Barriers, Challenges and Possible Solutions in Establishing Diabetes Self-Management Education (DSME) in India

Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c). A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models. Participants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005). Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members.

The objective of this study is to assess the scope of existing practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programmes in Sub-Saharan Africa (SSA). Type 2 diabetes mellitus (T2DM) in SSA imposes a heavy burden on current healthcare services. Complications such as foot ulcers can have a significant impact on patient care and healthcare resources. It is imperative to identify patients at risk of developing diabetic foot complications and empower them with diabetes self-management education and support from specialised foot clinics is crucial. However, the availability of such programmes and services in SSA is limited. Studies of nurse-led diabetic foot prevention services and/or educational programmes in low- or middle-income countries in SSA for adults with T2DM, written in English, between August 2013 and March 2024 were considered. Following the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting and reporting scoping reviews, searches were conducted on four electronic databases (CINAHL, ProQuest, MEDLINE, and Scopus) and Google Scholar. The titles and abstracts were scrutinised. All eligible papers were retrieved and screened for full text. The review included ten studies (across 14 papers), all of which focused on nurse-led diabetes self-management education (DSME) programmes in SSA. There are no specific educational programmes or services led by nurses that focus exclusively on diabetic foot prevention. The analysis highlighted the components of successful nurse-led DSMEs that led to positive glycaemic control and self-care behaviors, including the focus on behavior change and the DSME should be co-produced with service users. The theoretical aspects of the DSME include evidence-based, structured, interactive, culturally and linguistically appropriate group-based activities. The DSME should be delivered over a period of several weeks, and sessions should last between 1.5 and 2 h. Barriers to delivery and participation include the rainy season, stockouts, time and resources needed, and a DSME that meets diverse levels of literacy and education. There is a heightened need for nurse-led, co-produced, culturally congruent, frugal, and sustainable education interventions or programmes. There is also a need for diabetic foot screening and foot ulcer prevention services that can operate sustainably alongside these educational interventions through task-shifted, simple, and frugal initiatives.

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.

Health Services and Health Care Needs Fulfilled by Structured Clinical Programs for Children with Medical Complexity

Introduction: Diabetes mellitus (DM) is a chronic condition requiring effective self-care to prevent complications. However, many patients struggle with self-care due to limited health literacy, inadequate resources, and socio-cultural barriers. Objective: This systematic review examined the effectiveness of Diabetes Self-Management Education (DSME) interventions in improving self-care, glycemic control, and quality of life for individuals with type 2 diabetes. Methods: Following PRISMA guidelines, a search across multiple databases (2018-2025) identified 12 eligible experimental or quasi-experimental studies. The results consistently demonstrated that DSME significantly improved diabetes outcomes. Result and Discussion: Participants showed enhanced self-efficacy, dietary adherence, self-care behaviors, and glycemic control (HbA1c reductions of 0.6% to 1.1%). Quality of life also improved, with some studies reporting a 7.2-fold increase in the likelihood of better health-related quality of life among DSME participants. Furthermore, innovative and contextually adapted delivery methods, such as SMS, booklets, and culturally specific models like “PASTI SEMBUH,” proved highly feasible and acceptable, particularly in resource-limited settings. Conclusion: DSME is a powerful, evidence-based intervention In conclusion, DSME is a powerful, evidence-based intervention that improves clinical outcomes, quality of life, and self-care capacity in individuals with type 2 diabetes. Integrating diverse and contextually relevant DSME methods into national health strategies, especially in low- and middle-income countries, is crucial for wider reach and effectiveness.

Aims and objectivesTo assess the effectiveness of educational and/or psychological diabetes self‐management education (DSME) intervention for people with type 2 diabetes (T2DM) in the Asian Western Pacific (AWP) region.BackgroundTranslational research indicates that DSME is effective; therefore, it is important to look at the AWP region to see what has been implemented and what the potential barriers are for the low integration of DSME. The need for DSME is present, and programmes are being developed. Therefore, focusing a systematic review of DSME research in the AWP region would give a better understanding of which intervention approaches are associated with better clinical outcomes and are culturally acceptable.DesignA systematic review.MethodsA review of randomized controlled trials (RCTs) and comparative studies to evaluate the effectiveness of face‐to‐face delivery reporting educational and/or psychological interventions for people with T2DM was implemented. We conducted searches using MEDLINE, EMBASE, CINAHL, PubMed and ASSIA databases between January 1990–June 2018. Studies published in English and non‐English were included. Two reviewers independently extracted data on participant and intervention characteristics. The quality of evidence was rated on predetermined criteria. Main outcomes included glycaemic control (reduction in HbA1c level).ResultsWe included 21 DSME programmes (17 RCTs), while 15 were group‐based approaches. Twelve studies (60%) were categorized as high quality. Three studies (25%) had a moderate (good) effect. Eight trials were effective in improving glycaemic control and reported statistically significant improvements in HbA1c levels. 50% of these were high‐intensity group‐based programmes.

Empowering Diabetes Care Through Pharmacist-Led Education: A Randomized Controlled Trial in a Low-Resource Setting.

ObjectivesMedical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. MethodsData are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. ResultsWeighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). ConclusionsCSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

Type II diabetes (T2D), is a serious health issue accounting for 10.7% of mortality globally. 80% of cases worldwide are found in low- and middle-income countries (LMIC), with rapidly increasing prevalence. Diabetes-self management education (DSME) is a cost-effective program that provides at-risk individuals with the knowledge and skills they need to adopt lifestyle changes that will improve their health and well-being. This systematic review examined the application of DSME in LMICs and identified the corresponding implementation results (cost, fidelity, acceptance, and adoption) associated with successful implementation in low-resource settings. The available research on T2D and the use of DSME in LMIC were systematically searched for using six electronic databases (PubMed, Embase, Cochrane, Web of Science, Google Scholar, PAIS, and EBSCO Discovery) between the months of October and November of 2022. The articles that met the search criteria were subsequently imported into EndNote and Covidence for analysis. The Cochrane RoB methodology for randomized trials was used to evaluate the risk of bias (RoB) in the included studies. A narrative synthesis was used to summarize the results. A total of 773 studies were imported for screening, after 203 duplicates were removed, 570 remained. Abstract and title screenings resulted in the exclusion of 487 articles, leaving 83 for full-text review. Following a full-text review, 76 articles were excluded and seven were found to be relevant to our search. The most common reasons for exclusion were study design (n = 23), lack of results (n = 14), and wrong patient population (n = 12). Our systemic review found that DSME can be an acceptable and cost-effective solution in LMIC. While we intended to analyze cost, adoption, acceptability, and fidelity, our investigation revealed a gap in the literature on those areas, with most studies focusing on acceptability and cost and no studies identifying fidelity or adoption. To further evaluate the efficacy of DSME and enhance health outcomes for T2D in LMICs, more research is needed on its application. osf.io/7482t.

BackgroundIn high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive.AimTo compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings.Research design and methods.DesignSingle-blind randomised parallel comparator controlled multi-centre trial.Adults (> 18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 1:1 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotment concealed in opaque numbered envelopes. The intervention effect was assessed with linear mixed models.Main outcome: Change in HbA1c after 3-month follow-up.Primary analysis involved all participants.Clinicaltrial.gov identifier:NCT04780425, retrospectively registered on 03/03/2021.ResultsRecruitment: 22nd until 29th January 2021.We randomised 206 participants (69% female, median age 58 years [IQR: 49–64], baseline HbA1c median 64 mmol/mol [IQR: 45–88 mmol/mol],7.9%[IQR: 6.4–10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up were death (n = 1), stroke(n = 1) and unreachable or unavailable (n = 47). A reduction in HbA1c was found in both groups; -9 mmol/mol [95% CI: -13 to -5 mmol/mol], -0·9% [95% CI: -1·2% to -0·51%] in the intervention group and -3 mmol/mol [95% CI -6 to 1 mmol/mol], -0·3% [95% CI: -0·6% to 0.0%] in the control group. The intervention effect was 1 mmol/mol [95%CI:-5 TO 8 p = 0.726]; 0.1% [95% CI: -0.5, 0.7], p = 0·724], adjusted for site, age, and duration of diabetes.No significant harms were observed.ConclusionIn low-resource settings, diabetes self-management education might not be associated with glycaemic control. Clinician’s expectations from diabetes self-management education must therefore be guarded.

