Comparative Effectiveness of Teach-Back Method Versus Standard Education on Glycemic Control and Self-Management in Adults with Type 2 Diabetes: A Pragmatic Randomized Controlled Trial

Abstract

Background: Effective diabetes education is essential for glycemic control, yet 40-50% of patients fail to achieve targets despite standard education. Objective: To compare teach-back method versus standard education on glycemic control and self-management in adults with type 2 diabetes. Methods: Pragmatic RCT (n = 80) at outpatient diabetes clinics. Teach-back group (n = 40) received four 60-minute sessions with comprehension verification; control (n = 40) received identical content via standard approach. Primary: HbA1c at 6 months. Analysis: Linear mixed-effects models, ITT. Results: Teach-back achieved clinically significant HbA1c reduction (8.82%→7.42% vs 8.88%→8.28%; difference: -0.80%; 95% CI: -1.18 to -0.42; p < .001; d = 0.94). The 0.80% improvement exceeds the 0.50% clinically meaningful threshold and approximates the magnitude achieved with adding a second-line oral hypoglycemic agent. DSMQ improved more in teach-back (d = 0.87). Lower education patients showed larger effects (d = 1.24 vs d = 0.64; interaction p = .031). Conclusion: Teach-back significantly improves glycemic control and self-management. Findings support integration into routine diabetes nursing practice