Diabetes self-management education:Benefits and challenges

Diabetes mellitus has spread throughout many nations of the world and is now a serious threat.A lack of patient self‑management has been linked to this drain on global health.The consequences of diabetic patients’poor self‑management have increased a variety of complications and lengthened hospital stays.Poor information and skill acquisition have been linked to poor self‑management.Participating in a co‑operative approach known as diabetes self‑management education will help diabetes patients who want to successfully self‑manage their condition and any associated conditions.Information is one of the most important components of a diabetes management strategy.In conclusion,numerous studies have shown that patients with diabetes have poor self‑management skills and knowledge in all areas,making training in diabetes self‑management necessary to minimize the complications that may result from diabetes mellitus among the patients.This review discussed the severity of diabetes mellitus,diabetes self‑management,and the benefits and challenges of diabetes self‑management,which may aid individuals in understanding the significance of diabetes self‑management and how it relates to diabetes self‑care.

Systematic Review of Community Type 2 Diabetes Structured Health Education (CT2DSHE)

Aim: This paper aims to evaluate disparities of type 2 diabetes structured health education programmes that is utilised within the communities. Design: systematic review, (a type of secondary research design) aiming to summarize the results of prior primary research studies on available evidence Community type 2 diabetes structured education (CT2DSHE). Methods: Research question: Type 2 diabetic structured health education within a community how effective is it? Qualitative Systematic review, defined as a way to get reliable and objective picture of current available evidence on the specific topic—(CT2DSHE), (Denscombe, 2021) through reflexivity synthesis of available data as an example. This is valuable in time constraints such as project assignments that must be met within specific time and also to bring together available evidence together [1]. Results: This review has shown that CT2DSHE is effective with seven out of the eleven authors supporting, three authors against and one was neutral, further showed that knowledge and skills acquired can last longer with patient activation improved among T2DM patients ideal for sustaining their self-management of T2DM. Conclusion: This research provides suggestive answers to the research question: “Type 2 diabetic structured health education within a community how effective is it?”, This has demonstrated CT2DSHE effectiveness in knowledge acquisition and improving T2DM awareness among T2DM patients, whilst evidencing long effects beyond the study times of 3 - 9 months period in relation to patient activation. Also Identified diabetes education self-management on newly diagnosed (DESMOND) patient as CT2DSHE program for recommendation. Patient or Public Contribution: This work aspires to contribute to CT2DSHE in these areas;Influencing policy decision-making for community diabetes care within the UK and world at large., Contributing to already vast knowledge on diabetes self-management and reasons why?, Influencing educators on how CT2DSHEP are designed, delivered by putting the patient at the Centre and bringing different perspectives on CT2DSHEP in one place that is serving users time of having to consult several resources especially busy clinicians [2] [3].

Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Upshots of health education among patients with type 2 diabetes mellitus: A field study in Mysuru

Objective:This study was conducted to assess the impact of health education on lifestyle modification and disease status of diabetic patients for 6 months in rural Mysuru in Southern India.Materials and Methods:A quasi-experimental study was conducted among 104 patients with type 2 diabetes mellitus in rural Mysuru,India from July to December 2022.Participants were assigned to two groups:intervention(n=52)and control(n=52),and their data were collected.The intervention group was educated about the disease and its management and was given printed pamphlets containing information to be followed,whereas the participants in the control group were asked to continue their routine health checkups.The body mass index(BMI),weight,fasting blood sugar(FBS),knowledge about the disease,and behavior changes were recorded and compared between the two groups before and after 6 months.Results:The mean FBS value,BMI and weight decreased significantly in the intervention group after 6 months(FBS:164.79±47.59 mg/dL vs.141.92±25.63 mg/dL,P<0.001;BMI:22.97±3.75 kg/m2 vs.22.62±3.29 kg/m2,P<0.05;weight:62.82±11.92 kg vs.61.54±10.67 kg,P<0.05).The posttest period also showed an improvement in physical activity,diet,and medication adherence in the intervention group compared to the control group(P<0.05).The knowledge scores also improved postintervention which was statistically significant with the Wilcoxon signed-rank test(P<0.05).Conclusions:The effectiveness of the educational intervention was also supported by lower FBS levels and decrease in BMI and weight compared to before.The findings of this study may help and make it easier to plan studies on people with diabetes mellitus in various settings.

