Diabetes Self-management Education And Support Program Research Articles

Development of a tool to estimate sugar and caloric contents in alcoholic beverages for a diabetes self-management program in Thailand

Diabetes self-management education and support (DSMES) is recommended as a standard of care for patients with diabetes worldwide. Alcohol consumption is one aspect mentioned within the DSMES program in Thailand where alcohol consumption is the highest among Southeast Asian countries. Many diabetes guidelines suggest limiting alcohol intake to not more than one standard drink per day for adult women and two for adult men if they cannot abstain from drinking. In practice, however, the conversion of alcohol consumption into standard drinks, and nutritional information about the calorie and sugar contents of alcoholic beverages, especially domestically produced spirits, are not commonly available in Thailand. By reviewing the diabetes guidelines internationally and the Thailand alcoholic beverage industry, a visual health education tool to help convert different alcoholic beverages into standard drinks and to provide the calorie and sugar content of alcoholic beverages was developed as a part of the DSMES program. It was finalized following pilot testing and focus group discussions with policymakers, healthcare providers, and type 2 diabetes patients. The personalized counseling tool, integrated with guidelines and culturally tailored to the Thai setting is distributed to counselors/educators. It is a potentially useful tool for patients to make informed choices for their self-management of diabetes.

35-LB: The Impact of the COVID-19 Pandemic on A1C Reductions in Patients with Diabetes Mellitus Who Attended an ADA-Recognized DSMES Program

AM Diabetes Centers of America, an independent endocrinology practice in Bartlett, Tennessee, offers a diabetes self-management, education, and support (DSMES) program that has been recognized by the American Diabetes Association (ADA) since 2010. The program typically serves 450-500 participants per year, all from the Memphis/Mid-South area. Per ADA requirements, participants’ pre- and post-program attendance glycated hemoglobin (A1C), weight, blood pressure, and lipids, are reported annually. Of these, A1C was observed as a key metric indicating blood glucose control. Data sets from ADA Chronicle Diabetes were analyzed quantitatively to compare program attendance and A1C reductions between 2013-2019 and the pandemic peak in 2020-2021. From 2013-2018, program attendance grew at an average rate of 26% per year. Attendance dropped by 30% in 2019, but average A1C reduction among participants in 2019 was 0.8%, and average A1C reduction for all participants in 2013-2019 was 0.64% (SD=0.346; p=0.003). In 2020-2021, attendance dropped by an average of 30% per year, and average A1C reduction was only 0.45% (SD=0.05; p=0.035). In the first post-pandemic year, program attendance rebounded by 18% and average A1C reduction was 1.1%. Because a direct correlation exists between waning program attendance and reduced impact upon participants’ A1C levels during COVID-19, and because these trends reversed as soon as pandemic restrictions were lifted, it may be reasonably ascertained that the mandated restrictions on in-person meetings and outside activities were key factors in producing these results. Disclosure K. B. Stoneking: None. K. Latif: None. M. Moore: None. H. White: None.

543-P: A Peer-Led Diabetes Self-Management Education (DSME) and Support (DSMS) Intervention for Black Men with Type 2 Diabetes—Results of a Three-Month Pilot Randomized Clinical Control Trial

Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die from diabetes complications than non-Hispanic White men. To address the unique challenges this group faces in diabetes self-management, we implemented a 3-month peer-led and empowerment-based DSME/S intervention in metro-Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were recruited and randomized to either the intervention group (n=12) − 10 hours of DSME and 9 hours of DSMS, or to an enhanced usual care (EUC) group (n=13) − 10 hours of DSME. Peer leaders (n=3), trained by certified diabetes care and education specialists (CDCES) who used training materials related to Black men with diabetes, led the sessions (mean age: 59.7 years; 100% Black, male, and with at least some college education). Changes in A1C levels, diabetes self-care activities, and diabetes distress levels were assessed at baseline and post-intervention. In the intervention group, the mean A1C at baseline was 7.73%, SD 2.16, and at follow-up, 7.06%, SD 1.39. The EUC group experienced a 0.13% decrease in A1C levels (p = 0.68). Within the intervention group, differences in average diet and blood-glucose testing scores, both measured using the Summary of Diabetes Self-Care Activities (SDSCA) measure, from baseline were statistically significant [(p = 0.03, mean change: 1.32, SD 1.71) and (p < 0.05, mean change: 0.50, SD 0.74), respectively]; EUC group general diet scores were: p = 0.08, mean change: 1.77. Diabetes distress scores among those who attended 1-6 sessions, ≤ 50%, (n=4): p = 0.92, mean change: −0.75, SD 14.06. Of those who attended 7-12 sessions, > 50%, (n=7), the decrease in score was statistically significant: p = 0.003, mean change: −5.71, SD 3.20. Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the program is warranted to measure sustainability. Disclosure A.Ewen: None. K.A.Kloss: None. R.Nwankwo: None. M.M.Funnell: None. G.Piatt: None. J.M.Hawkins: None. Funding National Institute on Aging (2P30AG024824–16); Blue Cross Blue Shield Foundation of Michigan (003063.MG)

