The relative effectiveness of educational and behavioral instruction programs for patients with NIDDM: A randomized trial

In this randomized trial patients with non-insulin-dependent diabetes were allocated to one of four programs: a minimal instruction program (n=59), an education program of individual visits (n=57), an education program incorporating a group education course (n=66), and a behavioral program (n=59). Individual and group education programs had higher attrition rates than the behavioral and minimal programs. The four programs, which involved different amounts of patient contact time, delivery format, and instructional strategies, all produced reductions in HbA(1) and BMI, with no significant differences between the programs. There were no differences between groups over three time periods in total cholesterol, HDL cholesterol, systolic blood pressure, or proportion of patients consulting an ophthalmologist. The behavioral program produced a greater reduction in diastolic blood pressure over 12 months than the education programs and a greater reduction in the cholesterol risk ratio over 3 months than the other programs. The behavioral program patients were more likely to have visited a podiatrist after 6 months and reported higher satisfaction.