The Effect of an Educational Program Based on the Health Belief Model on Self-Efficacy among Patients with Type 2 Diabetes Referred to the Iranian Diabetes Association in 2014

Background: Patient self-efficacy is one of the most important factors in treating and overcoming disease. Objective: The aim of this study was to evaluate the effect of an educational program based on the health belief model on self-efficacy among patients with type 2 diabetes referred to the Iranian Diabetes Association in 2014. Method: A randomized controlled clinical trial was conducted. Eighty patients with type 2 diabetes were selected randomly by the double block sample method. They were then divided into two groups of intervention and control (40 patients in each group) by random allocation. Data were collected by a questionnaire based on the Health Belief Model and self-efficacy. The data were gathered two months after the educational program was held. The educational program was designed on the basis of data collected in the pre-test phase. Then, the educational program was executed for the intervention group in 8 sessions (each 30 minutes) using lectures and an educational booklet. Data analysis was done with Chi-square Test, Pearson’s correlation, Independent samples T-test and paired T-test. The significance level was considered at 0.05. Results: Before intervention, no significant difference was detected between the two groups. However, after intervention all variables were significantly different except for perceived threat. Moreover, there were significant linear relationships between Self-efficacy and all Health Belief Model components after the educational intervention in both groups (p < 0.05). Conclusion: The educational program based on the health belief model increased self-efficacy in type 2 diabetes mellitus patients.

Primary Healthcare System of Pakistan: Challenges to Self-Management of Type 2 Diabetes

This review article is aimed at describing the primary healthcare system of Pakistan and its challenges in the face of epidemic of type 2 diabetes, focusing particularly on the middle-aged population of rural area of Pakistan. The main concern in Pakistan is that its middle-aged population is facing the onslaught of obesity and overweight due to lack of physical activity. In addition unhealthy eating habits making it more difficult for this population to control their weight. All these factors are contributing to a high risk of type 2 diabetes for the population of Pakistan. This article provides insight into the primary health care system of Pakistan and highlights its deficiencies by identifying that its primary healthcare system has a poor utilization of health care services, the poor accessibility to health system and poor management of diabetes by the healthcare system, gender disparity and inequity in the health care system. The primary objective of this study is to provide an overview of self-management of diabetes among the middle-aged population of Pakistan and to identify the overall deficiencies in the primary healthcare system, its delivery and access to the system, barriers to self-management of diabetes and quality of life in that region.

Effect of a new health education model on continuous nursing in elderly patients with diabetes mellitus

Objective: We aimed to explore the effect of a new health education model on continuous nursing care in elderly patients with diabetes mellitus who had undergone an operation for fracture.Methods: Convenience sampling was used to select 59 elderly patients with diabetes mellitus and fracture. New health education methods were used, and patient parameters were evaluated before and after the intervention.Results: Evaluation of medication, reasonable diet, regular exercise, blood glucose monitoring, and regular follow-up compliance were significantly improved in the experimental group compared to the control group(P<0.05). There were also significant differences between groups in fasting blood glucose, 2-hour postprandial blood glucose, triglyceride, high-density lipoprotein, and low-density lipoprotein levels(P < 0.05); however, the differences between groups in terms of glycosylated hemoglobin and total cholesterol levels were not statistically significant(P > 0.05). Finally, the functional recovery and mental health of the experimental group were significantly better than those of the control group(P < 0.05).Conclusions: The implementation of a menu of voluntary services in community-based continuous nursing provided standardized nursing care for elderly patients with fracture and diabetes mellitus and improved their quality of life.

A comprehensive health education plus monitoring support program for older adults with knee osteoarthritis coexisting with overweight and type 2 diabetes

