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Published in: Health and Quality of Life Outcomes 1/2015

Open Access 01-12-2015 | Research

Increased number of structured diabetes education attendance was not associated with the improvement in patient-reported health-related quality of life: results from Patient Empowerment Programme (PEP)

Authors: Carlos K.H. Wong, William C.W. Wong, Eric Y.F. Wan, Winnie H.T. Wong, Frank W.K. Chan, Cindy L.K. Lam

Published in: Health and Quality of Life Outcomes | Issue 1/2015

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Abstract

Aims

To assess the effect of a structured education intervention, Patient Empowerment Programme (PEP) patient-reported health-related quality of life (HRQOL) among type 2 diabetes mellitus (T2DM) patients, and if positive effect is confirmed, to further explore any association between frequency of sessions attendance and HRQOL.

Methods

A total of 298 T2DM patients were recruited when they attended the first session of PEP, between March and September 2010, and were followed over a one-year period from baseline. HRQOL data were assessed using Short Form-12 Health Survey version 2 (SF-12) and Short Form-6 Dimension (SF-6D) at baseline and one-year follow-up. Individuals’ anthropometric and biomedical data were extracted from an administrative database in Hong Kong. Unadjusted and adjusted analyses of linear regression models were performed to examine the impact of PEP session attendance on the change in the HRQOL scores, accounting for the socio-demographic and clinical characteristics at baseline.

Results

Of the 298 eligible patients, 257 (86.2 %) participated in the baseline assessment and 179 (60.1 %) patients completed the follow-up assessment, respectively. Overall, PEP resulted in a significant improvement in SF-12 bodily pain and role emotional subscales and SF-6D utility scores. These positive changes were not associated with the level of participation as shown in both unadjusted and adjusted analyses.

