title: Does an advanced insulin education programme improve outcomes and health service use for people with Type 2 diabetes? A 5-year follow-up of the Newcastle Empowerment course.
abstract: OBJECTIVE
  To show that an advanced diabetes education programme delivers sustained benefits to people with diabetes prescribed insulin and healthcare providers over and above those provided by basic diabetes education.
  
  
  METHODS
  An historical cohort study of 68 people with Type 1 and 51 people with Type 2 diabetes on insulin who attended the 4-day Newcastle Empowerment programme in 2001 and 2002 compared with 71 people with Type 1 and 312 people with Type 2 diabetes who attended only the basic 4-day insulin education programme over the same period, followed until 2007. Primary outcome was all hospital admissions and emergency visits; secondary outcomes were the composite of first cardiac event or death and readmission for diabetes complications. Cox-proportional hazards regression was used to analyse Type 1 and Type 2 diabetes separately.
  
  
  RESULTS
  The empowerment programme significantly delayed time to first hospital admission/visit for patients with Type 2 diabetes; the hazard ratio (HR) of 0.41 (P = 0.01) translates into a delay of almost 3 years; this was partly driven by a significant reduction in cardiovascular events and mortality (HR = 0.24, P = 0.01). These effects were not seen for people with Type 1 diabetes.
  
  
  CONCLUSIONS
  A one-time, advanced diabetes education programme teaching intensive insulin self-management with an empowerment style can lead to sustained improvement in patient outcomes and reduce use of hospital services for people with Type 2 diabetes on insulin.
authors.affiliation: University of Newcastle and Hunter New England Health Service, NSW, Australia. julia.lowe@sunnybrook.ca
authors.forename: J M
authors.initials: JM
authors.lastname: Lowe
authors.forename: M
authors.initials: M
authors.lastname: Mensch
authors.forename: P
authors.initials: P
authors.lastname: McElduff
authors.forename: M
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: J
authors.initials: J
authors.lastname: Attia
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D016016:Proportional Hazards Models
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin