Educational multimedia may improve care for people with type 2 diabetes

Pointing at a computer

Clinical question:

In people with type 2 diabetes with low income, does providng educational multimedia, as compared with a printed  educational leaflet, lead to improvements in glycaemic control, self-care or diabetes knowledge?

This randomised controlled trial set out to determine whether a multimedia educational package in the doctor’s waiting room could improve outcomes at 3 months.  The package included testimonials by people with diabetes who were from the same ethnic background as the patients.

The evidence:

129 patients were recruited to the study.  Of these, 29 (22%) were lost to follow-up.  All of the patients got a standard diabetes education intervention. The control group was given the leaflet instead of the multimedia package.

At the end of the study the multimedia group were found to have been prescribed more oral antidiabetic drugs (OADs) than the control group.

Although they also had better glycaemic control after 3 months,  the difference was not statistically significant.

This study needs to be repeated in other settings, with more patients and with a longer term – and more complete – follow-up.

Appraisal hints:

Users of this research need to consider the following:

  • Three months’ follow-up is too short to demonstrate a sustained, clinically important improvement.
  • The study has a high risk of bias due to inadequate reporting of randomisation, the potential for co-interventions and a high drop-out rate.
  • Could the increase in use of OADs be brought about by factors other than the patients’ use of the multimedia program? For example, it seems that health professionals provided more assistance to the people who were using the multimedia package than those who were given the leaflet.
  • What is the mechanism by which the multimedia program works?
  • The patients were in a low income demographic:  they were US citizens with no health insurance and most were from an ethnic minority background.
  • To what extent could this package be implemented in your setting?  What would be the costs of creating it?  How important is it to use testimonials from people with the same background as the target patients?


The full text of this article is available from the link below:

Khan MA, Shah S, Grudzien A, Onyejekwe N, Banskota P, Karim S, Jin J, Kim Y, Gerber BS.  A diabetes education multimedia program in the waiting room setting. Diabetes Ther. 2011 Sep;2(3):178-88. Epub 2011 Aug 22.

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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