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Diabetes-specific knowledge is associated with performance of self-management activities but not with outpatient care

Adults with diabetes who are knowledgeable about their disease are more likely than those with less knowledge to manage their disease by checking blood sugar levels and following recommended diet and exercise. However, they are no more likely to receive recommended outpatient diabetes care to monitor the disease and prevent diabetes complications, according to a new study. This is an unexpected finding, according to the study's authors, since knowledgeable patients would be expected to be more likely to seek out needed preventive care. Also, providers who educate their diabetes patients would be expected to be more consistent in providing necessary ambulatory care.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS09936 and T32 HS00020), Stephen D. Persell, M.D., M.P.H., of Northwestern University, and his colleagues surveyed 670 adults with diabetes from three managed care plans to assess their diabetes knowledge and self-management activities. The researchers reviewed medical charts to assess the subjects' receipt of five processes of diabetes care: eye and foot exams, low-density lipoprotein cholesterol (LDL-C) testing, hemoglobin A1c (HbA1c) testing (indicating blood-sugar level), and urine microalbumin testing (an indicator of kidney function), as well as three metabolic outcomes: controlled hyperglycemia (HbA1c at 9.5 percent or less), controlled cholesterol (LDL-C less than 130 mg/dL), and controlled blood pressure (less than 140/90 mm Hg).

A one-point increase on the knowledge scale was associated with 23 percent, 29 percent, and 15 percent greater likelihood, respectively, of following a diabetes diet, taking blood glucose self-measurements, and exercising regularly, but there was no association with processes of care or metabolic outcomes. Using patient education to empower diabetes patients to oversee the quality of their outpatient care in addition to self-managing their diabetes could increase the benefits of patient education.

See "Relationship of diabetes-specific knowledge to self-management activities, ambulatory preventive care, and metabolic outcomes," by Dr. Persell, Nancy L. Keating, M.D., M.P.H., Mary Beth Landrum, Ph.D., and others, in the October 2004 Preventive Medicine 39, pp. 746-752.

Editor's Note: Another AHRQ-supported study on a related topic suggests that "readiness to change" behaviors associated with medication adherence, home glucose monitoring, and other self-care behaviors among diabetes patients with high functional health status are a significant predictor of future glycemic control. For more details, see O'Connor, P.J., Asche, S.E., Crain, A.L., and others (2004, October). "Is patient readiness to change a predictor of improved glycemic control?" (AHRQ grant HS09946). Diabetes Care 27, pp. 2325-2329.

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