KNOWLEDGE IMPROVEMENT AND METABOLIC CONTROL IN DIABETES EDUCATION - APPROACHING THE LIMITS

Evaluation of diabetes education programs (DEPs) has provided minimal empirical support for a relationship between improved knowledge and better metabolic control. We hypothesized that improved knowledge in specific areas is predictive of changes in specific measures of diabetes control. Patients (n = 558) attending one of five DEPs completed a diabetes knowledge questionnaire at baseline and post-DEP. Glycosylated hemoglobin (GHb) was measured at baseline and at 3 months follow-up. Total diabetes knowledge (DKN) scores increased significantly by 18%, but improvement was uncorrelated with changes in GHb (r = 0.03). Improvement in nine specific content areas failed to predict changes in GHb (all P > 0.05) and improvement in knowledge of the causes of hypoglycemia did not predict changes in frequency of hypoglycemia (x2 = 1.54, P > 0.05). We conclude that neither global nor specific knowledge improvement predicts metabolic control in diabetes and suggest that evaluation of diabetes education should focus more intensively on behavioral and attitudinal outcomes. © 1990.