An Evaluation of a Diabetes Self-Management Education (DSME) Intervention Delivered Using Avatar-Based Technology: Certified Diabetes Educators' Ratings and Perceptions.

Background: Models that address the needs of patients with diabetes mellitus (DM) in primary care (PC) are needed, as health systems move to value-based care. To support DM patients at high risk, an insurer-based program that paired nurse practice care managers (PCM) with certified diabetes educators (CDE) was designed to improve outcomes for DM patients with complex needs. Objective: To assess the durability of glycemic improvement after diabetes self-management education and support (DSMES) intervention within a model that relies on a PCM to identify, refer, and provide ongoing support to complex patients who received a CDE intervention in PC. Methods: 2 CDEs, serving rural and urban areas, were introduced as team members into PC practices. CDEs provided DM training to PCMs who then proactively identified and referred patients under clear criteria (DM related ER visits, hospitalizations, HbA1c>9, reported barriers to care) for DSMES in collaboration with PC provider and PCM. Post CDE intervention, the PCM was available for follow-up and ongoing support. HbA1c was monitored every 3 months after intervention and compared to baseline value to assess durability of improvement in glycemic control. Results: Of 222 patients referred, 1had 6 and 80 had 12-month data for analysis. Patients were 52% female; mean age 57 (SD 13.43). Mean HbA1c decreased from 9.6 to 8.4 over 6 months and 9.2 to 8.1 over 12 months (p<0.001). Improvement in glycemic control was maintained for at least 1 year after intervention. There was no significant change in BMI over this time. Conclusions: A model where CDEs partner with PCMs, who identify, refer, and provide ongoing support to patients post-CDE delivered DSMES, is an effective and feasible intervention to improve and sustain DM outcomes in PC. This collaborative approach expands opportunities to meet complex needs of DM patients and can contribute to the ability of practices and health plans to provide an effective intervention with ongoing patient support. Disclosure M. Zupa: None. V.C. Arena: None. M.B. Thearle: None. P.A. Johnson: None. L.M. Siminerio: None.

Implementation of a Diabetes Self-Management Education (DSME) Program as part of Discharge Counseling at a County Hospital. The CDC reports 30.3 million people in the United States have diabetes. Adults with diabetes that received Diabetes Self Management Education (DSME) have been shown to have improved outcomes and reduced healthcare expenditures. Those that did not receive DSME are four times more likely to develop complications. The 2016 American Diabetes Association (ADA) Standards of Care in Diabetes recommends that every person receive DSME at diagnosis and as needed thereafter, such as during hospital discharge. Diabetes education is most commonly provided by a Certified Diabetes Educator (CDE), most of whom are nurses or dietitians but about 8% of CDEs are pharmacists. At Zuckerberg San Francisco General Hospital and Trauma Center, there has not been a certified diabetes nurse educator (RN CDE) for the past 4 years. Pharmacists have the clinical training and counseling skills to be effective diabetes educators whether or not they are CDEs. Since August 2017, a pharmacist CDE along with the clinical pharmacy staff have been providing diabetes education along with discharge medication counseling to patients with diabetes prior to hospital discharge. Currently, national rates of newly diagnosed patients that report receiving DSME in their first year ranges from 4-7%. The Center for Disease Control (CDC) reports that 57.4% of people with diabetes report ever attending a DSME class and that 59.8% report ever attending a DSME class within California. At ZSFG, the pharmacist CDE and clinical pharmacy staff provide DSME to patients with newly diagnosed diabetes, diabetic ketoacidosis and diabetic exacerbations. From May 2017 to September 2018 quarterly DSME rates increased from 0.6% in quarter 2 of 2017 to 97.8% in quarter 3 of 2018. Thus, showing that pharmacists can be a valuable resource to improve inpatient diabetes education rates in an institutional setting. Disclosure L.I. Mulala: None.

