DPCA2-1

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