Diabetes Management Education Research Articles

Digital Health Professions Education on Diabetes Management: Systematic Review by the Digital Health Education Collaboration.

BackgroundThere is a shortage of health care professionals competent in diabetes management worldwide. Digital education is increasingly used in educating health professionals on diabetes. Digital diabetes self-management education for patients has been shown to improve patients’ knowledge and outcomes. However, the effectiveness of digital education on diabetes management for health care professionals is still unknown.ObjectiveThe objective of this study was to assess the effectiveness and economic impact of digital education in improving health care professionals’ knowledge, skills, attitudes, satisfaction, and competencies. We also assessed its impact on patient outcomes and health care professionals’ behavior.MethodsWe included randomized controlled trials evaluating the impact of digitalized diabetes management education for health care professionals pre- and postregistration. Publications from 1990 to 2017 were searched in MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, ERIC, and Web of Science. Screening, data extraction and risk of bias assessment were conducted independently by 2 authors.ResultsA total of 12 studies met the inclusion criteria. Studies were heterogeneous in terms of digital education modality, comparators, outcome measures, and intervention duration. Most studies comparing digital or blended education to traditional education reported significantly higher knowledge and skills scores in the intervention group. There was little or no between-group difference in patient outcomes or economic impact. Most studies were judged at a high or unclear risk of bias.ConclusionsDigital education seems to be more effective than traditional education in improving diabetes management–related knowledge and skills. The paucity and low quality of the available evidence call for urgent and well-designed studies focusing on important outcomes such as health care professionals’ behavior, patient outcomes, and cost-effectiveness as well as its impact in diverse settings, including developing countries.

Diabetes related distress in adults with type 2 diabetes mellitus: a community-based study

Background: Living with diabetes can be difficult, since it can affect the patient physically as well as psychologically. Patients with diabetes face psychological issues which may be part of the spectrum of disease experience, distinct from depression, which hinder glycaemic control. The objective of the study was to determine the prevalence of diabetes related distress, and its association with socio-demographic characteristics, in adults with type 2 diabetes.Methods: A community based cross sectional study was conducted among 250 individuals of 30-60 years, with type 2 diabetes.Results: The prevalence of diabetes related distress in the study population was 13.3%; among the sub scales highest reported was regimen related distress 21.6%, followed by physician related 17.2%, emotional burden 16.4%, and inter personal distress 14.8%. Diabetes related distress was found to have significant statistical association with occupational class. In occupational class, distress was higher among unemployed while least in unskilled workers. It was higher among older (above 50 years) participants, males, members of joint family, unmarried and those with more years of education though there was no significant difference.Conclusions: The prevalence of diabetes related distress (13.2%) especially regimen and physician related, underscores need for better clinician involvement paying appropriate attention to systematic diabetes self-care and management education, and timely diagnosis of distress for positive clinical outcome.

Gestational Diabetes Management Mentoring Intervention

In April 2017, the Leadership Sinai Centre for Diabetes (LSCD) had an unacceptable wait time for patients referred for gestational diabetes. One solution proposed to improve timely access to education was to have 2 Family Health Teams (FHT) deliver a gestational diabetes management (GDM) education program to their clients rather than referring them to the LSCD. These teams were already providing obstetrical care and had a diabetes team on site. To work towards this solution, the LSCD allied health team partnered with the FHTs to create a GDM mentoring program. The objectives were to have the LSCD GDM team share their expertise to equip the FHTs with the knowledge, skills and support necessary to deliver effective and timely education for their gestational clients. The mentorship program involved a process of working with the FHT staff members to review their learning needs, develop resources, shadow the current program, devise clear communication pathways with the physician and support the new program work of the FHTs. Evaluation of this program through pre- and post-tests, confidence scales, participant satisfaction and wait times revealed that 100% of the FHT staff increased their knowledge and 83% increased their confidence in their ability to manage gestational diabetes. Mentees contact mentors on an as needed basis for ongoing support. The FHT gestational clients are now seen within 1 week of their referral. This program has added to the success of other initiatives, reducing the LSCD wait time to less than 2 weeks for gestational education.