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.

Background: Diabetes mellitus is a chronic disease that ranks as the fourth leading cause of death in developing countries. The main pillars in the management of type 2 Diabetes Melitus (T2DM) are education, nutritional therapy, physical training, and pharmacological interventions. The provision of education that has had a positive impact on DM patients is the Diabetes Self-Management Education (DSME). Method: The purpose of this study was to evaluate the effectiveness of the application and web-based Diabetes Self-Management Education (DSME) method in patients with type 2 DM. This study used a systematic literature review design. Articles were collected through PubMed and Google Scholar databases using the keywords DSME Web Application, DSME Smartphone. The criteria for articles used were those published from 2014-2020. Results: the literature review show that the application-based DSME method is more effective in improving self-management of type 2 DM sufferers. Search for articles related to 9 sources that fall within the criteria. Conclusion: is that the application-based DSME method is more effective because it does not require a lot of money and a long time compared to doing direct control to health facilities, the application can also always be accessed whenever we want so that it can help improve self-management in people with Diabetes Mellitus

Rural America faces a dual challenge with a higher prevalence of diabetes mellitus (hereafter, diabetes) and diabetes-related mortality. Diabetes self-management education (DSME) can improve glucose control and reduce adverse effects of diabetes, but certified DSME programs remain disproportionately limited in rural counties than in urban counties. The goal of this study is to examine the proportion of urban and rural adults who report having received DSME using a nationwide, 29-state survey while considering the potential consequences of lower service availability. This cross-sectional study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Residence was defined as urban (metropolitan county) vs rural (non-metropolitan county). Logistic regression, incorporated survey weights, was used to determine the odds of having received DSME by residence. BRFSS is a nationally representative survey, and this study included participants from 29 states that were distributed throughout all regions of the United States. The study sample consisted of 28,179 adults who reported having diabetes, lived in one of the states that administered the diabetes module in 2019, and answered all relevant questions. The main outcome measure was whether a participant had ever received DSME. Participants were considered to have received DSME if they self-reported having ever taken a class on how to manage diabetes themselves. Overall, 54.5% of participants reported having received DSME; proportionately fewer rural residents (50.4%, ±1.1%) than urban residents (55.5%, ±1.0%) reported DSME. Rural disparities persisted after adjusting for demographic, enabling, and need factors (Adjusted Odds Ratio =0.79; CI, 0.71-0.89). By sociodemographic factors, Hispanic persons vs non-Hispanic White persons and single vs married/coupled individuals were less likely to report DSME receipt (both 0.76 [0.62-0.94]). Ongoing national efforts addressing rural disparities in diabetes-related complications should target individuals most at risk for missing current diabetes educational programming and design appropriate interventions.

An international literature search was conducted to identify studies published since 1995 examining the effects of diabetes self-management education (DSME) in community settings. Of the 24 publications identified, eight were examined to provide a discussion of intervention methods, the use by study authors of behavioral theories and models to explain cognitive and psychosocial processes, the employment of community partnerships and collaborations to enhance patient and community ownership of DSME, and the effects of DSME on intermediate- and short-term outcomes. Reported intermediate outcomes established that researchers are now beginning to recognize the complexity of diabetes.

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