HbA1c, weight, quality of life and hypoglycaemia awareness after a structured education programme teaching carbohydrate counting and insulin dose adjustment
MetadataShow full item record
AbstractObjective - The primary aim was to assess the effects of Aintree Hospital’s ‘4-Step’ programme which teaches carbohydrate counting and insulin dose adjustment to patients with Type 1 diabetes, on HbA1c, Weight, Quality of life and Hypoglycaemia awareness. A secondary aim was to compare the effects of group education and one to one clinics in HbA1c, Weight, Quality of life and Hypoglycaemia awareness. Methods -All parameters were measured at baseline and four months later. HbA1c is measured by blood test, Quality of Life using the Problem Areas in Diabetes questionnaire and Hypoglycaemia Awareness using the ‘Symptom Awareness of Hypoglycaemia’ questionnaire. A convenience sampling technique was used whereby patient data was collected over a 6 month period from all patients who fit the criteria. Those excluded were patients with patients receiving nutritional support and those undertaking weight management programmes, those undergoing chemo/radiotherapy and those on renal dialysis. Fifty two sets of patient data were collected in total. All patients underwent either group or one-to-one clinic sessions. The programme was of four weeks duration and patients were followed up for repeat measurements three months after the programme. Where populations fit a normal ’Gaussian’ distribution parametric paired t-tests were chosen for statistical analysis. Where the population was found to be skewed, non- parametric Wilcoxon tests were used. Results - Following the programme overall HbA1c levels improved by 0.29% (p=0.008) with greater improvements occurring in those undertaking joint clinics (p=0.037) than groups (p=0.111). There was an overall weight loss of 0.5kg which did not reach statistical significance (p=0.100). However weight loss was greater in those attending group education (p=0.04) compared to those attending clinics (p=0.438). Quality of life scores improved by 11% overall (p=0.000) with group education being slightly more effective in achieving improvements (p=0.000) than group education (p=0.001). There was no change in symptoms of Hypoglycaemia awareness in the population as a whole (p=0.052) although as with HbA1c, those undergoing individual education had great improvements (p=0.046) compared to those in groups (p=0.409). Conclusions - The study has served to demonstrate the effectiveness of Aintree’s ‘4-Step’ programme in achieving key improvements in clinical and non-clinical aspects of patients’ diabetes care. While the improvement in HbA1c is beneficial, it is unclear whether this is sustained over time. Longer term follow-up and refresher education at intervals may increase the likelihood of sustained clinical benefits. Whilst weight loss was shown to be minimal, the study importantly demonstrates that the ‘4-Step’ programme does not lead to weight gain, an important finding when offering a programme enabling greater food freedom. Quality of Life improvements were highly significant with impressive improvements. However, future studies would benefit from including a more detailed analysis of the Quality of Life questionnaire. Whilst highlighting aspects which are most favourably influenced by the programme, this would also enable targeting of those aspects which demonstrate lower levels of satisfaction for future service provision. Hypoglycaemia Awareness did not improve, possibly due to the short study duration. Future evaluations may be better placed to measure frequency of hypoglycaemia for a more accurate assessment of the impact of the ‘4-Step’ programme on hypoglycaemic events.
PublisherUniversity of Chester
TypeThesis or dissertation
The following license files are associated with this item: