medwireNews: Clinicians can safely recommend group diabetes education for older patients with poor glycemic control, report researchers.
Older adults (aged 60-75 years) received the same glycemic and psychosocial benefits from participating in such interventions as younger adults (aged 21-59 years) did in a secondary analysis of a randomized trial, they say.
"Despite the large numbers of older adults with diabetes, how to best provide self-management support to this group remains unclear because of limited randomized controlled trial data," explain Katie Weinger (Harvard Medical School, Boston, Massachusetts, USA) and colleagues.
"Consequently, evidence-based guidelines for this age group are not well established."
The team compared glycemic and self-management behaviors between older and younger adults across three arms of the trial, which included group-based structured behavioral education, a group-based attention control arm, and an individual education control arm.
The structured behavioral intervention comprised five sessions of a diabetes group education program on strategies and techniques for implementing self-care behaviors, such as keeping glucose logs, regulating food take, or engaging in physical activity.
Individuals in the attention control arm attended five sessions on standard diabetes care, while those in the individual control arm had unlimited one-to-one sessions with diabetes educators for 6 months, when they could discuss any aspect of their diabetes.
As reported in Diabetes Care, data collected at 3, 6, and 12 months post-intervention showed no difference in mean glycated hemoglobin (HbA1c) levels between older and younger individuals across the study population as a whole (n=222).
Older and younger individuals in the structured behavioral group had equal changes in HbA1c over time. However, among those in the attention control group, older patients had significantly greater reductions in HbA1c than younger patients, whereas in the individual control group, younger patients had greater HbA1c reductions.
Importantly, both older and younger individuals were able to maintain the improvements in HbA1c levels similarly at 12 months in the group conditions, with a mean HbA1c reduction of 0.72% in the older structural behavioral group and of 0.65% in the older attention control group, compared with respective reductions of 0.55% and 0.43% in the corresponding younger groups.
Relative to baseline, the group interventions did not significantly differ from the individual intervention in their effects on HbA1c control among the older adults at 3 and 6 months, but they did yield significantly greater reductions at 12 months.
Finally, both older and younger individuals showed improved self-reported self-care, blood glucose monitoring, depressive symptoms, diabetes-related quality of life, diabetes-specific self-efficacy, and emotional coping post intervention, and reduced frustration with self-care and diabetes-related distress.