The Effect of Group Counseling on Physiological Aspect of Self-care and HbA1C Level of Patients with Diabetes Type II

Document Type : Original Quantitative and Qualitative Research Paper


1 Evidence Based Care Research Centre, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 MS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Assistant Professor of Family Counseling, Faculty of Psychology and Educational Sciences, Ferdowsi University of Mashhad, Mashhad, Iran

4 MD. Parsian Diabetes Clinic. Mashhad, Iran


Background: The most important underlying cause of death in diabetic patients is poor self-care. The effect of education on self-care promotion has been widely investigated; however, the advisory role and impact of the treatment team have been scarcely investigated. 
Aim: Determining the effect of group counseling on the psychological aspect of self-care and level of glycosylated hemoglobin in the patients with diabetes type II.
Methods: In a randomized clinical trial, 73 patients with type II diabetes mellitus, who had been referred to Parsian Diabetes clinic of Mashhad in 2014, were divided into two groups of intervention and control. The group counseling program was performed in five 1.5-hour sessions with 3-day intervals, and each groups consisted of 8 to 10 people. The content of the meetings was problems in nutrition, exercise, diabetes mellitus disease, diabetes-related mental health problems, diabetes medications, and self-control of blood glucose. Researcher-made diabetes care questionnaire was filled and HbA1c test was measured before and two months after the intervention. Data were analyzed by SPSS version 11.5 using paired sample and independent t-tests.
Results: In this study,27.3 percent of the subjects were male and 72.7 were female with the mean age of 49.1 ± 8.3. The scores of physiological aspect of self-care and HbA1C of the diabetic patients before the intervention was not significantly different between the groups; but in the post-intervention phase, the self-care in intervention group (49.1±5.8) significantly increased compared to the control group (31.8±12.2) (p<0.001). In the post-intervention phase, HbA1C in the intervention group significantly decreased (8.3±0.9) compared to the control group (9.1±1.4) (p<0.006).
Conclusion: Group counseling might help to improve the diabetes self-care. Therefore, it can be added to the conventional training programs for better management of this chronic illness.


