645-P: Diabetes Pueblo: A Community Health Worker–Led Educational Intervention for Latinos with T2D

523-P: Seeking Methods to Engage Emerging Adults (EAs) with Type 1 Diabetes (T1D) in Diabetes Self-Management Education and Support (DSMES)—A Human-Centered Design Approach

521-P: Care Partner in Virtual Diabetes Self-Management Education and Support

ObjectiveTo determine the feasibility and acceptability of a coordinated community-based intervention for low-income adults with type 2 diabetes (T2D) that included (1) screening and referral, (2) shared decision-making (SDM), and (3) diabetes self-management education and support (DSMES).MethodsParticipants were screened for T2D through a mobile health unit in a low-income community in Guadalajara, Jalisco, Mexico, and referred for follow-up in a primary care health center serving that community. Primary care physicians (PCPs) within the health center were trained on SDM for T2D, and community health workers (CHWs) were trained to deliver DSMES. Feasibility was measured by the number of community members screened and referred for care, the number of PCPs implementing SDM, and the number of CHWs hired and trained on DSMES. Acceptability was assessed by the percentage of participants who completed the 3-month DSMES program. Potential clinical impact was determined by effect sizes of changes in HbA1c between baseline and 3 months. Other measurements included waist circumference (WC), body weight, diabetes distress, and diabetes self-care activities, assessed at baseline, and at 1 and 3 months during the study period.ResultsWith respect to feasibility, all PCPs from the clinic completed the SDM training and were able to implement it in their primary practice. The DSMES training was completed by 4 (50%) of CHWs, and 3 were selected to deliver the course to study participants. Related to acceptability, 182 community members were screened, of which 42 were eligible for participation and 23 were successfully enrolled. Out of six programmed sessions, average participant attendance was 80% with 60.9% of participants retained at three months. Changes in HbA1c from baseline to 3 months were 10.1 ± 2.7 to 9.4 ± 3.1.DiscussionThe use of community screening to refer low-income people living with T2D to a clinic-based SDM and DSMES intervention was feasible with large effect sizes for changes in HbA1c. The high attrition rates suggest that alternative strategies may be necessary to keep patients engaged in care.

514-P: The Role of Peer Support in Diabetes Self-Management Education and Support (DSMES) Services

Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020. In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt. Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not. Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.

This systematic review and network meta-analysis compared the effects of various diabetes self-management programs: Diabetes Self-Management Education (DSME), Diabetes Self-Management Support (DSMS), and Diabetes Self-Management Education and Support (DSMES). We searched four electronic databases for eligible articles up to March 1, 2023. Only randomized controlled trials investigating the effects of DSME, DSMS, or DSMES on glycated haemoglobin (HbA1c) level, fasting blood glucose (FBG), total cholesterol (TC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in adults with type 2 diabetes were included. Cochrane Risk of Bias 2.0 tool was used to assess each study quality, and Confidence in Network Meta-Analysis was applied to evaluate the certainty of the evidence. Data were pooled with a random-effects model under a frequentist framework. A total of 108 studies encompassing 17,735 participants (mean age 57.4years) were analysed. DSMES, compared with usual care, significantly reduced HbA1c level (mean difference=-0.61%, 95% confidence interval [CI]=-0.74 to -0.49; certainty of evidence=moderate), FBG (-23.33mg/dL; -31.33 to -15.34; high), TC (-5.62mg/dL; -8.69 to -2.55; high), SBP (-3.05mmHg; -5.20 to -0.91; high), and DBP (-2.15mmHg; -3.36 to -0.95; high). Compared with DSME, DSMES showed significantly greater improvements in HbA1c levels (-0.23%; -0.40 to -0.07; high) and DBP (-1.82mmHg; -3.47 to -0.17; high). DSMES was ranked as the top treatment for improving diabetes clinical outcomes (0.82-0.97) in people with type 2 diabetes. DSMES, in people with type 2 diabetes, yields the greatest improvement in the key clinical outcomes of HbA1c, fasting blood glucose, and blood pressure levels. Healthcare providers should incorporate the DSMES approach into their daily care routines. Approximately 30% of the studies reviewed raised some concerns about their quality, underscoring the need for high-quality studies in this area.

