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Introduction
Type 1 diabetes (T1D) is an autoimmune disease that necessitates lifelong insulin replacement therapy. Effective self-management of T1D has evolved to require patients to have an ability to formulate algorithms for insulin replacement dependent upon a complex array of interactive physiological parameters [1]. These parameters include consideration for dietary carbohydrate content and metabolism [2–5], personal glycemic patterns [6, 7], and adjustment for situations such as exercise or sick days [8]. Although tight glycemic control has been shown to delay or prevent the onset of diabetes-related micro-vascular and macro-vascular complications [9–12], the complexity of self-management has meant that the majority of people with T1D fail to maintain recommended levels of glycemic control [13–15]. Thus, the long-term prognosis for a person with T1D remains poor [16].
Diabetes education is a complex clinical intervention that provides the person with the knowledge and skills needed to perform diabetes self-care and make lifestyle changes to successfully manage the disease [17, 18]. As it has been estimated that 95% of diabetes care is self-management [19], clinician-led diabetes education is a fundamental component of assistance for people with T1D [20]. Clinical guidelines for the management of T1D recommend that diabetes education be provided to the patient by the diabetes health care team at diagnosis and at regular intervals throughout the patient journey [21–23]. Traditionally clinicians, who may include endocrinologists, diabetes educators (accredited diabetes nurse specialists), dietitians, or general practitioners (GP), have delivered diabetes education in a one-on-one situation with the patient. Evidence suggests that such education may be unstructured and provide inadequate knowledge to promote effective self-management [24]. National diabetes educator accreditation has been implemented in many countries to maintain higher standards of diabetes education [25–29]. However, there remains limited understanding of factors that may act as barriers or enablers to effective self-management knowledge translation [18, 30].
As health systems move toward more patient-centered systems of care, the pedagogy of diabetes education has developed to emphasize patient autonomy and consideration for patient lifestyle preferences [31, 32]. Research has supported this transformation [33–35]. A recent development has been the move to conduct structured group diabetes education courses [1, 18]. A theoretical basis in Social Learning Theory, which emphasizes skills attainment through observation, imitation, and modeling, has driven this development [36]. One internationally...