title: Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: a population-based cohort study.
abstract: OBJECTIVE
  Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling.
  
  
  METHODS
  With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups.
  
  
  RESULTS
  Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42-0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32-0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50-0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05-1.15) and lipid testing (OR 1.25, CI: 1.19-1.32), and were more likely to receive statins (OR 1.22, CI: 1.07-1.39).
  
  
  CONCLUSIONS
  Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Hwee
authors.forename: Karen
authors.initials: K
authors.lastname: Cauch-Dudek
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Ryan
authors.initials: R
authors.lastname: Ng
authors.affiliation: Institute for Clinical Evaluative Sciences. baiju.shah@ices.on.ca.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D003376:Counseling / Q000379:methods*; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006126:Group Processes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010353:Patient Education as Topic / Q000379:methods*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012648:Self Care; D016896:Treatment Outcome
keywords: Diabetes mellitus; comparative effectiveness research; health promotion; patient education; self care