Building Competency in Diabetes Education THE ESSENTIALS

2-26 | CHAPTER 2

• Feedback cycle — intervention and individual review. • Psychological emphasis. • Medical care providers involved (vs. non-medical).

However, Chodosh stated that the most important elements of SME cannot be conclusively determined, as yet, since the associations listed above were not statistically significant (64). Further meta-analysis and studies have concluded that there is an improved quality of life (65) and improved glycemic control for those who attend SME programs (30,66-68). However, as Klein et al. have stated in their review of diabetes SME, we have “miles to go” (61). “Our current interventions yield improvement in glycemic control that are promising but not yet compelling” (61,69,70). These meta-analyses confirm the trend initially stated by Norris that SME interventions have modest effects, and that the intervention effects appear to attenuate over time. Klein et al.’s review also synthesizes the results of behavioural interventions, stating that, when ‘mental models’ that are rooted in a cognitive model of “system dynamics” are added to the teaching of rules and procedures, there is a successful adaptive response (61). With the increasing cost in health care, it is interesting to note that diabetes self-management programs have been found to be cost effective in reducing hospital admissions, reducing outpatient visits and in all-cause use of medical services (10,42,70-72). All the reviews experience the limitations of attempting to measure the efficacy of different methodologies, settings, interventions, outcomes measured and lengths of follow-up in very heterogeneous populations (70).