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