title: Education as prescription for patients with type 2 diabetes mellitus: compliance and efficacy in clinical practice.
abstract: BACKGROUND
  Diabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription.
  
  
  METHODS
  We retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis.
  
  
  RESULTS
  Among the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001) or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037). The hemoglobin A1c decreased greater in the compliant group (from 7.84±1.54 at baseline to 6.79±1.06 at 3 months and 6.97±1.20 at 12 months after prescription in the compliant group vs. from 7.74±1.25 to 7.14±1.02 and 7.24±1.24 in the non-compliant group; P=0.001). The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032).
  
  
  CONCLUSIONS
  In our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Mi Yeon
authors.initials: MY
authors.lastname: Kim
authors.forename: Sunghwan
authors.initials: S
authors.lastname: Suh
authors.forename: Sang-Man
authors.initials: SM
authors.lastname: Jin
authors.forename: Se Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Ji Cheol
authors.initials: JC
authors.lastname: Bae
authors.forename: Kyu Yeon
authors.initials: KY
authors.lastname: Hur
authors.forename: Sung Hye
authors.initials: SH
authors.lastname: Kim
authors.forename: Mi Yong
authors.initials: MY
authors.lastname: Rha
authors.forename: Young Yun
authors.initials: YY
authors.lastname: Cho
authors.forename: Myung-Shik
authors.initials: MS
authors.lastname: Lee
authors.forename: Moon Kyu
authors.initials: MK
authors.lastname: Lee
authors.forename: Kwang-Won
authors.initials: KW
authors.lastname: Kim
authors.forename: Jae Hyeon
authors.initials: JH
authors.lastname: Kim
keywords: Diabetes mellitus, type 2; Education; Self care