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Enhancing the (cost-)effectiveness of diabetes self-management education: A comparative assessment of different educational approaches and conditions for successful implementation

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Best ways to manage diabetes

Diabetes is a common health problem that requires extensive self-care. Educating people how to manage disease symptoms can help improve the clinical outcome of affected individuals.


Nearly 60 million people in Europe are affected by type 2 diabetes (T2D), the fourth leading cause of death. This number is still expected to rise, since T2D is strongly associated with being overweight and obese, two prevalent phenomena in modern society. Because diabetes requires extensive self-care, educating people to 'read' T2D symptoms and seek medical consultation, or to self-manage the disease after diagnosis, is a promising healthcare strategy. However, while self-management education for people with diabetes has been shown to have positive outcomes, the cost-effectiveness of these interventions is not well known. Moreover, the relative effectiveness of different approaches to self-management education or the impact of conditions under which education is provided has not been well documented. Many T2D sufferers are unaware that they are affected by the condition, and a patient’s adherence to the treatment is affected by his or her level of health literacy. Therefore, the effectiveness of the different educational approaches also needs to be addressed according to patient ethnicity, age and health literacy standards. Funded by the EU, the project DIABETES LITERACY (Enhancing the (cost-)effectiveness of diabetes self-management education: A comparative assessment of different educational approaches and conditions for successful implementation) aimed to provide the necessary evidence for supporting self-management education for diabetes. For this purpose, the consortium performed a comparative analysis of national diabetes strategies and existing self-management programmes in different European countries, using the Diabetes Literacy Survey (DLS) to collect information. To substantiate the cost-effectiveness of T2D self-management education, costs of existing self-management education programs were compared with those of T2D treatment. To compare different approaches to diabetes self-management education, a multi-centre pre-post effectiveness study was carried out involving 366 adult patients participating in education programmes in 9 countries, showing only small differences in outcomes between the different delivery modes. Using the European Health Literacy Survey Questionnaire (HLS-EU-Q6) a significant relationship was shown between low health literacy and poorer health outcomes in diabetic patients, but the effectiveness of the self-management education programmes was not affected by the patients’ health literacy level. For low-literacy people, a website for diabetes self-management was created with audiovisual and interactive features in several languages. The dissemination of project outcomes primarily targeted the scientific community and health policymakers, but the ultimate goal was to also inform health professionals and organisations involved in diabetes care. There is a nice short video about the research results of the DIABETES LITERACY project. The outcomes of the DIABETES LITERACY study can help to reinforce the importance of health literacy and education in diabetes management. Investing in the self-management capacity of patients is a policy that should be implemented across Europe, as it may reduce current healthcare treatment costs and improve the clinical picture of diabetes patients.


Diabetes, self-care, health literacy, healthcare, DIABETES LITERACY

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