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Rationale, Aims and Objectives: 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., (© 2015 John Wiley & Sons, Ltd.)

Objective: The aim of this study was to describe the utilization of diabetes education centres by people not diagnosed with diabetes mellitus in real-world clinical care in Ontario., Methods: Using population-level health administrative databases and registries, all people in Ontario, Canada, who attended a diabetes self-management education centre in 2006 were identified. The proportion of attendees without diagnosed diabetes at the time of their visit was determined, they were stratified by centre and health region, and their utilization of diabetes education centres was characterized. They were then followed up until 2010 for incident diabetes., Results: Of 117,660 adults attending a diabetes education centre, 19,920 (16.9%) did not have diagnosed diabetes. There was a marked variation in the proportion of attendees without diagnosed diabetes between health regions and between individual centres. More attendees did not have diagnosed diabetes at centres based in community health centres (47.5%) or First Nations communities (22.1%) than those based in hospitals (13.9%) or other community settings (13.0%). Only 2741 attendees (13.8%) without diabetes attended group education classes; most attended individual counselling sessions. Diabetes incidence during follow up was 11.2 cases per 100 person years., Conclusions: One in 6 people receiving care at a diabetes education centre in Ontario did not have diabetes, and the significant regional variations could represent inappropriate overuse or underuse. Although education and counselling for patients at risk for diabetes is clinically important, the volume of such persons served at Ontario diabetes education centres may detract from the centres' core function of supporting and managing patients already diagnosed with diabetes., (Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

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)., Conclusion: 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.

Background: Patients newly-diagnosed with diabetes require self-management education to help them understand and manage the disease. The goals of the study were to determine the frequency of diabetes self-management education program utilization by newly-diagnosed patients, and to evaluate whether there were any demographic or clinical disparities in utilization., Methods: Using population-level health care data, all 46,553 adults who were diagnosed with any type of non-gestational diabetes in Ontario, Canada between January and June 2006 were identified. They were linked with a diabetes self-management education program registry to identify those who attended within 6 months of diagnosis. The demographic and clinical characteristics of attendees and non-attendees were compared., Results: A total of 9,568 (20.6%) patients attended a diabetes self-management education program within 6 months of diagnosis. Younger age, increasing socioeconomic status, and the absence of mental health conditions or other medical comorbidity were associated with attendance. Patients living in rural areas, where access to physicians may be limited, were markedly more likely to attend. Recent immigrants were 40% less likely to attend self-management education programs than longer-term immigrants or nonimmigrants., Conclusion: Only one in five newly-diagnosed diabetes patients attended a diabetes self-management education program. Demographic and clinical disparities in utilization persisted despite a publicly-funded health care system where patients could access these services without direct charges. Primary care providers and education programs must ensure that more newly-diagnosed diabetes patients receive self-management education, particularly those who are older, poorer, sicker, or recent immigrants.