Diabetes education: a chance to improve well-being of Turkish people with type 2 diabetes Emel O ¨ zer a,* , Ahmet M. S ¸engu ¨l b , Selda Gedik a , Serpil Salman c , Fatih Salman c , Mehmet Sargın d , Halim I ˙ s ¸sever e ,I ˙ lhan Satman a , Temel Yılmaz a a Diabetes Division, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, P.K. 75, Capa, 34 272 Istanbul, Turkey b Endocrinology Department, S ¸is¸li Etfal, Education and Research Hospital, Istanbul, Turkey c Diabetes Research and Applications Unit, Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey d Endocrinology Department, Kartal, Education and Research Hospital, Istanbul, Turkey e Public Health Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey Received 1 March 2002; received in revised form 20 October 2002; accepted 25 November 2002 Abstract To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program (n ¼ 126) or not (n ¼ 129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA 1c level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Diabetes education; Quality of life; Well-being 1. Introduction Diabetes education has been known to be one of the essential components of diabetes treatment since 1930s [1]. The goals of diabetes education are to optimize metabolic control, to prevent acute and chronic complications, and to improve quality of life (QOL) [2]. The outcomes of educa- tion need to be evaluated both for the program and the participants. The goals of the program include achievement of stated objectives, reaching the defined target population, and helping participants to improve their health outcomes. However, outcomes for the participants include the knowl- edge and skills necessary for self-management, desired self-management behaviors and improved health outcome [3]. Diabetes education program has an effect on short-term outcomes (HbA 1c , blood glucose variability, hypoglycemic episodes, serum cholesterol levels, blood pressure, smok- ing habits, body weight, QOL, functional limitations, psychological factors) and long-term health outcomes (complications including retinal, neuropathy, renal, sexual, and stroke; mortality caused by diabetes and any other reasons, and cost-effectiveness of the program) [4]. Brown, in a meta-analysis reviewed the outcomes of educational interventions in diabetes. In 78% of the recently published studies, only short-term outcomes were reported. On the other hand, long-term outcomes were evaluated in 22% [5]. Evaluation of programs has shown that diabetes education is generally effective in increasing knowledge, self-care behaviors, and metabolic control [5–7]. However, QOL outcomes were reported in approximately 2% of the pub- lished studies reviewed by Brown [5]. In a similar review by Norris et al. [7], among published diabetes education studies between 1980 and 1999, only three studies were found to be Patient Education and Counseling 51 (2003) 39–44 * Corresponding author. Tel.: þ90-212-533-5306; fax: þ90-212-635-8876. E-mail address: emelozer@yahoo.com (E. O ¨ zer). 0738-3991/$ – see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0738-3991(02)00246-X