Comparison of the Effectiveness of Interactive Diabetes Management Education and Stress Inoculation Training on the Self-care of Type II Diabetic Patients

Comparison of the Effectiveness of Interactive Diabetes Management Education and Stress Inoculation Training on the Self-care of Type II Diabetic Patients

The Diabetes Management Education Program in South Texas: An Economic and Clinical Impact Analysis.

Diabetes is a major chronic disease that can lead to serious health problems and high healthcare costs without appropriate disease management and treatment. In the United States, the number of people diagnosed with diabetes and the cost for diabetes treatment has dramatically increased over time. To improve patients' self-management skills and clinical outcomes, diabetes management education (DME) programs have been developed and operated in various regions. This community case study explores and calculates the economic and clinical impacts of expanding a model DME program into 26 counties located in South Texas. The study sample includes 355 patients with type 2 diabetes and a follow-up hemoglobin A1c level measurement among 1,275 individuals who participated in the DME program between September 2012 and August 2013. We used the Gilmer's cost differentials model and the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine methodology to predict 3-year healthcare cost savings and 10-year clinical benefits of implementing a DME program in the selected 26 Texas counties. Changes in estimated 3-year cost and the estimated treatment effect were based on baseline hemoglobin A1c level. An average 3-year reduction in medical treatment costs per program participant was $2,033 (in 2016 dollars). The total healthcare cost savings for the 26 targeted counties increases as the program participation rate increases. The total projected cost saving ranges from $12 million with 5% participation rate to $185 million with 75% participation rate. A 10-year outlook on additional clinical benefits associated with the implementation and expansion of the DME program at 60% participation is estimated to result in approximately 4,838 avoided coronary heart disease cases and another 392 cases of avoided strokes. The implementation of this model DME program in the selected 26 counties would contribute to substantial healthcare cost savings and clinical benefits. Organizations that provide DME services may benefit from reduction in medical treatment costs and improvement in clinical outcomes for populations with diabetes.

Measuring the social value of prevention and management of type 2 diabetes in a community setting.

Background:Type 2 diabetes affects 1 in 20 people over the age of 65. Although there is growing evidence around the effectiveness of lifestyle interventions to prevent or delay the onset of this disease, there is limited evidence of the wider social outcomes and value of such programmes. Social Return on Investment (SROI) is a method of defining, measuring and valuing the wider social outcomes and describing the process of change through the eyes of those who benefit. This paper aims to evaluate the wider impact and social value of the Westbank Living Well, Taking Control (LWTC) community-based diabetes prevention and management education programme. Methods:The SROI methodology involves a mixed methods design. Qualitative methods were used to identify outcomes that were viewed as important by stakeholders in terms of the impact they create. A quantitative approach was used to define the numbers experiencing the outcomes, a monetary representation of the outcomes and their value. Results:SROI analysis found that for every £1 invested in LWTC, there is £5.80 of social return over a three-year period. The sensitivity analysis showed that the value of the social return for every £1 invested in the LWTC is likely to be between £1.30 and £6.57. Conclusions:The study demonstrates the potential social value of a community-based diabetes prevention and management education programme in terms of outcomes for participants, and also the wider outcomes for staff, volunteers, family and friends of the participants and the organisations involved. Better appreciation of such wider outcomes could have an important role in building partnerships, community engagement and political mandate for public health interventions.

Fasting, Diabetes, and Optimizing Health Outcomes for Ramadan Observers: A Literature Review.

