Diabetes self-management education programs: Results from a nationwide population-based study on characteristics of participants, rating of programs and reasons for non-participation.

Abstract

Population-based studies of reasons for not participating in diabetes self-management education (DSME) are scarce. Therefore, we investigated what sociodemographic and disease-related factors are associated with participation in DSME, the reasons for not participating in DSME and how participants evaluate DSME. We used data from the nationwide survey "Disease knowledge and information needs-Diabetes mellitus 2017", which included a total of 1396 participants diagnosed with diabetes mellitus (diabetes; n = 394 DSME-participants, n = 1002 DSME-never-participants). Analyses used weighted logistic or multinominal regression analyses with bivariate and multivariable approaches. Participants were more likely to attend DSME if they had a medium (OR 1.82 [95%CI 1.21-2.73]),or high (OR 2.04 [95%CI 1.30-3.21]) level of education, had type 1 diabetes (OR 2.46 [1.24-4.90]) and insulin treatment (OR 1.96 [95%CI 1.33-2.90]). Participants were less likely to attend DSME if they lived in East Germany (OR 0.57 [95%CI 0.39-0.83]), had diabetes for >2 to 5 years (OR 0.52 [95%CI 0.31-0.88] compared to >5 years), did not agree that diabetes is a lifelong disease (OR 0.30 [95%CI 0.15-0.62], had never been encouraged by their physician to attend DSME (OR 0.19 [95%CI 0.13-0.27]) and were not familiar with disease management programs (OR 0.67 [95%CI 0.47-0.96]). The main reasons for non-participation were participant's personal perception that DSME was not necessary (26.6%), followed by lack of recommendation from treating physician (25.7%) and lack of information on DSME (20.7%). DSME-participants found DSME more helpful if they had a medium educational level (OR 2.06 [95%CI 1.10-3.89] ref: low level of education) and less helpful if they were never encouraged by their treatment team (OR 0.46 [95%CI 0.26-0.82]). Professionals treating persons with diabetes should encourage their patients to attend DSME and underline that diabetes is a lifelong disease. Overall, the majority of DSME participants rated DSME as helpful.