The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring.

Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.

An Academic-Community Engagement: A Roadmap for Developing a Culturally Relevant Diabetes Self-Management Program among Vietnamese Americans

Recognizing and addressing culture-specific differences concerning diabetes self-management education and support (DSMES) programs can potentially increase participation among Vietnamese Americans with type 2 diabetes and improve health outcomes. This paper describes the academic-community engagement process used to seek input from the Vietnamese community of Oklahoma to tailor a DSMES program. The Community Engagement Continuum (CEC) (CDC, 2011) was utilized as a conceptual framework to engage with the Vietnamese community. The academic team assembled a community advisory board (CAB) of stakeholders, who were selected to advise the team on intervention development; elicited community feedback; and integrated recommendations to tailor the DSMES program. Twenty-three CAB members participated in a minimum of three community engagement meetings over six months. Meetings were structured to elicit feedback and suggestions to ensure that the tailored program was embedded in Vietnamese cultural practices and accounted for community resources and needs. CAB members identified that education and resources must be provided in the Vietnamese language with special attention to culturally relevant adaptations concerning healthy eating and medication adherence. Application of the CEC framework facilitated the inclusion of Vietnamese community perspectives and beliefs, the identification of potential collaborators, the establishment of trust and relationships, and the development of a culturally relevant DSMES program. This engagement process may serve as a model for other underserved minority populations to develop culturally appropriate health promotion and disease prevention interventions.

Exploring barriers and facilitators to pharmacist-provided diabetes self-management education and support

BackgroundPharmacists have the necessary clinical experience and medication knowledge to effectively provide diabetes self-management education and support (DSMES); however, barriers exist to DSMES implementation by community pharmacists. ObjectiveThe aim of this study is to explore DSMES from the community pharmacists’ perspectives, identify barriers and facilitators to pharmacist DSMES implementation, and guide development of pharmacist-provided DSMES programs in Idaho. MethodsImplementation climate, the theoretical framework for this project, is focused on how community pharmacists in Idaho perceive they will be supported by patients, health care providers, and insurers in DSMES implementation. Pharmacist investigators with qualitative research experience conducted semistructured interviews with 6 licensed community pharmacists from Idaho via Zoom between March and June 2020. Recordings were transcribed verbatim and analyzed using HyperRESEARCH 4.5.1. Themes, patterns, and dominant concepts that emerged from respondents’ about DSMES were explored, labeled, and categorized into modifiable and nonmodifiable barriers and facilitators. This study was granted expedited approval by the Idaho State University Investigational Review Board. ResultsRelevant themes included current scope of practice, barriers, and facilitators. Subthemes related to the current scope of pharmacy practice included unclear roles and responsibilities and legislative constraints to practice. For barriers, subthemes included cost of set-up, billing and coding education, and the sustainability of services based on current reimbursement models. For facilitators, subthemes included the need for additional collaborations (external and internal), technology access, and trained pharmacy staff. ConclusionPharmacists are underutilized health care providers, capable of providing DSMES services if provided the necessary resources. This work identifies barriers and facilitators to pharmacist-led DSMES that can be considered by others when implementing DSMES or other disease management services.

Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes.

The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists' ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.

Informing a Randomized Control Trial in Rural Populations: Adaptation of a Diabetes Self-Management Education and Support Intervention.