Objectives:To examine the patient outcomes of a comprehensive health education plus village health volunteer monitoring support program on older adults with knee osteoarthritis who are overweight and have type 2 diabetes.Methods:Quasi-experimental,two-group,pretest-posttest design was applied.Using random geographic cluster sampling,older adults who met the inclusion criteria were assigned to two groups,62 in the intervention group and 71 in the control group.The intervention group received the comprehensive health education plus village health volunteer monitoring support program.The control group received only the comprehensive health education program.Study outcomes,including blood glucose level,knee pain and range of motion,body weight,physical ability(Timed Up and Go Test),fatigue,depressive symptoms,quality of sleep,and quality of life,were assessed at baseline,3 months,and 6 months after enrollment and analyzed using descriptive statistics and multivariate analysis of variance.Results:One hundred and ten participants completed the study(55 participants in each group).Most patient outcomes in the two groups showed general improvement with statistical significance(P<0.001):pain decreased,physical ability improved,less depressive symptoms and fatigue,quality of life and sleep improved.The interaction effect(the group and time)demonstrated statistically significant differences between the intervention and control groups on pain,knee range of motion,and fatigue according to each time follow-up(P<0.001).Conclusions:The comprehensive health education plus village health volunteer monitoring support program promotes good patient outcomes in this population.The integrated health education resource and support for older adults with knee osteoarthritis and type 2 diabetes is an effective,non-surgical treatment that highlights professional nursing roles and non-professional rolesdvillage health volunteers.Nurses should consider implementing a health education plus monitoring support program to mitigate the effects of chronic diseases and improve patients’quality of life.

Prediabetes and cardiovascular complications study:Highlights on gestational diabetes, self-management and primary health care

International collaboration on the prediabetes and cardiovascular complications study started in 2013.In 2017,a reflection was reported.Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus(GDM)was concerning.Hence,further observations have been made that warrant an update.The objective of this review is to highlight gaps between clinical knowledge and practice in GDM,diabetes self-management and primary health care(PHC)for rural dwellers.We followed a descriptive field notes method.Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment.Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed.Other data included cross-sectional evaluation of activities of daily living at two private hospitals.Up to 29%had high GDM risk factors,which fulfilled selection criteria for laboratory screening.Demographic data was complete in all women;however,incomplete documentation was observed with as much as 98%of basic data.High levels of physical activity were found in the population,and health lectures proved effective in food choices.The workforce need for diabetes care seems underestimated,but this may be better understood with reactivation of PHC services.The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus.Two proposals are to advance the use of a‘risk assessment and screening sheet’for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.

Application Analysis of Diabetes Health Education in Endocrinology Nursing

Objectives:To explore the clinical value of applying diabetes health education to endocrinology care.Methods:A total of 122 patients with diabetes admitted to our department from October 2016 to October 2017 were selected.After consulting patients,they were randomly divided into two groups,with 61 cases in each group.The control group performs routine care,and the experimental group provides patients with diabetes-specific health education.After three months,the compliance of the two groups of patients was compared.The ADL scores of the two groups of patients before and after treatment were compared.Results:Experimental group had significantly higher compliance rate than control group in all aspects.The difference was statistically significant(P<0.05).The ADL scores of both groups were significantly improved.The effects before and after the care were compared.The difference was statistically significant(P<0.05).The score of experimental group increased more significantly than that of the control group.The difference was statistically significant(P<0.05).Conclusions:In the endocrinology care,the implementation of diabetes special health education for patients can improve patient compliance and improve patients'daily living ability,which is an ideal nursing measure.It is worth promoting.

Knowledge about Diabetes Mellitus and Self-Care Activities before and after an Educational Program: A Pilot Study

Background: Health education has proven to be an effective strategy to enable people with diabetes mellitus to manage this condition. However, few studies in Brazilian population samples have been conducted to evaluate the effects of educational programs on diabetes knowledge and self-care. Aim: To evaluate the knowledge about diabetes mellitus and the performance of self-care activities, before and after participation in an educational program. Methods: This is an intervention study, with a quantitative approach, in a single comparison group, for the analysis of “before and after” results related to an educational program focused on self-care and concurrent physical training. The study interventions consisted of 42 exercise sessions, as well as individual educational meetings, according to the needs of each participant and through nursing consultations, using educational material prepared from the literature. The sample was initially composed of 33 adults with diabetes mellitus, but 18 completed the study. For the assessment of knowledge and self-care activities, the revised Brazilian versions of the Diabetes Knowledge Scale and the Diabetes Self-Care Activity Questionnaire were used, respectively, in the two moments of the study, that is, prior to the first educational meeting and immediately before the first physical training session, and after the last educational meeting, which ran parallel to the 42nd physical training session, making a six-month interval between the two assessment moments for each participant. Results: The analysis of knowledge about diabetes showed significant improvement after the educational program and, as for self-care, there was clinical improvement in all dimensions, but only the dimension “general diet” obtained statistically significant improvement. Conclusion: The educational program has been shown to be beneficial for improving knowledge and self-care of the disease, which reiterates the need to maintain interventions of this nature for people with diabetes mellitus.

