Diabetes Type 2 and the Effects of a Community-Specific Diabetic Education Program on Self-Management in Wilkinson and Amite Counties, Mississippi
Carol Bryant, Alcorn State University

An estimated 16 million people in the United States have diabetes, representing one in every 17 people or approximately six percent of the entire United States population (Buchanan & Davidson, 1997). Despite the implementation of many education programs for both professionals and patients as well as new treatment and monitoring methods, the diagnosed cases of diabetes continue to increase each year (Center for Disease Control and Prevention, 1998a). 

The purpose of this quasi-experimental, longitudinal pretest-post-test study was to determine the relationship between pre- and post treatment blood glucose levels for persons with diabetes, Type 2, participating in a community-specific diabetes teaching and self-management program following completion of the six week program, with blood glucose levels measured as HbA,_1c levels. Education material was prepared at a seventh grade education level based on the SMOG Testing criteria. 

A convenience sample of forty-three subjects with a diagnosis of Type 2 diabetes was selected from two local rural health clinics in Wilkinson and Amite Counties, Mississippi. A pretest HbA,_1c was performed on each client, followed by group education sessions in which subjects were presented education material in the forms of lectures, videos, presentations, active participation, and demonstrations. A post-test HbA_1c was performed at the end of the six-week teaching session to evaluate the effects of the education program. A written test was also administered at the beginning of the class instructed by the pharmacist and again at the completion of the same class to evaluate proper technique in self-glucose monitoring technique. The scores from the demographic questionnaire and the pretest and post-test of both the glucometer usage and the HbA_1c were analyzed using descriptive statistics. Significant improvement from the pretest scores was noted in the post-test scores of both the glucometer usage (t = 7.83789, df = 29, p = < 0.001) and the HbA_1c scores (t = 2.09388, df = 30, p = 0.0448). 

The results obtained in this study indicated that participation in a community-specific diabetes teaching and self-management program improved self-management of therapeutic regimens of individuals with Type 2 diabetes. The implications for the rural family nurse practitioners include identifying those individuals with poor self-management, making referrals to available education programs and/or establishing a community-specific education program, and through leadership and collaboration, developing a multidisciplinary approach to prevent or decrease the numerous, fatal complications of diabetes, Type 2.

Further research utilizing a much larger random sample over a longer period of time is recommended. In addition, future studies should examine the effect of gender and race on the results of this study due to the small number of male participants and African-American participants, who comprise 68% of the total population of Wilkinson County (1996 Census of Population and Housing, 1996). Further research should also explore possible reasons for the limited participation by the male and African American population of this area.