Gagliardino J J, Etchegoyen G
Department of Medical Science, CENEXA (UNLP-CONICET, PAHO/WHO Collaborating Center), Calles 60 y 120, 1900 La Plata, Argentina.
Diabetes Care. 2001 Jun;24(6):1001-7. doi: 10.2337/diacare.24.6.1001.
To implement an educational program in 10 Latin American countries and to evaluate its effect on the clinical, biochemical, and therapeutic aspects as well as the economic cost of diabetes.
Educators from each participating country were previously trained to implement the educational model. The patient population included 446 individuals with type 2 diabetes; all patients were <65 years of age, did not require insulin for metabolic control, did not have severe complications of diabetes or life-limiting illnesses, and had not previously participated in diabetes education courses. Clinical and therapeutic data and the cost of their pharmacological treatment were collected 6 months before participation in the educational program (-6 months), on entry into the program (time 0), and at 4, 8, and 12 months after initiation of the program.
All parameters measured had improved significantly (P < 0.001) by 1 year: fasting blood glucose (mean +/- SD) 10.6 +/- 3.5 vs. 8.7 +/- 3.0 mmol/l; HbA(1c) 9.0 +/- 2.0 vs. 7.8 +/- 1.6%; body weight 84.6 +/- 14.7 vs. 81.2 +/- 15.2 kg; systolic blood pressure 149.6 +/- 33.6 vs. 142.9 +/- 18.8 mmHg; total cholesterol 6.1 +/- 1.1 vs. 5.4 +/- 1.0 mmol/l; and triglycerides 2.7 +/- 1.8 vs. 2.1 +/- 1.2 mmol/l. At 12 months, the decrease in pharmacotherapy required for control of diabetes, hypertension, and hyperlipidemia represented a 62% decrease in the annual cost of treatment ($107,939.99 vs. $41,106.30 [U.S.]). After deducting the additional cost of glucosuria monitoring ($30,604), there was still a 34% annual savings.
The beneficial results of this educational model, implemented in 10 Latin American countries, reinforce the value of patient education as an essential part of diabetes care. They also suggest that an educational approach promoting healthy lifestyle habits and patient empowerment is an effective strategy with the potential to decrease the development of complications related to diabetes as well as the socioeconomic costs of the disease.
在10个拉丁美洲国家实施一项教育计划，并评估其对糖尿病的临床、生化和治疗方面以及经济成本的影响。
每个参与国家的教育工作者事先接受培训以实施该教育模式。患者群体包括446名2型糖尿病患者；所有患者年龄均小于65岁，代谢控制不需要胰岛素，没有严重的糖尿病并发症或危及生命的疾病，且之前未参加过糖尿病教育课程。在参与教育计划前6个月（-6个月）、进入计划时（时间0）以及计划启动后4、8和12个月收集临床和治疗数据以及他们药物治疗的成本。
到1年时，所有测量参数均有显著改善（P<0.001）：空腹血糖（均值±标准差）从10.6±3.5降至8.7±3.0 mmol/L；糖化血红蛋白从9.0±2.0降至7.8±1.6%；体重从84.6±14.7降至81.2±15.2 kg；收缩压从149.6±33.6降至142.9±18.8 mmHg；总胆固醇从6.1±1.1降至5.4±1.0 mmol/L；甘油三酯从2.7±1.8降至2.1±1.2 mmol/L。在12个月时，控制糖尿病、高血压和高脂血症所需的药物治疗减少，这意味着每年的治疗成本降低了62%（从107,939.99美元降至41,106.30美元[美国]）。扣除额外的糖尿监测成本（30,604美元）后，每年仍节省34%。
在10个拉丁美洲国家实施的这种教育模式所取得的有益结果，强化了患者教育作为糖尿病护理重要组成部分的价值。这些结果还表明，一种促进健康生活方式习惯和患者自主的教育方法是一种有效的策略，有可能减少与糖尿病相关的并发症的发生以及该疾病的社会经济成本。