Preferences of Persons with Type 2 Diabetes for Diabetes Self-Management Education Interventions: An Exploration

Objectives: Treatment preferences affect treatment engagement, adherence and outcomes. There is limited knowledge of patients’ preferences for Diabetes Self-Management Education (DSME). This study explored the preferences of Canadians with diabetes for components, mode and dose for implementing DSME interventions. Methods: A cross-sectional design was used. Adults with diabetes completed a questionnaire to assess participants’ preferences for components (i.e. content), mode (i.e. teaching strategies, delivering formats) and dose (i.e. number and length of sessions) of DSME. Descriptive statistics were used to analyze the data. Results: Participants (n = 100) were middle-aged men and women, who had diabetes for 6.1 years and previously received (95.0%) DSME. They indicated preference for DSME to include a combination of educational, behavioral and psychological components;to be delivered in individual, face-to-face sessions (4 sessions, 60 minutes each, given monthly) that allowed discussion with one diabetes educator to develop and carry out a care plan. Conclusions: Diabetes educators may consider eliciting patient’s preferences and tailoring DSME to fit patients’ preferences. Delivering interventions that are consistent with patients’ preferences increases their motivation to engage in intervention, satisfaction and adherence to treatment and achievement of desired outcomes.

Competences for self-care and self-control in diabetes mellitus type 2 in primary health care

The purpose of the guidelines of self-care and self-control of type 2 diabetes mellitus proposed by the Brazilian Ministry of Health is to strengthen and qualify users and health care professionals through the integrality and longitudinality of care with this disease.This article aims to present the self-care and self-control of people with type 2 diabetes mellitus in objective terms,taking into account the current recommen-dations based on scientific evidence and also from the subjective point of view,that is,emphasizing the aspects related to experience and subjectivity of these people.Next,we present the essential skills for self-care and self-control of users and professionals working in primary health care.

The Improving Effects of Diabetes Education on Diabetes Awareness and Management in Children and Adolescents with T1DM

Background: Diabetes education is crucial in empowering persons with Type 1 diabetes (T1DM) and their families to properly manage the condition by providing comprehensive knowledge, tools, and support. It boosts one’s belief in their ability to succeed, encourages following medical advice, and adds to the general enhancement of health. Objective: This study is to investigate the effectiveness of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively manage the condition. Furthermore, it strives to improve nursing care for families whose children have been diagnosed with Type 1 Diabetes Mellitus (T1DM). Design: This research study investigates the efficacy of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively handle the condition. Materials and Methods: A systematic search was conducted between the years 2000 and 2022, utilizing the Medline and Google Scholar databases. The purpose of the search was to uncover relevant papers pertaining to diabetes education, management of Type 1 Diabetes Mellitus (T1DM), nurse care, and empowerment. The search focused on peer-reviewed research, clinical trials, and scholarly articles that evaluated the efficacy of diabetes education in empowering individuals and families. Results: Diabetes education is crucial for understanding and controlling T1DM. It includes personalized sessions, webinars, group classes, and clinics that provide customized therapies. Comprehensive education enhances glycemic control and family dynamics. Nevertheless, the implementation of diabetes education for families requires specific standards, especially in the field of nursing. Conclusion: Diabetes education is essential for effectively managing Type 1 Diabetes Mellitus (T1DM), providing patients and families with crucial knowledge, resources, and confidence. It encourages independence in-home care and provides explicit guidelines for diabetic nurses to improve nursing care.

Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors

BACKGROUND The treatment of heart failure not only needs to relieve the clinical symptoms and improve the quality of life for patients but also needs to select scientific and reasonable ways to prevent or delay the progression of the disease,thus reducing the mortality and hospitalization rate.Although the previous regimen can effectively relieve symptoms in the early stage of treatment,long-term use may cause adverse events,such as arrhythmia,and even increase mortality.Therefore,conventional treatment cannot meet the actual health needs of patients,and scientific nursing intervention is very necessary.AIM To investigate the application of self-care based on full-course individualized health education (FCIHE) and its influencing factors in patients with chronic heart failure (CHF).METHODS We enrolled CHF patients who were admitted to our center between September 2015 and June 2016 and divided them into an intervention group (n = 50) and control group (n = 50) using a random number table.Routine nursing care was applied to the control group,and FCIHE was offered to the intervention group.The self-care behavior,6-min walking distance (6MWD),and 36-item short form health survey (SF-36) scores were compared between the two groups.The influencing factors of the self-care were also analyzed.RESULTS The 6MWD was not significantly different between the two groups at admission (P > 0.05);however,at 3 and 6 mo after discharge,6MWD was significantly increased,and it was significantly longer in the intervention group (P < 0.05).The scores for self-care behavior showed no significant difference at admission between the two groups (P > 0.05);however,at 3 and 6 mo after discharge,the total scores for self-care maintenance,management,confidence,and behavior of the intervention group were significantly higher than those of the control group (P < 0.05).There were no significant differences in the SF-36 scores at admission (P > 0.05);however,at 3 mo and 6 mo after discharge,the scores for all eight subscales,including physical functioning,role limitations due to physical problems,bodily pain,general health perceptions,vitality,social functioning,role-limitations due to emotional problems,and mental health,were significantly higher in the intervention group (P < 0.05).As shown by logistic regression analysis,the influencing factors of self-care mainly included age,cardiac function class,and education background (odds ratio > 1;all P < 0.05).CONCLUSION FCIHE improved self-care behavior and cardiac function in CHF patients.Age,cardiac function,and education level affected the implementation of self-care among CHF patients.

Socio-Economic and Health Indicators’ Relation to Self-Assessed Health: A Case Study of Phai Tha Pho, Phichit Province, Thailand

Background: Self-assessed health (SAH) is used as a common method of sociology research to understand the implications of self-reported health and the link to social factors like education, income, and occupation. The paper explores the impact of socio-economic and health indicators on self-assessed health in the middle-aged to the senior population in a rural community in Thailand. Methods: Primary data were collected after conducting a randomized sampling for 100 people using direct interviews in two locations within the sub-district of Phai Tha Pho, Thailand. The target demographic was the middle-age to elderly population. A logit model was applied to the collected samples. Results: The study highlights that higher education, income, and sleep are high predictors for positive SAH while high blood sugar level has significant adverse effects on SAH. Detection of metabolic syndrome further indicates degraded overall health perception over time. Conclusion: The study demonstrated the relationship between socio-economic indicators and illnesses alongside individual SAH in rural Thailand. Accordingly, policies have been proposed that include targeted subsidies for healthy food alternatives, promoting work-rest balance at all levels, and an expansion of sub-district education up to secondary school. SAH can be performed regularly and expanded across communities including areas of low-income living due to its low implementation costs. It could also be used as a tool to support the government’s public health initiatives complementing the existing five-year direct health check-up programme. A comparative study of SAH across regions is recommended for future research.

Intervention Effect Based on Self-Regulation to Promote the Continuation of Self-Care Behavior of Patients with Type-2 Diabetes Mellitus

[Purpose] The purpose of this study was to identify the effect of a support program based on self-regulation. [Methods] Participants: Patients with type-2 diabetes mellitus in rural areas;Research design: Quasi-experimental research. A t-test and Mann-Whitney U test were performed to compare the intervention and control groups before the intervention. For the comparison within the groups before and after the interventions, a t-test and the Wilcoxon signed-rank test were performed. For statistical analysis, the significance level was set to 5%. [Results] The intervention group included 19 participants (age 59.8 ± 6.14) and 10 participants in the control group (age 64.3 ± 3.95). After the program, the scores in knowledge about diabetes (p = 0.001) and sub-items of the diabetes self-management (foot care) (p = 0.048) of the intervention group statistically significantly increased, and the calorie intake decreased (p = 0.080). The intervention group had higher scores in all three sub items of the self-efficacy (positiveness, control, and total score). There were no statistically significant differences in the changes in BMI, HbA1c, and the subscales of self-efficacy between the two groups. However, the scores of these items of the intervention and control groups were 3.3 and 2.9, 2.2 and −0.3, and 5.5 and 2.6, respectively. [Conclusions] The support program based on self-regulation in this study helped the participants to acquire general knowledge of diabetes to assess own medical condition and problems in self-care behavior and practical knowledge to manage diabetes in daily life, and this shows the effectiveness of the program.