To examine the feasibility and potential health impact of a diabetes self-management education and support intervention involving peer support on glycaemic control and diabetes distress. A total of 41 South-Asian adults with Type 2 diabetes were recruited for a 24-week diabetes self-management education and support pilot intervention involving peer support. The intervention consisted of six weekly education sessions co-facilitated by a certified diabetes educator and two peer leaders, followed by 18 weekly support sessions facilitated by two peer leaders. Education sessions were guided entirely by participants' self-management questions and also emphasized goal setting and action planning. Support sessions were based on empowerment principles and participants discussed self-management challenges, shared emotions, asked self-management questions, problem-solved in a group, set goals, and developed and evaluated action plans. Feasibility outcomes included recruitment and retention. Primary health-related outcomes included HbA1c levels and diabetes distress (measured at baseline, 6 and 24weeks). Programme satisfaction was also assessed. Pre-established criteria for recruitment and retention were met. Paired t-tests showed no changes in HbA1c and diabetes distress at 6weeks. At 24weeks, HbA1c levels deteriorated [54mmol/mol (7.1%) vs 61mmol/mol (7.7%)] while diabetes distress scores improved (2.0 vs 1.7). Although feasible, findings suggest this peer-support model may have a positive impact on diabetes distress, but not on HbA1c levels. Culturally responsive modifications (e.g. intervention location) to the pilot model are needed and could lead to more favourable health outcomes for this community. Such a re-designed peer-support model will require further investigation.

A common problem of a person with diabetes mellitus was the lack of discipline in implementation of their daily self-care management. Diabetes Self-Management Education (DSME) was a system to help diabetes patients manage their activities to improve their health. DSME is the process which can improve the knowledge, skill, and ability of diabetes self-care. This study aimed to determine the effect of using diabetes self-management education (DSME) intervention and how it affected patients’ self-care management. This research was quasi experiment with one group pretest-posttest among patients with type-2 diabetes. There were 30 participants assigned by using purposive sampling into DSME intervention. Four sessions of DSME were conducted to the participants using illustrative media/fliers. The data were collected by questionnaires of Diabetes Self-Care Management. Then, it was analyzed by using paired t-test. The results showed that self-care management of the respondents before the intervention was 28.8 and it increased to 35.3 after the intervention (mean different=6.5). There were differences in the self-care score before and after the intervention (p=0.001). This study has limited time to do DSME. But, in four sessions, we have tried to explain more about diabetes interactively. Then, better to assess the type-2 diabetes patients with qualitative method or mixed with more participants included for the future researchers. This research was adopting a DSME to found significant improvements in the self-care management in type-2 diabetes mellitus patient. This demonstrates that DSME intervention can be such clinical importance in care of type-2 diabetes mellitus patient.Keywords: Diabetes self-management education, self-care management, type-2 diabetes patients.

IntroductionDiabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region.Materials and methodsThe study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis.ResultsNineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption.ConclusionsThe limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.

Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.

PurposeDiabetes patients must be equipped with the necessary knowledge to confidently undertake appropriate self-care activities. We prepared a diabetes self-management education (DSME) intervention and assessed how it affected patients’ self-reported levels of diabetes knowledge, self-care behaviors, and self-efficacy.Patients and methodsA before-and-after, two-group intervention study was conducted at Jimma University Medical Centre among adult patients with type 2 diabetes. At baseline, we randomly assigned 116 participants to the DSME intervention and 104 to a comparison group. Six interactive DSME sessions supported by an illustrative handbook and fliers, experience-sharing, and take-home activities were administered to the intervention group by two nurses during a six-month period. Diabetes knowledge, self-care behaviors, and self-efficacy were measured at baseline and at nine months following the commencement of DSME intervention (endpoint) in both groups.ResultsAt the endpoint, data from 78 intervention group participants and 64 comparison group participants were included in final analysis. The difference in the mean Diabetes Knowledge Scale scores before and after the DSME intervention was significantly greater in the intervention group (p = 0.044). The measured self-care behaviors included diet, exercise, glucose self-monitoring, footcare, smoking, alcohol consumption, and khat chewing. The mean number of days per week on which the intervention group participants followed general dietary recommendations increased significantly at the endpoint (p = 0.027). The intervention group followed specific dietary recommendations (p = 0.019) and performed footcare (p = 0.009) for a significantly greater number of days. There were no significant differences within or between the groups in other self-reported diabetes self-care behavior regimens or in diabetes self-efficacy.ConclusionOur study found significant improvements in the intervention participants’ diabetes knowledge scores and in their adherence to dietary and footcare recommendations. This demonstrates that our DSME intervention may be of clinical importance in developing countries such as Ethiopia.Trial registrationClinicalTrials.gov, Identifier NCT03185689, retrospectively registered on June 14, 2017: https://clinicaltrials.gov/ct2/show/NCT03185689.

