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Patient education—evaluation of a complex intervention
Open accessAbstract
Diabetes education or self-management programmes are complex interventions. Their evaluation is difficult because of problems in identifying and separately assessing the effect of the various components of the intervention. A phased approach defining sequential stages of a continuum of increasing evidence has been proposed as a framework for the design and evaluation of such complex interventions. As an example we present the available evidence for diabetes treatment and teaching programmes implemented in Germany. Evidence is compiled for structured group treatment and teaching programmes for Type I diabetes, non-insulin dependent Type II diabetes, and hypertension according to the following sequential stages of increasing evidence: (i) preclinical or theoretical phase; (ii) modelling the components of the intervention; (iii) exploratory trials; (iv) randomized controlled trials; (v) phase of implementation including replication and transfer to different settings. Evidence for most of these phases has been generated for the three programmes, although individual studies do not fulfill all important quality criteria by today's standards. The time span for gathering the evidence from the theoretical phase to surveillance after implementation was about 20 years. It can only be speculated which parts of the programmes are the most active ones. The presentation of a continuum of increasing evidence for diabetes education or self-management programmes could provide useful information for the appraisal of such complex interventions. Since this evidence cannot be readily extracted from databases we suggest that other research groups present their data in a similar way.
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“There is convincing evidence that formal training programs that teach patients to replace insulin “physiologically” by giving background and mealtime/correction doses of insulin can reduce the risk of severe hypoglycemia.”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [100]
In the citing paper
“There is convincing evidence that formal training programs that teach patients to replace insulin ' physiologically ' by giving background and mealtime/ correction doses of insulin can reduce the risk of severe hypoglycemia.”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [100]
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“The Insulin Treatment and Training programs developed by M € uhlhauser and Berger (100) have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia (101,102).”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [100]
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Metadata
- Authors
- I., M., & M., B.
- Venue
- Diabetologia
- Published
- 2002-12-01
- Volume
- 45
- Issue
- 12
- Pages
- 1723-1733
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2000503313
- Cited by
- 102
- References
- 36
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 8 · 2015: 6 · 2014: 3 · 2013: 5 · 2012: 3
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes education, self-management program, complex interventions, intervention evaluation, type 1 diabetes, type 2 diabetes, hypertension, randomized controlled trials, exploratory trials, implementation
- MeSH terms
- Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Germany, Humans, Hypertension, Patient Education as Topic, Self Care, Teaching, Randomized Controlled Trials as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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