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An education program to improve dietary compliance in insulin-dependent diabetics was evaluated from 1978 to 1980 at the Royal North Shore Hospital of Sydney. Dietary intake, biochemical status, health beliefs, knowledge, anthropometric and other measurements were made on 140 diabetics and their family members before and, where possible, 6 months after the program. Four aspects of compliance were assessed: dietary composition, body weight, carbohydrate spacing among meal periods and carbohydrate variation between days. There was a significant increase in the proportion of subjects who achieved the recommended goal of a high carbohydrate/low fat diet. Diabetics who complied with this recommendation were significantly more likely to have adequate glycemic control. Most of the participants were initially near ideal weight and there were few substantial weight changes. The proportions of diabetics with acceptable scores for carbohydrate spacing and variation did not change significantly. Subjects who complied with one aspect of the dietary regimen did not necessarily comply with other aspects. Dietary compliance was related to initial patterns of dietary intake but could not be predicted from any other factors such as demographic characteristics, duration of disease, knowledge or health beliefs, although this could have been due to small sample sizes.

The low compliance by diabetic patients to professional recommendations is a major therapeutic challenge today. Patient education programs have been promoted as a remedy,1 but those developed to date need careful evaluation to see if they change health behavior. The knowledge-action gap has been well demonstrated in a number of chronic disorders.2 The early evaluation of our program in Sydney indicates that the educational intervention does change health behavior, especially in the difficult area of dietary compliance.3 This paper describes the evolution and the essential characteristics of the program. On completing the course, the diabetic patient is encouraged to use the home measurement of blood glucose by Eyetone meter to continue self-evaluation of control and monitor the effect of his compliance.

An education programme was evaluated for 140 insulin-dependent diabetics and their family members from 1978 to 1980. Dietary, biochemical and other assessments were made before and 6 months after the programme. As a group, the diabetics were initially in good metabolic control and this was maintained, or improved, over the study period. The programme recommended a diet in which complex carbohydrate constituted at least 45% of energy intake and fat was limited to 30%. The diabetics and their family members significantly increased their consumption of complex carbohydrate and decreased fat intake. On this regimen, diabetics did not gain weight and their relatives lost weight. There were also improvements in knowledge of the disorder and in perceptions of susceptibility to complications and barriers to compliance.