title: Diabetes self-management education is not associated with a reduction in long-term diabetes complications: an effectiveness study in an elderly population.
abstract: OBJECTIVE
  The efficacy of diabetes self-management education on glycaemic control, self-care behaviour and knowledge has been established by short-term studies in experimental settings. The objective of this study was to assess its effectiveness to improve quality of care and reduce the risk of long-term diabetes complications in unselected older patients with recently diagnosed diabetes in routine clinical care.
  
  
  METHODS
  Using population-level health care administrative databases and registries, all patients aged ≥66 years in Ontario, Canada with diabetes for <5 years were identified. Self-management education programme attendees (n = 8485) in 2006 were matched with non-attendees using high-dimensional propensity scores, creating extremely well-balanced study arms. Quality of care measures and the long-term risk of diabetes complications were compared.
  
  
  RESULTS
  Self-management programme attendees were more likely than non-attendees to achieve process measures of quality of care such as retinal screening examinations (75.3% versus 70.3%, adjusted relative risk 1.05, 99% confidence interval 1.03-1.08), and ≥2 glycated haemoglobin tests (57.5% versus 53.3%, adjusted relative risk 1.08, 99% confidence interval 1.05-1.11). However, with a median follow-up of 5.3 years, diabetes complications and mortality were not different between arms.
  
  
  CONCLUSIONS
  In real-world clinical care, self-management education for older patients with recently diagnosed diabetes was associated with modest improvements in quality of care, but no reductions in long-term clinical events.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Hwee
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Cauch-Dudek
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Ng
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D009864:Ontario; D010353:Patient Education as Topic; D057216:Propensity Score; D011787:Quality of Health Care; D012648:Self Care
keywords: diabetes complications; effectiveness study; evaluation; quality of care; self-management education; seniors