Quality Improvement Project in Veterans with Prediabetes Enrolled in a Diabetes Self‐Management Education Program

Abstract

Veterans with prediabetes are referred to a Diabetes Self‐Management Education (DSME) to provide them with the skills, knowledge, and ability to adopt lifestyle behaviors that will prevent the onset of diabetes.PurposeTo evaluate the impact of goal setting and behavior changes on body weight (BW; kg), hemoglobin A1C (A1C; %), and systolic blood pressure (SBP; mmHg) in Veterans with prediabetes.MethodsSecondary data analysis was conducted on de‐identified data collected on Veterans with prediabetes who attended DSME at Louis Stokes Cleveland Department of Veterans Affairs Medical Center. BW, SBP, and A1C were assessed pre‐ and post‐DSME and then compared as follows: 1) Behavior Changes: Veterans who followed the American Association of Diabetes Educators 7 (AADE7; n=16) self‐care behaviors vs. those who did not (C; n=40); 2) Goal Setting (Diet and Exercise): Veterans were grouped and compared according to goals of diet only (Diet, n=51), exercise only (Ex; n=34), diet and exercise (Diet+Ex; n=27), or control (i.e., no goals set; n=9); and 3) Goal Setting (Objective vs. Subjective): Veterans with objective (n=57; i.e., goals measured by changes in biomarkers) vs. subjective (n=27; i.e., goals measured by changes in lifestyle behaviors) goals. The changes in BW, A1C, and SBP were evaluated utilizing two‐way analysis of variance (Group × Time). Dunnett's Test was used to evaluate if goal setting groups (Diet, Ex, and Diet+Ex) differed from control.ResultsThe change in BW, A1C, and SBP were similar between AADE7 (change in BW=−1.3±4.9kg, A1C=−0.2±0.4%, and SBP=3±18mmHg) and C groups (change in BW=−1.9±7.8kg, A1C=−0.0±0.4%, and SBP=2±17mmHg; p>0.05). Goal setting choices for diet and exercise were not associated with changes in BW (Diet=−0.8±3.8kg, Ex=−1.1±3.7kg, Diet+Ex=−1.7±5.7kg, and control=−5.5±22.1kg; p>0.05) and A1C (Diet=−0.2±0.3%; Ex=0.0±0.3%; Diet+Ex=0.0±0.4%; and control=−0.1±0.2%; p>0.05). Lastly, the changes between the subjective group (change in A1C= −0.1±0.4%; BW= −2.2±20.3kg; SBP=2±32mmHg) and the objective group (change in A1C= −0.1±0.4%; BW= −2.2±7.4kg; SBP=1±17mmHg) were also similar (p>0.05).ConclusionBehavior changes and goal setting choices were not associated changes in BW, A1C, or SBP in Veterans with prediabetes participating in DSME program. The incorporation of self‐monitoring devices (e.g., fitness trackers and continuous glucose monitors). which provide immediate feedback, may aid Veteran with prediabetes in making recommended lifestyle changes to prevent the onset of diabetes.