Feasibility of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking andDiabetes Self-Management Education Intervention.

Outcomes of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention.

The purpose of this systematic review and meta-analysis is to evaluate the effectiveness of diabetes self-management education (DSME) interventions delivered in conjunction with primary care among Hispanic adults with type 2 diabetes mellitus (T2DM). A systematic search of PubMed, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature identified randomized controlled trials (RCT) that tested the effect of DSME interventions in Hispanic adults with T2DM. Studies reporting hemoglobin A1C (A1C) pre and post intervention or change in A1C were eligible for inclusion in the meta-analysis. Of 625 studies identified, 13 RCTs met criteria for inclusion in the systematic review; of these, 11 studies were included in the meta-analysis. The 13 RCTs represent data from 2784 adult Hispanic subjects. DSME interventions (individual, group, telephone/electronic, and multimodal sessions) varied in intensity from 1-time DSME sessions with phone follow-up to contact every 4 to 6 weeks over 5 years. At ≥6 months following intervention, pooled A1C reduction was -0.25 (95% CI, -0.42 to -0.07), favoring the intervention group. DSME in conjunction with primary care is effective in improving glycemic control in Hispanic adults with T2DM. Future comparative effectiveness research is needed to identify best delivery methods to optimize effectiveness of DSME delivered to the Hispanic population.

The purpose of this study was to investigate perceptions about family inclusion and support in diabetes self-management education. Surveys were mailed to certified diabetes educators (CDEs) in all 50 states and the District of Columbia, with a return of 225 surveys. Descriptive and inferential statistics (eg, t test, analysis of variance, correlation, and chi-square) were used as appropriate. Levels of importance placed on family involvement in diabetes education were significantly related to the emphasis placed on family during CDEs' formal or preprofessional education. CDEs' formal exposure to family theory influenced perceptions of their knowledge about family and the frequency that family support was emphasized in self-management activities but was unrelated to perceptions of their skillfulness in educating family members. Diabetes educators' personal values of family support were significantly related to how frequently family members were asked to participate in formal diabetes education classes. CDEs perceived that they were meeting individuals' self-management needs significantly better than those of families. Regional differences did not appear to be a factor in how CDEs incorporated family in diabetes education. Diabetes educators without formal exposure to family theory may be overestimating how much they emphasize family support in diabetes education. Increasing formal education about the importance of family involvement in self-management behaviors could positively affect individual diabetes self-management outcomes.