IntroductionGlobally, and in Australia, diabetes has become a common chronic health condition. Diabetes is also quite prevalent in culturally and linguistically diverse pockets of the Australian population, including Muslims. There are over 90 million Muslims with diabetes worldwide. Diabetes management and medication use can be affected by religious practices such as fasting during Ramadan. During Ramadan, Muslims refrain from oral or intravenous substances from sunrise to sunset. This may lead to many potential health or medication-related risks for patients with diabetes who observe this religious practice. This literature review aimed to explore (1) health care-related interventions and (2) intentions, perspectives, or needs of health care professionals (HCPs) to provide clinical services to patients with diabetes while fasting during Ramadan with a view to improve health outcomes for those patients.MethodsUsing a scoping review approach, a comprehensive search was conducted. Databases searched systematically included PubMed, Medline, Embase, and International Pharmaceutical s. Studies published in English that described interventions or intentions to provide interventions regarding diabetes and Ramadan fasting were included.ResultsFourteen published articles that met the inclusion criteria were retrieved and content analyzed. Of those, nine intervention studies regarded diabetes management education. Five studies described professional service intention, four of which were related to the role of pharmacists in diabetes management in Qatar, Australia, and Egypt, and one French study examined the general practitioners’ (GPs) experiences in diabetes management for Ramadan observers. The intervention studies had promising outcomes for diabetes management during Ramadan. Effect sizes for improvement in HbA1c post intervention ranged widely from −1.14 to 1.7. Pharmacists appeared to be willing to participate in programs to help fasting patients with diabetes achieve a safe therapeutic outcome. Service intention studies highlighted pharmacists’ and GPs’ need for training prior to providing services from a clinical as well as cultural competence perspective.ConclusionInterventions research in this area requires robustly designed and structured interventions that can be tested in different contexts. This literature review revealed many gaps regarding diabetes management in Ramadan. Health professionals are willing to provide services for fasting diabetes patients, but need upskilling.

Knowledge Confidence and Desire for Further Diabetes-Management Education among Nurses and Personal Support Workers in Long-Term Care.

Diabetes care in the long-term care (LTC) setting is complicated by increased prevalence of comorbidities, age-related changes in medication tolerance, frailty and limited resources. Registered nurses (RNs), registered practical nurses (RPNs) and personal support workers (PSWs) are responsible for front-line diabetes care; however, there is limited formal diabetes education in this setting. The current study aimed to assess the knowledge confidence and desire for additional diabetes education among nurses and PSWs in the LTC setting. We studied 89 RNs, RPNs and PSWs (Mage=43.6, 94.3% female) in 2 LTC facilities in the Kitchener-Waterloo area who participated in an online survey assessing knowledge and confidence in 6 key areas of diabetes care (nutrition, insulin, oral medications, hypoglycemia, hyperglycemia and sick-day management). Interest in further diabetes education was also explored. Self-rated knowledge and confidence were generally moderate to high, ranging from 46% to 79% being moderately to very knowledgeable and from 61% to 74% being moderately to very confident. Knowledge and confidence was highest for nutrition and management of hypo- and hyperglycemia and lower for sick-day management, oral medications and insulin. There were significant differences between clinicians such that PSWs reported less knowledge and confidence than RNs and RPNs on most parameters. Among the whole sample, 85% wanted education about diabetes, and this rate did not vary by occupation. The most commonly reported areas for additional education concerning diabetes were for management of hypo- and hyperglycemia (30% to 31%) and insulin (31%). Overall, the findings indicate moderate levels of self-rated knowledge across diabetes care areas; however, most clinicians feel there is room for more diabetes-care education, particularly regarding insulin and management of hypo- and hyperglycemia.

Abstract P056: Diabetes Education for Stroke Inpatients is Incomplete and Differs by Stroke Severity, Age, and Substance Abuse History

Introduction: Diabetes is a well-established risk factor for stroke and other vascular disease. Consequently, diabetes management is important for prevention of primary and secondary vascular events. Hospitals offer diabetes education, but it is unknown if the appropriate patients are receiving the necessary information. The objective of this study was to determine the factors associated with receiving diabetes management teaching among patients presenting to a hospital with an ischemic stroke (ISC) or Transient Ischemic Attack (TIA) who have a concurrent new diabetes diagnosis. Methods: Data from 20 hospitals in a multi-state healthcare system stroke registry from 2002 to May 2015 were used. ISC or TIA patients with a new, in-hospital diagnosis of diabetes were included. Patients on comfort care, transferred to an outside facility from the emergency department, discharged to hospice or expired were excluded. Associations between receiving diabetes management education and demography, insurance, medical history, BMI, functional status, and stroke severity of the patient were examined using a generalized linear mixed model with a logit link. Results: Data from 336 newly diagnosed diabetes patients were used in the analyses. Of those, 269 (80.1%) received diabetes management education, while 67 (19.9%) did not. Patients with a medical history of drug or alcohol abuse were 79% less likely to receive diabetes management training than those without a history (adjusted odds ratio [AOR] = 0.215, p=.014). Patients who were overweight or obese weight were over three times more likely to receive diabetes management education than patients who were of normal weight or underweight (AOR = 2.92, p=.003). For every one-point increase of the NIH Stroke Scale score, the likelihood of receiving education decreased by 6% (AOR=.913, p=.005), and with each additional five years of age the likelihood of receiving education decreased by 14% (AOR=.861, p=.017). Gender, insurance type, discharge status, and medical histories of atrial fibrillation, CAD/prior MI, previous strokes, previous TIA, hypertension, family history of stroke were not significant predictors. Conclusions: Almost 20% of patients with newly diagnosed diabetes did not receive diabetes management education. While education was appropriately targeted to overweight and obese patients, these results indicate that patients with a history of drug and alcohol abuse, those who are normal or under-weight and those with more severe strokes were underserved. More work needs to be done to ensure that stroke patients are receiving appropriate education to prevent subsequent cerebrovascular events.

