The prevalence of diabetes is higher among precarious people. Unfortunately, therapeutic patient education (TPE), which makes it possible to optimize the care process and improve disease control by making the patient more independent, is more difficult to access. One of the main reasons is that the vast majority of ETP programs are offered by hospital establishments. A team from Rennes wanted to evaluate whether this approach, implemented in primary care, could promote access to this care. They thus conducted a study within the MSP “Rennes Nord-Ouest” in the priority district of Villejean, in which participants who had benefited from a validated program were compared to a group of control subjects, matched on diabetes imbalance. within the same structure.
This retrospective cohort study recruited patients aged 18 years or older with type 1 or 2 diabetes who had benefited from the diabetes TPE program. The program was offered to them by a medical or paramedical professional. The program was composed of 7 to 9 workshops spread over one to two months, after an initial shared educational assessment (index date). The variation in the HbA1c level 12 months before and 12 months after the index date was evaluated and compared to that of control patients: this group was composed of adult type 1 or 2 diabetic subjects, aged 18 or over, from the patient base of attending physicians monitoring participants in the ETP cohort. They were identified within the SOPHIA diabetes database (general diet base bringing together subjects who had a prescription for at least three antidiabetic drugs during the year and benefited from remote support): they were matched 2: 1 on several parameters including sex, nature of diabetes and age.
Better glycemic balance at 1 year
In total, 69 patients benefited from TPE and were compared to 138 matched subjects. Comparison of the two groups at inclusion shows comparable socio-demographic characteristics and duration of diabetes: 64% women, 96% type 2 diabetes, average age 58-60 years and average age 49 at diagnosis. . 60 to 65% of them had no activity or were retired. Medically, they presented the main comorbidities at the same frequency (76% arterial hypertension, 18 to 19% diabetic nephropathy, 47 to 50% of subjects were obese).
Concerning diabetic disease, the average HbA1c level was higher in the ETP group than in the control group (8.3% versus 7.1%; p versus 17.9%; p = 0.02) and more often benefited from annual ophthalmological follow-up (72.2% versus 44.4%; p versus 4.3%; p = 0.01).
After the intervention, the average HbA1c level at 1 year was 7.6% in the ETP group compared to 7.5% in the control group, i.e. a respective change of −0.73% and +0.35%. (p
For the authors, these data suggest that health professionals could better offer the TPE program to their most unbalanced diabetic patients. The fact that this group adheres better to ophthalmological follow-up could be explained by active assistance from the medical office in making appointments, potentially because they could have a lower level of health literacy.
