• JoAnn Sperl-Hillen, Sarah Beaton, Omar Fernandes, Ann Von Worley, Gabriela Vazquez-Benitez, Ann Hanson, Jodi Lavin-Tompkins, William Parsons, Kenneth Adams, and C Victor Spain.
• HealthPartners Institute for Education and Research, 8170 33rd Ave S, Mail stop 21111R, Minneapolis, MN 55440, USA. Joann.M.SperlHillen@ healthpartners.com
• Am J Manag Care. 2013 Feb 1; 19 (2): 104-12.

ObjectivesTo evaluate whether outcomes from diabetes self-management education for patients with suboptimal control were sustained.Study DesignA randomized controlled trial of 623 adults with type 2 diabetes and glycated hemoglobin (A1C) > 7% assigned to receive conventional individual education (IE), group education (GE) using US Diabetes Conversation Maps, or usual care (UC) with no education.MethodsA1C tests, Problem Areas in Diabetes (PAID), Diabetes Self-Efficacy (DES), Recommended Food Score (RFS), physical activity, and medication use were quantified at baseline and 1 year of follow-up through electronic health records and quarterly mailed surveys. Short-term (mean 6.8 months) and long-term (12.8 months) outcomes were evaluated using linear mixed models. In addition, follow-up trajectories were plotted in a random effects generalized additive model with smooth splines.ResultsCompared with UC, IE resulted in long-term improved DES and PAID scores (DES, +.11, P = .03 and PAID, -2.94, P = .04), but not significantly improved long-term RFS or physical activity change. The A1C trajectory declined more steeply in IE than GE and UC for the first 150 days post randomization. However, by 250 days, there was no treatment group A1C difference. The model fit likelihood ratio test for A1C intervention trends was significant for 3 distinct non-linear trajectories (P = .02).ConclusionsConventional IE (but not GE) resulted in significant and sustained improvements in self-efficacy and reduced diabetes distress compared with UC, but short-term improvements in A1C, nutrition, and physical activity were not sustained. Patients may need ongoing reinforcement to achieve lasting behavioral change and glucose control.

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