yu
Journal of Korean Academy of Community Health Nursing.2014; 25(2): 119. CrossRef
Nutrition Knowledge, Dietary Attitude, and Dietary Behavior among Children and Adolescents with Type 1 Diabetes
Na-Yeon Noh, So-Young Nam, Hee-Suk Kang, Ji-Eun Lee, Soo-Kyung Lee
Korean Journal of Community Nutrition.2013; 18(2): 101. CrossRef
Effect of Diabetes Education Program on Glycemic Control and Self Management for Patients with Type 2 Diabetes Mellitus
Ji Hyun Kim, Sang Ah Chang
Korean Diabetes Journal.2009; 33(6): 518. CrossRef

The Long-term Effect of a Structured Diabetes Education Program for Uncontrolled Type 2 Diabetes Mellitus Patients-a 4-Year Follow-up.: Min Sun Song, Ki Ho Song, Seung Hyun Ko, Yu Bai Ahn, Joon Sung Kim, Jin Hee Shin, Yang Kyung Cho, Kun Ho Yoon, Bong Youn Cha, Ho Young Son, Dong Han Lee; Korean Diabetes J. 2005;29(2):140-150. Published online March 1, 2005

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Abstract PDF: BACKGROUND
Diabetes mellitus is a chronic illness with many metabolic complications. The prevalence of diabetes mellitus has markedly increased. Until now, however, little data have been presented for the long-term evaluation of a structured diabetes education program (SDEP) for patients with type 2 diabetes mellitus. The aim of this study was to examine the effects of the SDEP on glycemic control, lipid profiles, and self-care behavior over a four-year follow-up period. METHODS: A total of 248 diabetic patients completed the SDEP from December 1999 to September 2000. Ninety-eight patients were followed-up for more than four years and 75 of them were selected for the study, after those subjects having a baseline glycated hemoglobin(HbA1c) levels below 7.9% were excluded. The laboratory data included the glycemic control status(fasting blood sugar and HbA1c), serum creatinine, and lipid profiles. Compliance with their diet, self monitoring of blood glucose, and their exercise frequency were monitored with a questionnaire that was completed by the patients when they visited the hospital. The data were analyzed by using repeated ANOVA measures and chi2 testing for detecting trends. RESULTS: There were no significant decreases in the fasting blood glucose, creatinine, total cholesterol, triglycerides or low density lipoprotein cholesterol for the SDEP group compared with the control group. The self-care behavior of the SDEP group was much better than that of the control group and it was well maintained. Although the self-care behavior tended to deteriorate with time in the SDEP group, the exercise frequency did not change. The HbA1c level was much improved in the SDEP group(HbA1c: SDEP, 7.9+/-1.2% vs. 8.9+/-1.6% for the control; P =0.009). High density lipoprotein(HDL) cholesterol was also relatively improved in the SDEP group(HDL cholesterol: SDEP, 1.1+/-0.2 mmol/L vs. 1.0+/-0.3mmol/L for the control; P=0.006). CONCLUSIONS: The glycemic control status of diabetic patients who undertook the SDEP was satisfactory for one year after the program, although all the habitual compliance measures decreased gradually with time over the total four years. These results demonstrate that the SDEP for patients with diabetes is useful in improving their long-term glycemic control and self-care behavior. Regular and sustained reinforcement with encouragement will be required for the diabetic patients to maintain their self-care

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