An Educational Intervention Using Steno Balance Cards to Improve Glycemic Control in Patients With Poorly Controlled Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (T2DM) is largely attributableto lifestyle factors. Although physiological and medical care needs must be met, psychosocial factors should not be neglected. Purpose: The aim of this study was to determine whether a 6-month intervention consisting of educational sessions using Steno Balance Cards, which involves guided group dialogue, resulted in better glycemic outcomes than conventional diabeteseducation. Methods: Patients with T2DM whose glycolated hemoglobin A1c levels were higher than 8% were recruited from September to October 2015. Ninety-two patients were assigned to either the psychosocial balance dialogue (PBD) group (n = 46) or the standard care (SC) group (n = 46). The PBD group received instructions about diabetes using the Steno "Balance Card" method, which involves the use of themed picture cards to elicit group dialogue. The Balance Cards were developed by the Danish Steno Diabetes Center. In the SC group, patients received general diabetes education using a conventional teachingmode. Results: In the PBD group, glycolated hemoglobin A1c decreased 1.3% from 8.1% ± 0.7% to 6.8% ± 0.8%, whereas it decreased 0.6% in the SC group from 8.0% ± 0.6% to 7.4% ± 0.7%, with p <.05. At the end of the 6-month study period, the PBD group and the SC group completed a health-related quality of life questionnaire(12-item Short-Form Health Survey) and a well-being index (WHO-5) questionnaire. In the PBD group, the difference before and after the intervention showed that the well-being (WHO-5) score increased by 45.4 points, whereas the physiological score increased by 28.0, and the mental component score increased by 29.0. In the SC group, the well-being (WHO-5) score increased by 6.4, whereas the physiological score increased by 4.7, and the mental component score increased by 9.6. There were statistically significant differences in questionnairescores between the two groups (p <.05). Conclusions/Implications for Practice: The results of this study indicate that the dialogue sessions using Steno Balance Cards are beneficial for patients with T2DM in terms of improved glycemic control and quality of life.