Developing Effective Diabetes Programming for Black Men

The purpose of this study is to obtain feedback from 20 men on developing effective programming to reduce the impact of diabetes (t2dm) among Black men. Three focus groups were convened in Des Moines, Iowa. Men were recruited, all either diagnosed with t2dm (n = 10), pre-diabetic (n = 1), or experienced t2dm through family and friends (n = 9). The results highlighted themes related to t2dm knowledge, masculinity, and behavioral health; gender-centered diabetes management education; and family support and functioning. Men provided recommendations for program format and content, desirable facilitator characteristics, and whether to include spouses/partners, relatives, and friends. These results provide guidance and ideas to nurses wishing to enhance t2dm education and patient outcomes for Black men.

Evaluation of the Effectiveness of the H.A.N.D.S.SM Program: A School Nurse Diabetes Management Education Program.

The purpose of this project was to determine the effectiveness of the Helping Administer to the Needs of the Student with Diabetes in Schools (H.A.N.D.S.(sm)) continuing education program in improving the level of experience and competence in performing services associated with diabetes care. This program is a live course for school nurses providing clinical information about diabetes management and their professional role in the care of students with diabetes. Pre- and post-surveys were administered via e-mail to assess their level of experience and competence in diabetes care. A total of 105 nurses completed both surveys and were included in the analysis. The changes between pre- and post-survey questions were assessed. The H.A.N.D.S. participants' levels of experience and competence for each of the four categories of diabetes care improved significantly, and a greater number of nurses reported being able to perform the services independently and having the ability to teach others.

Effectiveness of the smart care service for diabetes management.

ObjectivesThe aim of this study was to assess the effectiveness of the Smart Care service for the diabetes management.MethodsFifty-six patients with diabetes mellitus were recruited in Daegu, Korea. All participants completed a diabetes management education course (diet, exercise, and complications) for their self-care and received access to a care management website through a netbook and smartphone. The website accepts uploads of glucose level, body weight, HbA1c, low-density lipoprotein cholesterol level, and blood pressure. Participants communicated with the care manager through the internal management system of the website. The intervention was applied for 6 months.ResultsParticipants receiving the Smart Care service had lower blood glucose and HbA1c during 6 months follow-up when 1-month values (p < 0.001) were compared. There was no significant difference in body weight and body mass index between 1 month and 6 months. The average number of remote consultation with the Smart Care service per person was 10.4 by nurses, 3.0 by nutritionists, and 1.6 by sports curers. Regression analysis indicated that the number of times counseling was offered by nurses influences body weight and that the number of minutes of telephone counseling influences both body weight and body mass index.ConclusionsWe have confirmed that the Smart Care service might be an effective system for reduction in blood glucose and HbA1c. We expect that the Smart Care service will contribute to delaying diabetes complications and improving the quality of life of patients with diabetes.

Effectiveness of a Community Health Worker–led Diabetes Self-Management Education Program and Implications for CHW Involvement in Care Coordination Strategies

The purpose of this study was to evaluate the effectiveness of a Community Health Worker (CHW)-led diabetes self-management education (DSME) program and to understand how CHWs and primary care providers (PCPs) work together to provide comprehensive diabetes care. A quantitative pre- and postassessment of change in patients' blood glucose levels (A1C), blood pressure, and body mass index was performed to determine the clinical effectiveness of the program. Qualitative, semi-structured interviews with 5 CHWs and 7 PCPs were conducted to assess how CHWs were incorporated into clinical teams and their impact on care delivery and diabetes-related outcomes. Patients who participated in the program experienced a statistically significant decrease in mean A1C levels and systolic blood pressure readings 1 year post baseline. CHWs provided high-quality care and bridged the gap between patients and care providers through diabetes management support and education, medication assistance, access to community resources, and social support. CHWs play a variety of roles in helping patients overcome barriers to diabetes control and can be successfully integrated into a health care system's care coordination strategy.