Diabetes self-management education and support (DSME/S) has been demonstrated as an effective intervention and a billable service; however, DSME/S has yet to be successfully translated and diffused into mainstream practice. This project sought to improve glycemic control (measured by A1C or fasting blood glucose [FBG]) and quality of life (QOL) of Medicare patients age 65 years and older with type 2 diabetes (T2DM) using DSME/S. DSME/S included information sharing between patients and providers, psychosocial support, behavioral support with lifestyle modification, multi-disciplinary integration, and care coordination. Patient-specific data were compared before and 4 weeks after project implementation. Use of DSME/S increased by 15% (p < .005). Participants demonstrated a statistically significant decrease in mean FBG and a statistically significant increase in QOL. This project demonstrated the successful translation of evidence related to DSME/S into practice through improving diabetes care and promoting continuing education for all of the providers. [J Contin Educ Nurs. 2020;51(3):119-123.].

623-P: COVID-Impact on Type 2 Diabetes Self-Management during the Pandemic

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes (1–7). Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Table 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial DSME is typically provided by a health professional, whereas ongoing support can be provided by personnel within a practice and a variety of community-based resources. DSME/S programs are designed to address the patient’s health beliefs, cultural needs, current knowledge, physical limitations, emotional concerns, family support, financial status, medical history, health literacy, numeracy, and other factors that influence each person’s ability to meet the challenges of self-management. View this table: Table 1 Key definitions It is the position of the American Diabetes Association (ADA) that all individuals with diabetes receive DSME/S at diagnosis and as needed thereafter (8). This position statement focuses on the particular needs of individuals with type 2 diabetes. The needs will be similar to those of people with other types of diabetes (type 1 diabetes, prediabetes, and gestational diabetes mellitus); however, the research and examples referred to in this article focus …

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.

Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

BACKGROUND:Type 2 diabetes (T2DM) decreases the life expectancy and quality of life of diabetics and causes economic and societal problems. For this purpose, diabetes self-management education and support (DSMES) has been designed for many years, which is recently provided through technology-assisted education. Therefore, we developed a web-based program in accordance with DSMES to assess its effect on self-care behaviors and glycated hemoglobin (HbA1c) for patients with T2DM during the coronavirus disease (COVID-19) pandemic, which is described in detail in this paper.MATERIALS AND METHODS:This randomized controlled trial (RCT) was performed on 70 diabetic patients in Al-Zahra Hospital for three months. After random allocation, web-based educational content (including videos, lectures, educational motion graphics, text files, educational posters, and podcasts) according to DSMES was provided for the intervention group to improve self-care behaviors and HbA1c levels. The control group received routine educational pamphlets. A diabetes self-management questionnaire (21 questions) with a Likert scale was completed to assess self-care behaviors scores before and after intervention and three months later. Also, HbA1c was determined before and after the intervention. Analysis of variance with repeated measurements will be applied to compare mean scores of self-care behaviors components three times, and an independent t-test analyzed mean differences of HbA1c values.CONCLUSION:The obtained results of this study might be useful for promoting self-care behaviors and assessing HbA1c in diabetic patients.

BackgroundAlthough evidence shows that diabetes self-management education and support (DSMES) is an effective tool to help individuals with type 2 diabetes (T2DM) improve their health outcomes, there remains a large number of individuals not attending DSMES. Understanding how frequently patients receive referrals to DSMES and the number of DSMES hours they receive is important to determine, as well as patients’ health outcomes of utilizing DSMES. This will help us understand patterns of utilization and the outcomes that occur when such a valuable resource is utilized.MethodsSecondary data analysis was conducted of patient electronic medical records at a primary healthcare federally qualified clinic and 2 area hospitals. We identified 105 adult patients with a new T2DM diagnosis with at least 2 A1c lab results 3 to 12 months apart during the study period.ResultsOnly 53.5% were referred to DSMES. Out of those who were referred, 66% received no DSMES, 17% received 1-hour assessment, 4% received partial DSMES, and 13% received 8 or more hours. Linear regression of percent change in A1c and number of DSMES hours received, revealed that receiving 1 (P = .001) or 8 or more hours of DSMES (P = .022) had a significant negative relationship with the percent difference in A1c compared to the group who received no DSMES. Patients who had an hour of assessment had a similar percent reduction in A1c to those who had partial DSMES.ConclusionReferral rates and enrollment in DSMES remain low. Those who enrolled often dropped out after the one-hour assessment session. Results suggest making the one-hour assessment session more educationally comprehensive or longer to retain patients. Improving the DSMES referral process and further investing physicians’ decisions on whether to refer or not refer patients to DSMES are key for future studies.

1824-LB: A Qualitative Analysis of the DM-BOOST Program—Enhancing Patient Engagement and Experience with Diabetes Self-Management Education and Support

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations