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Diabetes education: Essential but underfunded in Australia<br />
developments in the understanding and<br />
management of diabetes, and in the many<br />
ways in which complications of diabetes can<br />
be delayed or prevented. However, suboptimal<br />
management of many of the contributing<br />
factors to these complications, such as<br />
unhealthy lifestyle and elevated blood glucose,<br />
blood lipids and blood pressure, remains a<br />
significant problem for people with diabetes<br />
and the health care system. In all these areas,<br />
the most important person to address and<br />
optimally manage these factors is the person<br />
with diabetes. The person with diabetes needs<br />
timely and appropriate diabetes education to<br />
enable them to manage their diabetes.<br />
Diabetes education<br />
One of the goals of diabetes education<br />
is to assist people with diabetes to better<br />
understand their diabetes in order to enable<br />
them to make informed choices about selfmanagement,<br />
to improve their quality of<br />
life and to reduce the risk of complications<br />
(Australian Diabetes Educators Association,<br />
2016). This also increases the confidence of<br />
people with diabetes to manage their condition<br />
and assists them to undertake the practical<br />
aspects of monitoring and managing therapy<br />
(Australian Diabetes Educators Association,<br />
2016). Diabetes education also helps people<br />
with diabetes and their families to deal with<br />
the daily physical and emotional demands<br />
of the condition in the context of their<br />
social, cultural and economic circumstances<br />
(Australian Diabetes Educators Association,<br />
2016).<br />
Optimal diabetes management involves<br />
co-ordinated multidisciplinary care in the<br />
hospital setting and in the community,<br />
with the person with diabetes having the<br />
central role (Haas et al, 2013). Initial and<br />
ongoing education about diabetes is a critical<br />
process provided by all those involved in the<br />
multidisciplinary care of people with diabetes.<br />
This article focuses on the roles provided by<br />
diabetes educators and credentialled diabetes<br />
educators in Australia, and on the evidence<br />
supporting those roles, and highlights issues<br />
with access to these health professionals.<br />
Evidence for the importance and effectiveness<br />
of structured diabetes education<br />
There is randomised controlled trial evidence that<br />
structured diabetes education improves blood<br />
glucose levels, blood pressure, weight and lipid<br />
levels, as well as blood glucose self-monitoring<br />
(Norris et al, 2001; 2002; Ellis et al, 2004;<br />
Minet et al, 2010). There is also evidence that<br />
diabetes education can increase use of glucose,<br />
lipid and blood pressure-lowering medications,<br />
and consultation rates with optometrists or<br />
ophthalmologists (Murray and Shah, 2016).<br />
An Australian study showed that a structured<br />
education and treatment program can result in<br />
reduced mortality and reduced use of hospital<br />
services by people with type 2 diabetes (Lowe et<br />
al, 2009).<br />
While more recent local data is not available,<br />
the American Diabetes Association (ADA, 2013)<br />
estimated that in 2012 the average number<br />
of workdays lost per patient per year from<br />
diabetes was 1.1 days, with another 5.1 days<br />
characterised by reduced work performance<br />
and 5.8 days of reduced participation in the<br />
labour force. In 2002, it was estimated that<br />
the average income lost by patients and carers<br />
in Australia from type 2 diabetes was $35 per<br />
person per year, while income loss was higher<br />
when complications were present. However, the<br />
study population had a mean age of 65 years,<br />
so employment rates reflected that older age<br />
demographic, and the analysis did not include<br />
people with type 1 diabetes (Colagiuri, 2003).<br />
These analyses highlight the links between<br />
diabetes and reduced productivity, but studies<br />
connecting the provision of structured diabetes<br />
education to improvements in productivity have<br />
not yet been done.<br />
While the benefits of structured diabetes<br />
education are now well-established, there can be<br />
considerable variability in the amount and type<br />
of education provided. Comparison of studies<br />
examining effectiveness of diabetes education are<br />
often complicated by the variation in number<br />
of sessions provided, how they are delivered and<br />
the period of follow-up after study completion.<br />
Studies also vary in the methodology utilised for<br />
comparisons and in how rates of people dropping<br />
out of the study are managed. A recent meta-<br />
Page points<br />
1. One of the goals of diabetes<br />
education is to assist people<br />
with diabetes to better<br />
understand their diabetes in<br />
order to enable them to make<br />
informed choices about selfmanagement,<br />
to improve their<br />
quality of life and to reduce the<br />
risk of complications.<br />
2. An Australian study showed<br />
that a structured education and<br />
treatment program can result in<br />
reduced mortality and reduced<br />
use of hospital services by<br />
people with type 2 diabetes.<br />
3. While the benefits of structured<br />
diabetes education are now<br />
well-established, there is<br />
considerable variability in the<br />
amount and type of education<br />
provided.<br />
Diabetes & Primary Care Australia Vol 2 No 1 2017 11