Empowering diabetes out-patients with structured education: Short-term andlong-term effects of functional insulin treatment on perceived control over diabetes

Objective: To investigate short-term and long-term effects of structured ou tpatient education for Functional Insulin Treatment (FIT: selective insulin dosages for eating, fasting or correcting hyperglycaemia) on perceived con trol over diabetes and related health beliefs. FIT was thought to influence the perception of self-efficacy in diabetes, in contrast to conventional t reatment, based on scheduled, rigid food intake and insulin delivery-it all ows flexible eating, provided independent control of glycemia. Methods: Str uctured, comprehensive, outpatient group training in FIT for selective use of insulin either for eating, fasting or correction included practical "ins ulin games." The FIT program focused on everyday criteria for choices of in sulin dosages and thus on the patient's ability to execute his/her newly ga ined flexible treatment to his/her everyday life while preventing acute and late complications. To evaluate effects of FIT on "Perceived Control over Diabetes" and related "Health Beliefs Concerning Diabetes" (Bradley's quest ionnaires, 1984), a fully randomized shortterm controlled Study 1 (four wee ks, 32 patients), and long term uncontrolled pilot Study 2 (three years, 68 patients) were performed. Results: The short-term study revealed that FIT induced the feeling of independence from situational control while self-man aging diabetes. In the long-term study, the patients were increasingly free d from the feeling of being under the control of physician and treatment-re lated restrictions, which-together with higher perceived self-efficacy-cont ributed to the feeling of "empowerment." This was associated with high trea tment satisfaction and significant improvement of glycemic control. Conclus ion: Structured out-patient group training for FIT results in measurable im provement of patients' perceived control over diabetes and self-efficacy. ( C) 2000 Elsevier Science Inc. All rights reserved.