Analogy-based education improves glycemic control in diabetic patients with hyperglycemia

Patients with diabetes receive standard treatment after diagnosis. This includes visiting their primary care physicians and studying the disease and why and how they should take care of themselves by attending formal diabetes training conducted by certified educators and nutritionists. If the patient’s diabetes does not improve, he is referred to a specialist. However, a diabetes specialist from Baylor College of Medicine has learned over time that many of his patients often do not understand the basic concepts of diabetes despite receiving regular care, so he developed an educational approach known as comprehensive diabetes education based on analogies. (ABCDE), using easy to understand language. The results of this retrospective study are published in Healthcare.

“It didn’t start as a research project, but it was an attempt on my part to overcome the clinical barrier to more effective and meaningful diabetes education,” said Dr. Rajagopal Sehar, Associate Professor Margaret M. and Alberta B. Department of Medicine Alkeka in the Department of Endocrinology, Diabetes and Metabolism in Baylor. “It started with small steps, but was so well received by patients that I thought, ‘How can I report this clinical outcome in an article so I can inform healthcare professionals about an alternative and effective way to communicate with diabetes?’

Diabetics in underpopulated populations often face economic, racial, ethnic, and language barriers that make them feel overwhelmed and struggle with understanding the importance of their diagnosis. Because standard diabetes education may be confusing to patients, they often fail to take important steps to improve their overall health, which include controlling and maintaining good hemoglobin A1c (HbA1c) levels and focusing on a healthy diet with avoiding sugary drinks and fast food.

Skhar has developed a new ABCDE approach to educating patients about these foundational concepts of diabetes treatment. Diabetes education includes learning the importance of medication, maintaining a healthy diet, regular exercise, annual retinal examinations, and hemoglobin A1c control. He uses a variety of analogies to effectively communicate the concepts of diabetes to his patients who visit his diabetes clinic for HIV patients in Houston.

The analogy of the speedometer

One of the analogies that resonated with patients to understand hemoglobin A1c was the “speedometer analogy,” where it compares diabetes to a car to more accurately explain the HbA1c test.

“The concept of the HbA1c test is a bit abstract,” Sehar said. “Explaining that HbA1c is the average value of sugar over a 3-month period is how most doctors and educators present it to patients, but it’s hard to contact and respond to it, and many patients don’t understand and appreciate the critical difference between a good value of 7% or a dangerously high value ”.

He tells his patients: pretend that diabetes is a machine. The speedometer of your car with diabetes is an A1c test that tells you how fast your diabetes is moving. A good value for your diabetes test is 7%. If your HbA1c test score is 7%, it looks like you’re driving at 20 mph in the school area, it’s a completely safe speed.

If your A1c figure is 8%, then it is one point above the norm. Each A1c point is like an extra 20 miles per hour. If patient A1c is 14%, he will travel at 160 mph. Just as anyone walking in front of your car at 160 miles per hour can seriously damage, your car moving with diabetes will damage your eyes, kidneys, feet, heart and brain if you don’t slow down and do not lower your HbA1c level to a safer level. .

This is why diabetes remains the leading cause of blindness, amputations, kidney failure, heart attacks and strokes. This style of messaging resonates heavily with patients, and the response is immediate in terms of improving self-care, Sehar explained.

The analogy of a chair

Sehar uses the “chair analogy” to explain the major components of diabetes treatment, such as healthy eating, daily exercise, and commitment to diabetes medication. A real chair needs four strong legs for stability, and if one leg breaks, the chair falls. Similarly, good diabetes control is maintained by four legs, and when they are broken, diabetes is poorly controlled. He explains that these legs of the sugar chair:

  • First leg: Everything you drink should be healthy. Drink mostly water, avoiding sugary drinks.
  • Second leg: you need to eat healthy.
  • Third leg: physical activity and exercise on the advice of a doctor and common sense.
  • Fourth leg: take diabetes medication as prescribed.

Just as a chair cannot stand on one leg alone, trying to fight diabetes by taking only medication and ignoring healthy food, drinks and exercise will not improve diabetes.

“I combine these analogies into diabetes education. Once my patients understand these fundamental concepts, medical advice is always taken very well. I see the light of recognition and connection on their faces, and many of my patients have since shared that they understood diabetes much better with the ABCDE approach, ”Sehar said. “The results were amazing: attitudes, behavior and enthusiasm for diabetes self-care have improved significantly, leading to improved glycemic control.”

Lessons of study

In a retrospective study, Sehar reports his experience working with 24 diabetics (12 women and 12 men) who were referred to him for uncontrolled diabetes. These patients were already receiving routine care and medication, but they missed doses and did not take them daily. They also did not follow a healthy diet. He did not change their medication, prescribe new medications, or change the medication dose, but instead introduced the ABCDE approach to help them understand the importance of diet, exercise, and medication compliance. When these patients returned three months later, he noticed a clear drop in blood sugar, and his patients expressed improved feelings with more hope and enthusiasm. He noticed a steady decline in diabetes outcomes even during their second visit, which came six months after they first received the ABCDE approach.

“When the numbers start to improve, it means they appreciate how well they feel. They notice that they urinate less during the day and do not wake up several times at night to urinate, and they have more energy and generally feel much better. They link these improvements to improved self-care and identify ABCDE as a major cause of behavior change. They want to take better care of themselves, ”Sehar said.

Three Es

He emphasizes the importance of diabetes education with an approach he calls the “three Es”:

  • Learning: Every diabetic needs to be properly educated to understand their own diabetes
  • Encourage: let patients know they can do it, and help them overcome their frustration with diabetes
  • Empower: Help patients take care of their own diabetes

Sehar says he is not trying to invent a wheel. He believes that the basic concepts of diabetes, which are already in the lessons of diabetes education, are correct and adequate. It uses different languages ​​with the ABCDE approach to convey these concepts to patients. Moving forward, Sehar hopes to obtain funding to conduct promising clinical trials in collaboration with behavioral psychologists and other professionals involved in behavior modification research.

The next steps

“The next step is to conduct a forward-looking study with new patients with diabetes, where one group will receive both traditional diabetes education and the ABCDE approach, while another group will receive only traditional diabetes education without ABCDE to assess whether such an approach will affect the achievement of glycemic targets, ”he said.

He hopes it will become an easily accessible learning tool that providers can use in their clinics.

“In my experience, many patients have difficulty understanding these simple and basic concepts. It is very useful for patients to find simple language to explain it in such a way that it leads to a better understanding, ”Sehar said. “I’m constantly developing new analogies to explain more detailed concepts of diabetes, such as beta cell function, insulin resistance, why you need to start insulin injections, how diabetes medications work, and more.”

This publication is a retrospective analysis of the impact of ABCDE’s approach to diabetes education on glycemic outcomes developed by Sekhar for patients attending its diabetes clinic.

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