In type 2 diabetes, individualised education may be better than group education

An image of a doctor surrounded by patients.

It’s difficult to tell how education improves health.  If you education someone, they behave in a certain way, and it’s the behaviour that improves their health, not the education.  However, a properly controlled trial can investigate these matters, as long as there’s enough participants to enable randomisation to do its stuff and even out all of the differences between the groups.

This randomised trial recruited people with poorly controlled type 2 diabetes (HbA1c > 7%)  looked compared three conditions:

  • Diabetes education delivered in a group
  • Diabetes education delivered individually
  • Standard care (described as “no education”).

They followed these patients for about 6 months and found that the individually-tailored group improved their glycaemic control (HbA1c) more than the other two groups.

Appraisal hints

This study has some methodological problems:

  • Were the groups the same at the start of the trial?  Was the randomisation properly random and was treatment allocation properly concealed?
  • Were the groups treated in the same way throughout the trial?
  • Were their carers aware of which group they had been assigned to?
  • A plethora of quality of life outcomes were measured:  could there be selective reporting of favourable outcomes?
  • Are any other co-interventions that might have influence the outcome?  How did the “better education” manifest itself?
  • It seems ethically difficult to fail to offer any kind of education at all to patients.  What type of care did the control group actually get?
  • Were the patients followed for long enough to detect any differences?
  • Did enough of them complete the trial?


Sperl-Hillen J, Beaton S, Fernandes O, Von Worley A, Vazquez-Benitez G, Parker E, Hanson A, Lavin-Tompkins J, Glasrud P, Davis H, Adams K, Parsons W, Spain CV.  Comparative Effectiveness of Patient Education Methods for Type 2 Diabetes: A Randomized Controlled Trial.
Arch Intern Med. 2011 Oct 10.

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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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