Prevention and Treatment of Diabetic Foot Ulcer by Health Education of Specialized Nurses

Objective:To analyze the preventive effect of specialized nurse health education on diabetic foot ulcers.Methods:From January 2022 to December 2022,90 diabetic high-risk foot patients that were admitted to the Endocrinology Department of a general hospital in Macao that met the inclusion criteria were selected as the research subjects.The research subjects were randomly divided into an intervention group and a control group,with 45 cases in each group by mechanical sampling method.The foot care knowledge of the patients one month and three months after the intervention were evaluated and analyzed.Results:The scores of foot care knowledge in the intervention group were higher than those in the control group at one month and three months after the intervention,and the dift'ercncc was statistically significant(P<0.05).Conclusion:Health education by specialized nurses are essential in preventing and treating diabetic foot ulcers.Effective prevention and management of diabetic foot ulcers can be achieved through guidance on diet control,exercise,foot care,blood sugar monitoring,infection prevention,stress reduction,appropriate medication,and regular follow-up.

Effect of Health Education Based on Integrative Therapy of Chinese and Western Medicine for Adult Patients with Type 2 Diabetes Mellitus： A Randomized Controlled Study

Objective： To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus（T2DM） from the aspects of knowledge, attitude and practice（KAP）, health-related quality of life（HRQo L）, body mass index（BMI） and glucose control. Methods： Patients were individually randomized into intervention group（receiving integrative education, n=120） and control group（receiving usual education, n=120）. The primary outcome was the changes in glycosylated hemoglobin A1c（HbA1c） levels after 3, 6, 9 and 12 months from baseline. Hierarchical linear models（HLMs） were used to assess within-group changes in outcomes over time and between-group differences in patterns of change. Secondary outcomes were KAP scores, HRQo L scores and BMI after 6 and 12 months, paired-sample t test was used to assess within-group changes in outcomes in 6 and 12 months, independent-sample t test was used to assess between-group differences in patterns of change. Results： HbA1c decreased statistically from baseline to 3 months, from 3 to 6 months, from 6 to 9 months and from 9 to 12 months in the intervention group（all P〈0.01）; and decreased significantly from baseline to 3 months, and from 3 to 6 months in the control group（P〈0.01）. There were significant between-group differences from baseline to 3 months（P=0.044）, from 6 to 9 months（P〈0.01） and from 9 to 12 months（P〈0.01）. Significant improvements in the intervention group along with significant between-group differences were found in KAP and HRQo L scores respectively（all P〈0.05）. The number in the intervention group of normal weight increased from 56 at baseline to 81（6 months）, 94（12 months）, the number in the control group were 63（baseline）, 69（6 months）, 70（12 months）, the χ~2 of hierarchical analysis of BMI were 6.93（P=0.075）, 10.31（P=0.016）, 15.53（P〈0.01）, respectively. Conclusion： Health education based on integrative therapy of Chinese and Western medicine is beneficial to the control of T2DM and should be recommended for T2DM.

Comparative efficacy of social media delivered health education on glycemic control: A meta-analysis

Objective:To compare outcomes associated with patient education about glycemic control via group chat versus patient education as usual among individuals with diabetes in China.Methods:We searched the following databases both in English and in Chinese languages:PubMed,CNKI,Wanfang database,VIP database,and CBM for articles published up to Jan 1,2018.The studies were screened by two independent reviewers.Using criteria from the risk of bias assessment tool developed by Cochrane Collaboration to assess the risk of bias of eligible studies.A meta-analysis of studies was performed using comprehensive meta-analysis version 3.0.Results:Twenty-five unique randomized clinical trials,including 2,838 patients,were identified.The education delivered via group chat had large overall pooled effect sizes in improving glucose control measured by hemoglobin A1c[Hedges'g=-0.81,95%CI:(-0.98,-0.64)],fasting blood glucose[Hedges'g=-1.11,95%CI:(-1.37,-0.85)],and 2 h postprandial blood glucose[Hedges'g=-0.98,95%CI:(-1.20,-0.76)].Additionally,patient education delivered via group chat has shown consistently superior outcomes in glucose control in short-term(0-3 months),mid-term(3-6 months)and longer-term(6-12 months).Conclusions:Educational interventions via group chat had a superior outcome in blood glucose control compared to education as usual in China.Educational interventions via group chat had superior shortterm,mid-term,and longer-term outcomes in blood glucose control compared to education as usual in China.