Internet Psycho-Education Programs Improve Outcomes in Youth With Type 1 Diabetes

OBJECTIVEThe purpose of this study was to determine the efficacy of two Internet-based psycho-educational programs designed to improve outcomes for youth with type 1 diabetes transitioning to adolescence.RESEARCH DESIGN AND METHODSThe study was a multisite clinical trial of 320 youth (aged 11–14 years; 37% minority; 55% female) randomized to one of two Internet-based interventions: TeenCope or Managing Diabetes. Primary outcomes were HbA1c and quality of life (QOL). Secondary outcomes included coping, self-efficacy, social competence, self-management, and family conflict. Data were collected at baseline and after 3, 6, and 12 months online. Youth were invited to cross over to the other program after 12 months, and follow-up data were collected at 18 months. Analyses were based on mixed models using intent-to-treat and per-protocol procedures.RESULTSYouth in both groups had stable QOL and minimal increases in HbA1c levels over 12 months, but there were no significant differences between the groups in primary outcomes. After 18 months, youth who completed both programs had lower HbA1c (P = 0.04); higher QOL (P = 0.02), social acceptance (P = 0.01), and self-efficacy (P = 0.03) and lower perceived stress (P = 0.02) and diabetes family conflict (P = 0.02) compared with those who completed only one program.CONCLUSIONSInternet interventions for youth with type 1 diabetes transitioning to adolescence result in improved outcomes, but completion of both programs was better than only one, suggesting that these youth need both diabetes management education and behavioral interventions. Delivering these programs via the Internet represents an efficient way to reach youth and improve outcomes.

Self-Monitoring of Blood Glucose in Glucagon-Like Peptide-1–Based Treatment Approaches

In Brief Recently, European expert recommendations suggested individualized self-monitoring of blood glucose (SMBG) strategies to optimize diabetes management in patients with type 2 diabetes who are treated with glucagon-like peptide-1 (GLP-1)–based approaches. These suggestions include simple and clinically applicable SMBG glucose testing patterns, or schemes. Potential benefits of SMBG in GLP-1–based treatment approaches were seen for several clinical scenarios: early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and diabetes education.

Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

BackgroundType 1 diabetes is among the most prevalent chronic childhood diseases in the US. Initial type 1 diabetes management education and care can take place in different clinical settings. This study assessed metabolic outcomes (i.e. hemoglobin A1C), healthcare utilization and costs among new-onset type 1 diabetic children who received initial diabetes education and care in a hospital compared to those children in an outpatient pediatric endocrinology clinic.MethodsA retrospective cross-sectional study was conducted from the payer’s perspective. New-onset type 1 diabetic children, aged 1–18, presented at Baystate Children’s Hospital (Massachusetts) from 2008–2009 were included in the study if lab test confirmed diagnosis and there was one year of follow-up. Inpatients spent at least one night in the hospital during a 10-day diagnosis period and received all or part of diabetes education there. Outpatients were diagnosed and received all diabetes education in a pediatric endocrinology clinic. Metabolic outcomes were measured at diagnosis and at one year post-diagnosis. Healthcare charges and electronic medical records data were reviewed from 2008–2010. Healthcare costs components included diagnostic test, pediatric, endocrinology and hospitalists care, critical and emergency care, type 1 diabetes related supplies, prescription drugs, and IV products.ResultsStudy sample included 84 patients (33 inpatient and 51 outpatients). No statistically significant differences in patient demographic characteristics were found between groups. There were no statistically significant differences in metabolic outcomes between groups. Total cost at one year post-diagnosis per new-onset type 1 diabetic child was $12,332 and $5,053 in the inpatient and outpatient groups, respectively. The average healthcare cost for pediatric endocrinology care was $4,080 and $3,904 per child in the inpatient and outpatient groups, respectively.ConclusionProvision of initial type 1 diabetes education and care to new-onset non-critically ill children in a hospital setting increases healthcare costs without improving patient’s glycemic control in the first year post-diagnosis.