Conclusions

The PEP made significant improvement in bodily pain, role emotional and overall aspects of HRQOL. Higher number of session attendance was not associated with improvement in HRQOL in primary care real-world setting.
Key Messages
● Participants with type 2 diabetes mellitus who participated in structured diabetes education programme made significant improvement in bodily pain and role emotional subscales and SF-6D scores.
● There was no association between the number of sessions attended and any aspect of HRQOL.
Literature
1.
go back to reference Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes/Metabolism Research and Reviews. 1999;15:205–18.PubMedCrossRef Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes/Metabolism Research and Reviews. 1999;15:205–18.PubMedCrossRef
2.
go back to reference Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care. 1997;20:585–90.PubMedCrossRef Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care. 1997;20:585–90.PubMedCrossRef
3.
go back to reference Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care. 1994;17:267–74.PubMedCrossRef Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care. 1994;17:267–74.PubMedCrossRef
4.
go back to reference Glasglow RE, Toobert DJG,CD. Psychosocial barriers to diabetes self-management and quality of life. Diabetes Spectrum. 2001;14:33–41.CrossRef Glasglow RE, Toobert DJG,CD. Psychosocial barriers to diabetes self-management and quality of life. Diabetes Spectrum. 2001;14:33–41.CrossRef
5.
go back to reference Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabetic Medicine. 2005;22:1379–85.PubMedCrossRef Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabetic Medicine. 2005;22:1379–85.PubMedCrossRef
6.
7.
go back to reference Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns. 2003;51:5–15.PubMedCrossRef Steed L, Cooke D, Newman S. A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Educ Couns. 2003;51:5–15.PubMedCrossRef
8.
go back to reference Knight KM, Dornan T, Bundy C. The diabetes educator: trying hard, but must concentrate more on behaviour. Diabetic Medicine. 2006;23:485–501.PubMedCrossRef Knight KM, Dornan T, Bundy C. The diabetes educator: trying hard, but must concentrate more on behaviour. Diabetic Medicine. 2006;23:485–501.PubMedCrossRef
9.
go back to reference Steinsbekk A, Rygg LO, 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.PubMedCentralPubMedCrossRef Steinsbekk A, Rygg LO, 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.PubMedCentralPubMedCrossRef
10.
go back to reference Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005;29:225–35.PubMedCrossRef Rosal MC, Olendzki B, Reed GW, Gumieniak O, Scavron J, Ockene I. Diabetes self-management among low-income Spanish-speaking patients: a pilot study. Ann Behav Med. 2005;29:225–35.PubMedCrossRef
11.
go back to reference Wattana C, Srisuphan W, Pothiban L, Upchurch SL. Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Nurs Health Sci. 2007;9:135–41.PubMedCrossRef Wattana C, Srisuphan W, Pothiban L, Upchurch SL. Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes. Nurs Health Sci. 2007;9:135–41.PubMedCrossRef
12.
go back to reference Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabetic Medicine. 2006;23:944–54.PubMedCrossRef Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT Programme makes a difference. Diabetic Medicine. 2006;23:944–54.PubMedCrossRef
13.
go back to reference Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336:491–5.PubMedCentralPubMedCrossRef Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al. Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ. 2008;336:491–5.PubMedCentralPubMedCrossRef
14.
go back to reference Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, et al. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Archives of internal medicine. 2011;171:2001–10.PubMedCrossRef Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, et al. Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial. Archives of internal medicine. 2011;171:2001–10.PubMedCrossRef
15.
go back to reference Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30:1017–25.PubMedCrossRef Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30:1017–25.PubMedCrossRef
16.
go back to reference Loveman E, Cave C, Green C, Royle P, Dunn N, Waugh N. The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation. Health Technol Assess. 2003;7:iii. 1–190.CrossRef Loveman E, Cave C, Green C, Royle P, Dunn N, Waugh N. The clinical and cost-effectiveness of patient education models for diabetes: a systematic review and economic evaluation. Health Technol Assess. 2003;7:iii. 1–190.CrossRef
17.
go back to reference Gillett M, Dallosso HM, Dixon S, Brennan A, Carey ME, Campbell MJ, et al. Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. BMJ. 2010;341:c4093.PubMedCentralPubMedCrossRef Gillett M, Dallosso HM, Dixon S, Brennan A, Carey ME, Campbell MJ, et al. Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. BMJ. 2010;341:c4093.PubMedCentralPubMedCrossRef
18.
go back to reference Wong CKH, Wong WCW, Lam CLK, Wan YF, Wong WHT, Chung KL, et al. Effects of Patient Empowerment Programme (PEP) on Clinical Outcomes and Health service Utilization in Type 2 Diabetes Mellitus in Primary Care: An Observational Matched Cohort Study. PLOS One. 2014;9:e95328.PubMedCentralPubMedCrossRef Wong CKH, Wong WCW, Lam CLK, Wan YF, Wong WHT, Chung KL, et al. Effects of Patient Empowerment Programme (PEP) on Clinical Outcomes and Health service Utilization in Type 2 Diabetes Mellitus in Primary Care: An Observational Matched Cohort Study. PLOS One. 2014;9:e95328.PubMedCentralPubMedCrossRef
19.
go back to reference Wong CKH, Wong WCW, Wan YF, Chan AKC, Chung KL, Chan FWC, et al. Patient Empowerment Programme in Primary Care Reduced All-cause Mortality and Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus: A Population-based Propensity-Matched Cohort Study. Diabetes, Obesity and Metabolism. 2015;17:128–35.PubMedCrossRef Wong CKH, Wong WCW, Wan YF, Chan AKC, Chung KL, Chan FWC, et al. Patient Empowerment Programme in Primary Care Reduced All-cause Mortality and Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus: A Population-based Propensity-Matched Cohort Study. Diabetes, Obesity and Metabolism. 2015;17:128–35.PubMedCrossRef
20.
go back to reference Wong CKH, Wong WCW, Wan YF, Chan AKC, Chan FWC, Lam CLK. Patient Empowerment Programme (PEP) and Risk of Microvascular Diseases among Patients with Type 2 Diabetes Mellitus in Primary Care: A Population-based Propensity Matched Cohort Study. Diabetes Care. 2015;38:e116–117.PubMedCrossRef Wong CKH, Wong WCW, Wan YF, Chan AKC, Chan FWC, Lam CLK. Patient Empowerment Programme (PEP) and Risk of Microvascular Diseases among Patients with Type 2 Diabetes Mellitus in Primary Care: A Population-based Propensity Matched Cohort Study. Diabetes Care. 2015;38:e116–117.PubMedCrossRef
21.
go back to reference Wong CKH, Wong WCW, Wan YF, Chan AKC, Chan FWC, Lam CLK: Effect of a Structured Diabetes Education Program in Primary Care on Hospitalizations and Emergency Department Visits among Type 2 Diabetes Mellitus: Results from the Patient Empowerment Programme (PEP). Diabetic Medicine 2015, In Press. Wong CKH, Wong WCW, Wan YF, Chan AKC, Chan FWC, Lam CLK: Effect of a Structured Diabetes Education Program in Primary Care on Hospitalizations and Emergency Department Visits among Type 2 Diabetes Mellitus: Results from the Patient Empowerment Programme (PEP). Diabetic Medicine 2015, In Press.
22.
go back to reference Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Quality of Life Research. 2005;14:539–47.PubMedCrossRef Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Quality of Life Research. 2005;14:539–47.PubMedCrossRef
23.
go back to reference Lam CLK, Wong CKH, Lam ETP, Lo YYC, Huang WW. Population Norm of Chinese (HK) SF-12 Health Survey_Version 2 of Chinese Adults in Hong Kong. Hong Kong Practitioner. 2010;32:77–86. Lam CLK, Wong CKH, Lam ETP, Lo YYC, Huang WW. Population Norm of Chinese (HK) SF-12 Health Survey_Version 2 of Chinese Adults in Hong Kong. Hong Kong Practitioner. 2010;32:77–86.
24.
go back to reference Wong CKH, Lo YYC, Wong WHT, Fung CSC. The associations of body mass index with physical and mental aspects of health-related quality of life in Chinese patients with type 2 diabetes mellitus: results from a cross-sectional survey. Health and Quality of Life Outcomes. 2013;11:142.PubMedCentralPubMedCrossRef Wong CKH, Lo YYC, Wong WHT, Fung CSC. The associations of body mass index with physical and mental aspects of health-related quality of life in Chinese patients with type 2 diabetes mellitus: results from a cross-sectional survey. Health and Quality of Life Outcomes. 2013;11:142.PubMedCentralPubMedCrossRef
25.
go back to reference Neumann PJ, Goldie SJ, Weinstein MC. Preference-Based Measures in Economic Evaluation in Health Care. Annual Review of Public Health. 2000;21:587–611.PubMedCrossRef Neumann PJ, Goldie SJ, Weinstein MC. Preference-Based Measures in Economic Evaluation in Health Care. Annual Review of Public Health. 2000;21:587–611.PubMedCrossRef
26.
go back to reference Brazier JE, Roberts J. The Estimation of a Preference-Based Measure of Health From the SF-12. Medical Care. 2004;42:851–9.PubMedCrossRef Brazier JE, Roberts J. The Estimation of a Preference-Based Measure of Health From the SF-12. Medical Care. 2004;42:851–9.PubMedCrossRef
27.
go back to reference Wong CKH, Lam ETP, Lam CLK. Comparison of direct-measured and derived short form six dimensions (SF-6D) health preference values among chronic hepatitis B patients. Quality of Life Research. 2013;22:2973–81.PubMedCrossRef Wong CKH, Lam ETP, Lam CLK. Comparison of direct-measured and derived short form six dimensions (SF-6D) health preference values among chronic hepatitis B patients. Quality of Life Research. 2013;22:2973–81.PubMedCrossRef
