First use of Simulation in Therapeutic Patient Education (S-TPE) in adults with diabetes: a pilot study

Objective To pilot test the feasibility and acceptability of Simulation in Therapeutic Patient Education (S-TPE), in both adult patients with diabetes and educators. Conception Adult patients with insulin-dependent diabetes and who participated in a full TPE programme for the implementation of a FreeStyle were included in this monocentric pilot study. S-TPE intervention was based on a consensus conference determining the conditions and objectives of S-TPE. Main outcomes were the patients' and educators' perception of the usefulness of S-TPE and the patient's satisfaction level at the conclusion of the simulation sequence, measured on validated scales. Secondary outcomes were organisational, human, material and temporal, facilitating and limiting factors for patients and educators, patient self-efficacy and anxiety scores. Interventions The final session of TPE used the simulation. For each group, one patient volunteered to be the simulated patient. Intervention was divided into three steps: (1) a pre-briefing, (2) a simulation of hypoglycaemia and (3) a debriefing with the group of patients and educators. The whole intervention lasted about 2 hours. Results We included 23 patients (mean age +/- SD 63 +/- 15 years, 14 men) and 3 educators. After S-TPE intervention, patients' and educators' perceived usefulness score were 20.6/25 and 37.5/40, respectively. Patient's satisfaction score was 51.9/60. Qualitative analysis revealed no limiting factors to implementing S-TPE. Self-efficacy was stable. Decrease in anxiety score after S-TPE reached statistical significance in women (from 35.1 +/- 4.5 to 32.7 +/- 5.5, p=0.04) but not in men. Conclusion No limiting factors that could prevent the conduct of clinical trials to assess S-TPE efficacy in patients with diabetes were identified. S-TPE appears as a promising technique to improve diabetes management.