Racial and ethnic disparities in type 2 diabetes outcomes are a major public health concern. Interventions targeting multiple barriers may help address disparities. To conduct a systematic review and meta-analysis of diabetes self-management education (DSME) interventions in minority populations. We hypothesized that interventions addressing multiple levels (individual, interpersonal, community, and societal) and/or domains (biological, behavioral, physical/built environment, sociocultural environment, and health care system) would have the greatest effect on hyperglycemia. We performed an electronic search of research databases PubMed, Scopus, CINAHL, and PsycINFO (1985-2019). We included randomized controlled trials of DSME interventions among U.S. adults with type 2 diabetes from racial and ethnic minority populations. We extracted study parameters on DSME interventions and changes in percent hemoglobin A1c (HbA1c). A total of 106 randomized controlled trials were included. Twenty-five percent (n = 27) of interventions were exclusively individual-behavioral, 51% (n = 54) were multilevel, 66% (n = 70) were multidomain, and 42% (n = 45) were both multilevel and multidomain. Individual-behavioral interventions reduced HbA1c by -0.34 percentage points (95% CI -0.46, -0.22; I2 = 33%) (-3.7 [-5.0, -2.4] mmol/mol). Multilevel interventions reduced HbA1c by -0.40 percentage points (95% CI -0.51, -0.29; I2 = 68%) (-4.4 [-5.6, -3.2] mmol/mol). Multidomain interventions reduced HbA1c by -0.39 percentage points (95% CI -0.49, -0.29; I2 = 68%) (-4.3 [-5.4, -3.2] mmol/mol). Interventions that were both multilevel and multidomain reduced HbA1c by -0.43 percentage points (95% CI -0.55, -0.31; I2 = 69%) (-4.7 [-6.0, -3.4] mmol/mol). The analyses were restricted to RCTs. Multilevel and multidomain DSME interventions had a modest impact on HbA1c. Few DSME trials have targeted the community and society levels or physical environment domain. Future research is needed to evaluate the effects of these interventions on outcomes beyond HbA1c.

Diabetes self-management education (DSME) is an integral component of diabetes care; however, skilled educators and recognized programs are not uniformly available in rural communities. To increase access to quality DSME, the Montana Diabetes Control Program and the Montana chapter of the American Association of Diabetes Educators developed a mentoring program with 3 levels: basic, intermediate, and advanced. All participants were assisted by a volunteer certified diabetes educator (CDE) mentor. In addition, the program provided technical support for recognition through the American Diabetes Association and the Indian Health Service. From 2000 to 2005, 90 individuals participated; 76% were nurses and 21% dietitians. Twenty-seven of the 90 enrollees (30%) completed their structured option, and 13 achieved CDE certification. Most provided services in frontier counties (66%). Statewide, the number of CDEs in Montana increased 46% from 52 in 2000 to 76 in 2005. Twenty-five of the 30 facilities that received technical assistance achieved recognition. Statewide, the number of recognized education programs increased from 2 in 2000 to 22 in 2005. Twelve (55%) of these programs were located in frontier counties. Mentoring and technical support is an effective method to increase personnel skills for DSME and to increase access to quality education programs in rural areas.

Background:Achieving effective glycemic control remains a major challenge in Africa, with over 50% of individuals with diabetes not meeting recommended targets. This systematic review aimed to evaluate the effectiveness of diabetes self-management education (DSME) interventions on glycemic control (HbA1c) in persons with diabetes in Africa.Methods:Studies were retrieved from searches conducted on PubMed, CINAHL, Scopus, Web of Science, and Cochrane Library, from their inception to 9 June 2024. The search strategy included keywords and database-specific indexed terms such as (i) diabetes, (ii) diabetes self-management education, (iii) glycemic control, and (iv) Africa. The DerSimonian-Laird random effect model was used to pool the mean difference in HbA1c levels. Heterogeneity across studies was assessed using the I2 statistic, and subgroup analyses were conducted to explore sources of variability.Results:Seventeen randomized controlled trials involving 3730 participants met the inclusion criteria. Most DSME interventions were delivered in person, with only two studies utilizing mobile health (mHealth) approaches. The meta-analysis showed a significant reduction in HbA1c levels in the DSME intervention compared to usual care, with a pooled mean difference of −1.02% (95% CI −1.46 to −0.58). Subgroup analyses revealed variations in effectiveness based on intervention characteristics; however, these were not statistically significant.Conclusion:DSME interventions significantly improve glycemic control compared to usual care among people with diabetes in Africa. Future research should investigate context-specific factors that may influence the effectiveness of these interventions.

Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs. The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger's regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being. This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.