Abstract
The aim of our project was to test the effect of an ambulatory group therapeutic and educational course for Type-2 diabetic patients in the Diabetes Center on the patients' metabolic status. In the first year, 35 diabetics with a mean age 58 +- 10 (35 - 79) years and mean diabetes duration of 8.5 +- 7.7 years took part in the course.
The course was headed by an educational team. The patients had four half-day ambulatory sessions each week over a one-month period.
After the course, there was a statistically significant decrease in body mass index (BMI, from 31,8 +- 6.2 to 31.4 +- 6.2 kg/m 2 , p < 0.001) and a decrease in glycosylated hemoglobin Hb1c (from 7.8 +- 1.7 to 7.6 +- 1.7%, p < 0.001). There were also a statistically significant improvement in the lipid spectrum; reductions in the levels of cholesterol (from 6.1 +- 1.2 to 5.7 +- 1.9 mmol/L; p < 0.01) and triglycerides (from 2.8 +- 1.8 to 2.5 +- 1.8 mmol/L; p < 0.05); HDL cholesterol did not change statistically significantly (1.1 +- 0.3 mmol/L before and after the course).
Systolic blood pressure declined statistically significantly (from 143 +- 21 to 137 +- 17 mmHg; p < 0.05) while there was no significant change in diastolic blood pressure (83 +- 14 vs 81 +- 12 mmHg). Uric acid levels also did not change significantly; however, they were within the normal range already before the course (273 +- 75 vs 277 +- 75 mmol/L).
The above beneficial metabolic changes during the educational course were due mainly to a change in diet (reduction in total energy intake by 163 kcal/day; p < 0.05) and increased rates of self-monitoring of glycemia (from 29 to 69% of patients; p < 0.001) and glycosuria (from 17 to 60% of patients; p < 0.01). Educational courses in Diabetes Centers may aid, in a most effective manner, in the treatment of the metabolic syndrome in Type-2 diabetic patients; however, motivation of patients and health-care professionals to this technique of management remains a problem.