FPIN's Clinical Inquiries

Diabetes Education and Glycemic Control


Am Fam Physician. 2018 Feb 15;97(4):269-270.

Clinical Question

Does counseling by a diabetes educator improve A1C levels in patients with type 2 diabetes mellitus?

Evidence-Based Answer

Counseling by a diabetes educator or a team of educators delivered in a variety of formats may reduce A1C levels by 0.2% to 0.8% compared with usual care alone. Diabetes educators should be considered for patients who have higher baseline A1C levels (8% to 9%) because this group had greater improvement in glycemic control after diabetes self-management education. (Strength of Recommendation: C, based on meta-analyses of randomized controlled trials [RCTs] with disease-oriented outcomes.)

Evidence Summary

A meta-analysis examined 21 RCTs focusing on group-based diabetes self-management education vs. routine care in 2,833 adults with type 2 diabetes.1 The intervention consisted of at least one session with at least six to 24 months of follow-up. The setting for diabetes education was typically in primary care offices (12 out of 21 studies). The educators were health care professionals (physicians, nurses, or dietitians). The average baseline A1C level was 8.2%. Patients had diabetes for a mean duration of eight years, and 82% were taking diabetes medications. In the diabetes education group, A1C levels were reduced at six months (13 trials; N = 1,883; mean difference [MD] = −0.44%; 95% confidence interval [CI], −0.69 to −0.19), at 12 months (11 trials; N = 1,503; MD = −0.46%; 95% CI, −0.74 to −0.18), and at two years (three trials; N = 397; MD = −0.87%; 95% CI, −1.25 to −0.49).

A Cochrane review of nine RCTs including 1,359 adults with type 2 diabetes examined the effect of individual diabetes education vs. group education or usual care on A1C levels over six to 18 months.2 Most of the diabetes education was performed by diabetes educators and dietitians, included face-to-face counseling, and covered the pathophysiology of diabetes, control of diabetes through diet and exercise, medication compliance, and glucose monitoring. Compared with usual care, patients receiving

Address correspondence to Corey Lyon, DO, at corey.lyon@ucdenver.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Steinsbekk A, Rygg LØ, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12:213....

2. Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009;(1):CD005268.

3. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25(7):1159–1171.

4. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926–943.

5. Haas L, Maryniuk M, Beck J, et al.; 2012 Standards Revision Task Force. National standards for diabetes self-management education and support. Diabetes Care. 2013;36(suppl 1):S100–S108.

6. American Diabetes Association. Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes Care. 2015;38(suppl):S20–S30.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Associate Medical Editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at http://www.aafp.org/afp/fpin.



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Jan 15, 2019

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