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Am Fam Physician. 2022;105(4):428-429

Author disclosure: No relevant financial relationships.

Clinical Question

Do patient education interventions improve A1C values in patients with type 2 diabetes mellitus?

Evidence-Based Answer

Patient education interventions, specifically those including face-to-face interactions with trained educators or nurses, improve A1C values in patients by 0.3% to 1.4% compared with usual diabetes care. (Strength of Recommendation: C, based on randomized controlled trials [RCTs] and systematic reviews of RCTs of disease-oriented outcomes.)

Evidence Summary

A 2015 meta-analysis of 132 RCTs performed in 16 industrialized countries evaluated the effectiveness of diabetes behavioral education programs compared with usual care or active controls.1 The education had to be a multicomponent program with repeat interactions with trained teachers over at least four weeks with behavioral modifications and structured dietary or physical activity interventions. Usual care consisted of medical care without additional support. Active controls were education programs that did not meet the diabetes behavioral education program requirements. Compared with usual care, behavioral programs reduced A1C levels at the end of the intervention (mean difference [MD] = −0.35; 95% CI, −0.56 to −0.14). Results were more modest for behavioral programs compared with active control groups (MD = −0.24; 95% CI, −0.41 to −0.07). Reductions in A1C were greatest in patients with an initial baseline A1C level of 7% or higher and adults younger than 65 years. Limitations of this meta-analysis were that all trials had a medium or high risk of bias and that most outcomes were reported immediately after the interventions.

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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 (

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