Assessment of Group-Based Diabetes Education Using the “Continuing Your Journey With Diabetes” Conversation Map in the Veteran Population

Both type 1 and type 2 diabetes have been recognized as serious health concerns. The majority of cases of type 2 diabetes are preventable, and, after diagnosis, various complications can be prevented by effective self-management. Although there are multiple pharmacological interventions for the treatment of diabetes, it is difficult to achieve target A1C levels with drug therapy alone. Most patients must also implement various lifestyle modifications such as following a healthy diet and getting adequate physical activity, both of which require willingness and motivation. Therefore, patient education is an important component of diabetes management. Each patient’s unique needs and barriers require an individualized strategy for diabetes management (1). Diabetes self-management education is listed as one of seven crucial elements in the Joint Commission standards of care addressing diabetes care (2). The National Standards for Diabetes Self-Management Education (3) states that group education can be effective and that programs using behavioral and psychosocial strategies result in improved outcomes. A 2009 Cochrane review (4) concluded that group-based training helped participants improve fasting blood glucose and A1C, decreasing the need for diabetes medications. Such programs may also help decrease blood pressure and body weight, although studies evaluating such outcomes are limited. The Conversation Map education tool was developed by Healthy Interactions to empower patients with diabetes and help them proactively manage their health. Reaney et al. (5) recently reviewed this tool in more detail. The Conversation Map promotes effective communication among patients with type 2 diabetes, their health care providers, and their support network. This learnercentered approach is intended to improve health literacy, a significant predictor of health status. A conversation with other patients, led by a facilitator using a Socratic approach, is meant to encourage participants to share personal knowledge and experiences, ultimately engaging and motivating patients to take control of their health (6). Although information regarding diabetes education is abundant, research specifically relating to the Conversation Map program is somewhat limited. Results of the Interactive Dialogue to Educate and Activate study, a multisite, randomized trial evaluating individual versus group education using the Conversation Map, were published in 2010 (7). It is of interest that SperlHillen et al. (8) recently published an article comparing group education with the Conversation Map to individual education sessions and found individual education sessions to be more effective. However, it should be noted that 28% (68 or 243) of those in the Conversation Map group did not attend the education session or Assessment of Group-Based Diabetes Education Using the “Continuing Your Journey With Diabetes” Conversation Map in the Veteran Population