Waikato Diabetes Education Study
Ross LawrensonGrace JoshyYoska Eerens Wayne Johnstone
Background
• Patients that have had a comprehensive education and training program are more likely to lose weight and have better quality of life (Davies et al. 2008).
• We know that patients from ethnic minorities or those who are from deprived communities are less likely to achieve optimum control of their diabetes.
• We hypothesize that this is because they have not received a satisfactory/appropriate education program.
• We believe all patients with newly diagnosed Type 2 diabetes should receive adequate disease specific education within 6-months of diagnosis.
• Needed an understanding of what is happening in the Waikato
Methods• All patients identified with type 2 diabetes on the Waikato
Regional Diabetes Register with a year of diagnosis of 2007 were selected as the study group.
• A questionnaire was developed asking a series of question collecting basic demographic data as well as a series of questions regarding the education received, who provided it and self perceived knowledge.
• Input into the design of the questionnaire was obtained from a diabetes nurse, a dietician, a Maori researcher, a GP and consumer representatives.
• The questions were focused on important aspects of diabetes care such as diet, blood glucose, blood pressure, cholesterol, foot care, eye care, exercise and smoking.
• Questionnaire was posted• All non respondents were followed up by telephone
Results
• 675 questionnaires sent out• 667 possible responses (6 deceased,2 with IGT excluded) • 255 responded initially• 85 further on follow up – these were more likely to be
Maori (28% vs 13%) and tended to be younger (mean age 60.9 vs 63.0)
• Remainder refused or were not contactable by phone• 340/667 (51%) response• Mean age of respondents 63 years compared with 59 for
non respondents
Response rate by ethnicity
Ethnicity Number Number responded
% Responded
European 432 257 59.5%
Maori 145 55 38%
Indian 22 10 45.5%
Asian 11 1 9%
Pacific 21 4 19%
Other 36 13 36%
Total 667 340 51%
Response rate by self identified ethnicity – 91% agreement
Ethnicity Number responded WRDS
Self identified ethnicity
European 257 257 (243)
Maori 55 58 (55)
Indian 10 8 (5)
Asian 1 4 (1)
Pacific 4 10 (3)
Other 13 3 (2)
Total 340 340 (309)
Self reported year of diagnosis – 75% agreement or 95% within 1 year either side
1988-2005 13
2006 29
2007 254
2008 40
Not known 4
Results – 333 analysed (7 who were diagnosed between 1988 and 2004 excluded)
Number Percent
Age
20-54 93 27.9
55-64 89 26.7
65-74 87 26.1
75+ 64 19.2
Gender
Male 180 54.1
Female 153 45.9
Ethnicity
Maori 57 17.1
Non Maori 276 82.9
Who were you diagnosed by ?
• By your General Practitioner 300 (90%)• By your local hospital 20 (6%)• By someone else - please tell us who this was
13 (4%)
Method of diagnosis
Have symptoms and go to your doctor expecting you might have diabetes? 42 (12.6%)
Go to your doctor/hospital with an illness but not think of diabetes as a diagnosis? 69 (20.9%)
Have a routine blood test which showed diabetes?207 (62.2%)
Some other route to diagnosis 15 (4.5%)
198/333 (59.5%) diagnosed by a routine blood test from GP
Belong to a support group47/333 (14%) belong to Diabetes NZMean knowledge score of Diabetes NZ members was 7.3 vs 6.9 for non members8/57 (14%) Maori and 39/276 (14%) non-Maori6 others belonged to another group
02468
1012141618
20-54 55-64 65-74 75+
%
Age
Use of the Internet – 28% use the Internet to find out information about diabetes• 22/57 (38.6%) Maori had access to Internet at home and
28/57 (49%) had access either at home or elsewhere• 150/276 (54.3%) non-Maori had access to Internet at
home and 175/276 (63%) had access either at home or elsewhere
• 9/57 (15.8%) Maori (9/28 of those with access - 32.1%) said they had used the Internet to look for information about diabetes 85/276 (30.8%) non-Maori (85/175 of those with access - 48.6%) said they had used the Internet to look for information about diabetes
• Only 8 people said they got most of their information about diabetes from the Internet