28.
go back to reference Lam CLK, Brazier J, McGhee SM. Valuation of the SF-6D Health States Is Feasible, Acceptable, Reliable, and Valid in a Chinese Population. Value in Health. 2008;11:295–303.PubMedCrossRef Lam CLK, Brazier J, McGhee SM. Valuation of the SF-6D Health States Is Feasible, Acceptable, Reliable, and Valid in a Chinese Population. Value in Health. 2008;11:295–303.PubMedCrossRef
29.
go back to reference McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, et al. Quality-adjusted life years: population-specific measurement of the quality component. Hong Kong Medical Journal. 2011;17 Suppl 6:s17–21. McGhee SM, Brazier J, Lam CLK, Wong LC, Chau J, Cheung A, et al. Quality-adjusted life years: population-specific measurement of the quality component. Hong Kong Medical Journal. 2011;17 Suppl 6:s17–21.
30.
go back to reference Walters S, Brazier J. What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health and Quality of Life Outcomes. 2003;1:4.PubMedCentralPubMedCrossRef Walters S, Brazier J. What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health and Quality of Life Outcomes. 2003;1:4.PubMedCentralPubMedCrossRef
31.
go back to reference Vadstrup ES, Frølich A, Perrild H, Borg E, Røder M. Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project. Journal of Diabetes Mellitus. 2012;2:308–15.CrossRef Vadstrup ES, Frølich A, Perrild H, Borg E, Røder M. Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project. Journal of Diabetes Mellitus. 2012;2:308–15.CrossRef
32.
go back to reference Vadstrup ES, Frolich A, Perrild H, Borg E, Roder M. Health-related quality of life and self-related health in patients with type 2 diabetes: effects of group-based rehabilitation versus individual counselling. Health and Quality of Life Outcomes. 2011;9:110.PubMedCentralPubMedCrossRef Vadstrup ES, Frolich A, Perrild H, Borg E, Roder M. Health-related quality of life and self-related health in patients with type 2 diabetes: effects of group-based rehabilitation versus individual counselling. Health and Quality of Life Outcomes. 2011;9:110.PubMedCentralPubMedCrossRef
33.
go back to reference Khunti K, Gray LJ, Skinner T, Carey ME, Realf K, Dallosso H, et al. Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. BMJ. 2012;344:e2333.PubMedCentralPubMedCrossRef Khunti K, Gray LJ, Skinner T, Carey ME, Realf K, Dallosso H, et al. Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. BMJ. 2012;344:e2333.PubMedCentralPubMedCrossRef
34.
go back to reference Trento M, Gamba S, Gentile L, Grassi G, Miselli V, Morone G, et al. Rethink Organization to iMprove Education and Outcomes (ROMEO): a multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care. 2010;33:745–7.PubMedCentralPubMedCrossRef Trento M, Gamba S, Gentile L, Grassi G, Miselli V, Morone G, et al. Rethink Organization to iMprove Education and Outcomes (ROMEO): a multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes Care. 2010;33:745–7.PubMedCentralPubMedCrossRef
35.
go back to reference Fan L, Sidani S. Effectiveness of diabetes self-management education intervention elements: A meta-analysis. Canadian Journal of Diabetes. 2009;33:18–26.CrossRef Fan L, Sidani S. Effectiveness of diabetes self-management education intervention elements: A meta-analysis. Canadian Journal of Diabetes. 2009;33:18–26.CrossRef
36.
go back to reference Fisher EB, Boothroyd RI, Coufal MM, Baumann LC, Mbanya JC, Rotheram-Borus MJ, et al. Peer Support For Self-Management Of Diabetes Improved Outcomes In International Settings. Health Affairs. 2012;31:130–9.PubMedCentralPubMedCrossRef Fisher EB, Boothroyd RI, Coufal MM, Baumann LC, Mbanya JC, Rotheram-Borus MJ, et al. Peer Support For Self-Management Of Diabetes Improved Outcomes In International Settings. Health Affairs. 2012;31:130–9.PubMedCentralPubMedCrossRef
37.
go back to reference Carey ME, Mandalia PK, Daly H, Gray LJ, Hale R, Martin Stacey L, et al. Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial. Diabetic Medicine. 2014;31:1431–8.PubMedCrossRef Carey ME, Mandalia PK, Daly H, Gray LJ, Hale R, Martin Stacey L, et al. Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial. Diabetic Medicine. 2014;31:1431–8.PubMedCrossRef
Metadata
Title
Increased number of structured diabetes education attendance was not associated with the improvement in patient-reported health-related quality of life: results from Patient Empowerment Programme (PEP)
Authors
Carlos K.H. Wong
William C.W. Wong
Eric Y.F. Wan
Winnie H.T. Wong
Frank W.K. Chan
Cindy L.K. Lam
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2015
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-015-0324-3

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