Application of “one-step”diabetes education management system in clinic

Objective To evaluate the application value of the one-stepdiabetes education management system in clinic. Methods The “one-step” diabetes education management system was construct.80 newly diagnosed patients with type 2 diabetes mellitus were selected and randomly divided into the control group and the experimental group with 40 patients in each group.The patients in the experimental group received “one-step”diabetes education management system by diabetes specialist nurses,while patients in the con-trol group received routine diabetic education.The fasting blood glucose (FBG),HbAlc,medical compliance behaviors and other indices were compared between two groups. Results FBG,HbAlc and medical compliance were better,and the risk score of complications was higher in the experimental group than those of the control group,there were significant differences between them. Conclusions Application of “one-step”diabetes education management system in treatment and nursing of patients shows maneuverability and practicality.It has clinical application value and deserves to be spread. Key words: “One-step”diabetes education management system; Type 2 diabetes mellitus; Compliance

The role of self-monitoring of blood glucose in glucagon-like peptide-1-based treatment approaches: a European expert recommendation.

The role of glucagon-like peptide (GLP)-1-based treatment approaches for type 2 diabetes mellitus (T2DM) is increasing. Although self-monitoring of blood glucose (SMBG) has been performed in numerous studies on GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, the potential role of SMBG in GLP-1-based treatment strategies has not been elaborated. The expert recommendation suggests individualized SMBG strategies in GLP-1-based treatment approaches and suggests simple and clinically applicable SMBG schemes. Potential benefits of SMBG in GLP-1-based treatment approaches are early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and diabetes education. Its length and frequency should depend on the clinical setting and the quality of metabolic control. It is considered to play an important role for the optimization of diabetes management in T2DM patients treated with GLP-1-based approaches.

Diabetes Management in the Nursing Home

Diabetes mellitus is a disease with debilitating potential. Growing numbers of elderly individuals are being admitted to under-resourced nursing homes with this often complicated, time-intensive, and costly diagnosis. The purpose of this systematic review of the literature was to determine the trends in diabetes management in nursing homes over the last decade including the use of clinical practice guidelines and the evaluation of management outcomes. Ten medical, nursing, psychological, legal, and business databases were searched for articles written in English between 2000 and 2010 addressing diabetes management in nursing homes or long-term care settings. They were analyzed to determine diabetes management characteristics, use of clinical practice guidelines, resident outcomes associated with different regimens, and implications for improved management and outcomes. A total of 20 studies from 6 countries, primarily the United States, including both qualitative and quantitative designs and a combined sample of 779,707 residents, met the inclusion criteria. The majority of the studies described frequencies of various management practices and found rare clinical practice guideline adherence. A severe lack of research relating management practices to health and quality-of-life outcomes was evident as was a lack of the voice of the resident in determining the diabetes regimen. Clear implications were found for improvement in diabetes management education for residents, families, and all health care providers in this setting.

Endurance Athletes and Type 1 Diabetes

The purpose of this study was to gain insight into the current diabetes management practices of endurance athletes with type 1 diabetes and to compare these practices with the guidelines for athletes established by the American Diabetes Association (ADA). Participants included in this descriptive study were endurance athletes aged 18 years and older with type 1 diabetes. The survey questions were based on the current clinical recommendations for endurance athletes with type 1 diabetes, as established by the ADA. A link to the questionnaire was posted on the Web site of the Diabetes Exercise and Sports Association (DESA). A total of 38 questions were included in the survey, and 91 usable surveys were received. Analysis of variance was used for several comparisons using SPSS version 17. Half of the clinical guidelines were followed by the participants. Among these, about 50% followed many of the guidelines "most of the time" or "almost always" and 40% followed the guidelines "sometimes" or "most of the time." Results of ANOVA showed several trends (nonsignificant) in the occurrence of low blood glucose when the guidelines were not followed. Endurance athletes with type 1 diabetes do not consistently follow the clinical guidelines for blood glucose management as recommended by the ADA. The results of this study reflect a need among athletes for diabetes management education programs that promote a better understanding of the potential negative side effects of suboptimal blood glucose control.