Main Subjects

  1. Mcculloch  K, Nathan M. Overview of medical care in adults with diabetes mellitus. [Homepage on the Internet]. C2013 [updated:  Jan 30, 2013; cited 2014 Nov 9]. Available at:
  2.  Suzanne C S, Brenda G B, Janice L H, Kerry H C.Brunner and suddarths textbook of medical-surgical nursing. Translate by Asadi Nooghabi A A, Dehghan Nayeri N. 12th ed.Tehran Andishe Rafi., 2010.
  3. Vinter, N. R., Petricek, G., & Katic, M. Obstacles Which Patient with Type2 Diabetes Meet while Adhering to the Rapeutic Regimen in Everyday life Qualitative Study. Creation Medical Journal. 2004; 45(1): 630-6.
  4. Duluth MN. Overview of medical care [homepage on the Internet]. C2012 [updated:  Oct 20, 2012; cited 2014 Nov 9]. Availabl at:
  5. Baquedano IR, Dos Santos MA, Martins TA, Zanetti ML. Self-Care of Patients with Diabetes Mellitus Cared for at an Emergency Service in Mexico. Rev Lat Am Enfermagem. 2010; 18(6):1195-202.
  6. Morovatisharifabad MA,Rohanitonekaboni N. Determinants of Diabetes Self-Care Model for Patients Referred to Yazd Diabetes Research Center Bimonthly journal.2009;16(81):29-36 (Persian)
  7. Aghvamy M, Mohammadzadeh SH, Gallalmanesh M, Zare R. Assessment the Education Compariment to Two Ways: Groupe Education and Computer Education on Quality of Life in the Children 8-12 Years Suffering from Asthma in the Valiasr Hospital of Zanjan. Zanjan University of Medical Science Journal.2010; 19(74):78-85 (Persian)
  8. Vosoghi Karkazloo N, Abootalebi Daryasari Gh, Farahani B, Mohammadnezhad E, Sajjadi A. The Study of Self-Care Agency in Patients with Diabetes (Ardabil).Journal of Birjand University of Medical Sciences.2010:8(4);197-204 (Persian)
  9. Parham M, Riahin AA, Jandaghi M, Darivandpour A. Self Care Behaviors of Diabetic Patients in Qom. Qom Univ Med Sciense Journal .2013;6(4):81-7 (Persian)
  10. Pendsey Sh. Practical Management of Diabetes. Delhi: Jaypee Brothers Publ; 2002
  11. Dalewitz J, Khan N, Hershey CO. Barriers to control of blood glucose in diabetes mellitus. Am J Med Qual 2000; 15(1): 16-25.
  12. Khazarlo S, Feizi A. The Relationship between Self-Efficacy and Function in Patients Suffering Diabetes, Diabetes Clinic Oromie. School of Nursing and Midwifery.2013; 10(3):369-75 (Persian)
  13. Gagliardino Juan J, Etchegoyen G. A Model Educational Program for People with Type 2 Diabetes. Diabetes Care 2001; 24(6):1001-7
  14. Ramezani T. Requiring Depression Counseling for Women with Breast Cancer.Andishe va Raftar. 2001;6(8):70-7 (Persian)
  15. Farsi Z, Jabari-Moroui M, Ebadi A. Application of Health Belief Model in Change of Self Care Behaviors of Diabetic Patients. Iran Journal of Nursing.2009; 22(61):61-73 (Persian)
  16. Mahmoodi A. Effect of Self Care Education on Decreasing HbA1C among Diabetic Patients. Medical Sciences Journal of Islamic Azad University 2006; 16(3): 171-6 (Persian)
  17. Jalilian F, Zinat Motlagh F, Solhi M. Effectiveness of Education Program on Increasing Self Management among Patients withType II Diabetes. Scientific Journal of Ilam University of Medical Sciences.2011:20(1); 26-34 (Persian)
  18. Adler AI, Stratton IM, Neil HA. Association of Systolic Blood Pressure with Macrovascular and Microvascular Complications of Type 2 Diabetes: Prospective Observational Study. Jaypee Brothers Publ.2000; 1(1) 321 (7258):412–9.
  19. Hanninen J, Takala J, Kiukaanniemi SK. Good Continuity of Care May Improve Quality of Life in Type 2 Diabetes. Diabetes Res Clin Pract. 2001; 51(1):21-7
  20. Baghery H, Memarian R, Alhani F. Survey the Effect of Group Counselling on Quality of Life in Myocardial Infarction Patients who Have Been Referred to the Clinics of Imam Khomeini and Shariati Hospitals in Tehran.hakim jurnal.2007;6(4):89-95 (Persian)
  21. Karimoi H M, Pourdehghan M, Faghihzadeh S, Montazeri A, Milani G M. The Eeffects of Group Counseling on Symptom Scales of Life Quality in Patients with Breast Cancer Treated by Chemotherapy. Behbod Journal.2006;1(1):10-22 (Persian)
  22. Robert L, Marianne H. Introduction to Counseling and Guidance.6th ed.Tehran: besat; 2011.p 249.
  23. Taylor  C,Lillis C,Lemone P, Lynn P.Fundamental of Nursing:The Art and Science of Nursing Care.6th ed.2008.vol(1).p 14.