Access at home and use of the Internet by age category (non-Maori only)
0
10
20
30
40
50
60
70
80
20-54 55-64 65-74 75+
HomeUse
Age
Initial information about diabetes
• 272/307 (89%) of people who answered the question said they got most of their information about diabetes from their GP surgery (no difference between Maori and non-Maori)
• 25/57 (43.9%) of Maori had a family member included in their education compared with 87/276 (31.5%) of non-Maori
• Of those that answered the question 14/34 (41.2%) Maori and 46/157 (29.3%) non-Maori said they would like their family included
Group education• Only 22/333 (6.6%) of respondents said they had attended a
group education session• Maori were twice as likely (12.3%) as non-Maori (5.4%) to
have attended a group session• Of those who stated a preference, 145/255 (56.9%) said they
did not want to attend group sessions . Non Maori (59.3%) were more likely to say they did not want a group session than Maori (43.9%)
• 61/255 (23.9%) said they were happy to attend group sessions if individual sessions were not available (no difference between Maori and non-Maori)
• 36/255 (14.1%) said they would prefer group sessions – Maori were twice as likely to say they wanted group sessions (24.4%) compared with non-Maori (12.1%)
General knowledge
• 24/333 (7.2%) said that they were not given any information when they were first diagnosed
• Most common source of information was the practice nurse (199), the GP (179), the Diabetes Nurse (51) or a hospital doctor (11)
• Mean knowledge score out of 10 was 6.9 – the score for Maori was 6.3 compared with 7.1 for non-Maori
Dietary advice
• Only 16 patients said they had not received dietary advice
• 30% of patients said they had seen a dietician (42% of Maori and 28% of non-Maori)
• 63.5% said that they had dietary advice from the practice nurse
• Mean score on knowledge about diet was 7.0
Blood glucose monitoring
• 49/333 (14.7%) had not had information about blood glucose monitoring
• Most common source of information was the GP or practice nurse
• One poignant comment was that the patient who had a monitor but no one had shown them how to use it.
Blood pressure
• 88/333 (26.4%) had not had information about blood pressure monitoring
• Most common source of information was the GP or practice nurse
• Mean knowledge score was 6.4
Cholesterol
• 63/333 (18.9%) had not had information about cholesterol
• Most commonly mentioned source of information was the GP -178/237 (75%)
• Mean knowledge score was 6.4
Foot care
• 63/333 (18.9%) had not had information about foot care
• Most common source of information was the practice nurse 117/248 (47%)
• 21/333 (6.3%) had seen a podiatrist• Mean knowledge score was 6.6
Eye care
• 34/333 (10.2%) said they had not had information about eye checks
• Most common source of information was the GP 115/265 (43%)
• 69 mentioned an optometrist or ophthalmologist as having given advice
• Mean knowledge score was 6.8
Exercise48/333 said that they had not had advice about exercise
55% had advice from their GP and 45% from a practice nurse
0
10
20
30
40
50
60
More Same Less
Percent
Smoking41/48 (85%) had been given advice to give up smoking although only 21 mentioned a health professional
0
10
20
30
40
50
60
Smoker Ex Never
Maorinon-Maori
Qualitative data
• Large amount of qualitative data available for analysis
Limitations
• Poor response rate – especially from Maori, Pacific and Asian
• Some missing data• Need to analyse qualitative data
Summary
• Diabetes is most commonly diagnosed in asymptomatic patients who attend their general practitioner
• 93% of patients have received education about diabetes and generally knowledge is rated at 7/10
• Lowest scores were related to BP and cholesterol• Only 1/3 had increased the exercise they took• Small differences between Maori and non-Maori but
60% Maori were non-respondents• High non-respondent rate from Asians• Commonest source of information is the GP and the
practice nurse. 28% of patients use the Internet for information about diabetes