  24. Kimberly Renee H. A Comparison of Traditional Group Counseling and Problem-Based Learning Interventions for 7th Grade victims of Bullies. ProQuest.2004.
  25. Karlsen B, Idsoe T, Dirdal I, Hanestad B R, Bru E. Effects of a Group-Based Counselling  Programme on Diabetes-Related Stress, Coping, Psychological Well-Being and Metabolic Control in Adults with Type 1 or Type 2 Diabetes. Patient Educ Couns.2004; 53(1):299-308.
  26. Kotsanos JG, Vignati L, Huster W, Andrejasich C, Boggs MB, Jacobson AM, et al. Health-Related Qualityof- Life Results from Multinational Clinical Trials of Insulin Lispro. Assessing benefits of a new diabetes therapy. Diabetes Care. 1997; 20(6):948-58.
  27. Abbasi A , Shamsizadeh M , Asayesh H , Rahmani H , Hosseini SA ,Talebi M. The Relationship between Caregiver Burdens with Coping Strategies in Family Caregivers of Cancer Patients. Iranian Nursing Scientific Association.2013;1(3):62-71(Persian)
  28. Shahbodaghi Z, Borhani F. The Effect of Empowerment Program on Hemoglobin A1C in Type 2 Diabetes Patients. Medical - Surgical Nursing Journal 2012; 1(2):23-9. (Persian)
  29. Fakhar F, Navabinejad Sh, Froghan M. Effect of Therapeutic Group Counseling Approach on the Mental Health of Older Women. Journal of Aging Iran.2008; 3(7):58-67. (Persian)
  30. Porebrahim T. Comparison of the Therapeutic Efficacy of Group Counseling, Individual Counseling with a Model of Depression in Elderly Sanatoriums in Tehran. PhD Thesis Consultation. Allameh Tabatabai University.2006. (Persian)
  31. Khoshkonesh A, Taghipor A, Bashiri A. The Effect of Group Counseling, Cognitive Anxiety and Depression in Elderly Women Living in Nursing Homes in the City of Sabzevar Rate of 86-87. Journal of Aging Iran.2009; 4(14):7-14. (Persian)
  32. Bidi  F, Hassanpour K, Ranjbarzadeh A, Kheradmand A. Effectiveness of Educational Program on Knowledge, Attitude, Self Care and Life Style in patients with type II diabetes. Quarterly Journal of Sabzevar University of Medical Sciences.2013; 19(4):336-44. (Persian)
  33. Rakhshandero S, Ghafari M, Heidarnia AR, Rajab A. Effectiveness of an Educational  Intervention on Metabolic Control of Diabetic Patients Attending Iranian Diabetes Association. Iranian Journal of Diabetes and Lipid Disorders.2009;1(1)57-64 (Persian)
  34. Hazavehei SMM, Sharifirad G, Mohebi S. The Effect of Educational Program Based on Health Belief Model on Diabetic Foot Care. Int J Diabetes Dev Ctries 2007; 27(1):18-23. (Persian)
  35. Kashfi SM, Khani jyhouni A, Bahadori khalili R, Hatami M. Evaluation of the Effects of Educating about Nutrition and Jogging on the Blood Sugar of Type II Diabetic Patients of a Clinic in Shiraz, Iran. Hakim Research Journal 2009; 12(3): 54- 60. (Persian)
  36. Milenkovic T, Gavrilovic S, Percan V, and Petrovski G. Influence of Diabetic Education on Patient Well-Being and Metabolic Control. Diabetologia Croatica 2004; 33(3): 91-6.
  37. Shabbidar S, Fathi B, and Mousavi Shirazifard N. The Effects of Clinical Nutrition Education on Glycemic Control Outcomes in Type 2 Diabetes. International Journal of Diabetes in Developing Countries 2006; 26(4): 156-9. (Persian)
  38. Aghamolaei T, Eftekhar H, Mohammad K, Nakhjavani M, Shojaeizadeh D, Ghofranipour F, and et al. Effects of Health Education Program on Behavior, and Health-Related Quality of Life in Diabetic Patients. Acta Medica Iranica 2005; 43(2): 89-94. (Persian)
  39. Rezaei N, Tahbaz F, Kimiagar M, and Alavi Majd H. Effect of Nutrition Education on Knowledge, Attitude, and Practice of Type 1 Diabetic Patients in Aligoodarz. Journal of Shahrekord University of Medical Sciences 2006; 8(2): 52-9. (Persian)
  40. Esther CG, Ovalle-Berúmen F, and Gomez- Meza MV. Metabolic Control of Adults with Type 2 Diabetes Mellitus through Education and Counseling. J Nurs Scholarsh 2006; 38(4): 344-51.
  41. Scain SF, Friedman R, and Gross JL. A Structured Educational Program Improves Metabolic Control in Patients with Type 2 Diabetes. Diabetes Educ. 2009; 35(4): 603-11.
  42. Kyzer H, Hakkak R, Caroll P, Hays N, and Harris MM. Effectiveness of Outpatient Diabetes Education on HbA1C Levels. FASEB J. 2008; 22(1): 872-4.