BackgroundOver 34 million people in the United States have diabetes, with 1.5 million diagnosed every year. Diabetes self-management education and support (DSMES) is a crucial component of treatment to delay or prevent complications. Rural communities face many unique challenges in accessing DSMES, including geographic barriers and availability of DSMES programs that are culturally adapted to rural context.ObjectiveBoot Camp Translation (BCT) is an established approach to community-based participatory research used to translate complex clinical and scientific information into concepts, messages, and materials that are understandable, meaningful, and relevant to community members and patients. This study aimed to utilize BCT to adapt an existing DSMES program for delivery in rural primary care for English- and Spanish-speaking people with diabetes.MethodsThe High Plains Research Network (HPRN) Community Advisory Council (C.A.C.) partnered with researchers at the University of Colorado and University of Utah to use BCT to aid in translating medical jargon and materials from an existing DSMES program, called “Diabetes One Day (D1D).” BCT consisted of 10 virtual meetings over a 6-month period among the C.A.C., which included 15 diverse community stakeholders. Both English-speaking and bilingual Spanish-English–speaking C.A.C. members were recruited to reflect the diversity of the rural communities in which the adapted program would be delivered.ResultsThe BCT process guided adaptations to D1D for use in rural settings (R-D1D). R-D1D adaptations reflect both content and delivery to assure that the intervention is appropriate and likely to be accepted by rural English- and Spanish-speaking people with diabetes. Additionally, BCT informed the design of recruitment and program materials and identification of recruitment venues. During the BCT process, the importance of tailoring materials to reflect culture differences in English- and Spanish-speaking patients was identified.ConclusionsBCT was an effective strategy for academic researchers to partner with rural community members to adapt an existing DSMES intervention for delivery in rural areas to both English- and Spanish-speaking patients with diabetes. Through BCT, adaptations to recruitment materials and methods, program content and delivery, and supplemental materials were developed. The need to culturally adapt Spanish materials with input from stakeholders rather than simply translate materials into Spanish was highlighted. The importance of increasing awareness of the connection between diabetes and depression or diabetes distress, adaptations to include local foods, and the importance of the relationship between people with diabetes and their primary care practices were identified.

Care Partner Support Following a Diabetes Self-Management Education and Support Intervention.

The purpose of the study was to understand care partner (CP) perceptions of an interdisciplinary diabetes self-management education and support (DSMES) intervention and explore how the interdisciplinary DSMES intervention influences diabetes-specific day-to-day interactions from the CP's perspective. A multiple-methods research design comprised of an online survey including demographics and supportive behaviors and a semistructured interview was conducted. The survey was completed by 16 CPs. Of the 16 CPs, 11 participated in semistructured interviews. Survey data were analyzed using descriptive statistics. Thematic analysis of semistructured interviews was conducted. CPs provided support in 3 primary areas: (1) meal planning and preparation (87.5%), (2) participating in physical activity (56.3%), and (3) assisting with technology (43.8%). The main themes described by CPs include (1) the importance of diabetes education for caregivers, including the information they retained from the program, the acquisition of tools to support the person with diabetes, and the desire for more and ongoing education; (2) diabetes education enhances the CP's ability to provide social support and the challenges associated with support; and (3) partners described collaborative diabetes management such as finding middle ground and making changes together. CPs play a significant role in patient diabetes self-management by providing social support and partnership. DSMES programs should seek to include CPs to enhance patient support.

516-P: A One-Year Curriculum for Diabetes Self-Management Education to Promote Lasting Lifestyle Changes

The use of telehealth for Diabetes Self-Management Education and Support (DSMES) is expanding. There is a need among people with diabetes (PWD) to manage their diabetes, as they represent 20% of ICU admissions, 30% of hospitalized cases and have an increased risk of COVID-related mortality. While people at risk for diabetes or prediabetes may join a 1-year CDC accredited diabetes prevention program to make lifestyle changes to reduce their diabetes risk, PWD are often offered short-term DSMES programs that do not necessarily incorporate long-term goals. We developed a year-long intensive Diabetes Self-Management Education and Support (iDSMES) program combining Virtual Diabetes Conversation Map® and selected modified modules from the PreventT2® curriculum to suit PWD. The curriculum included 18 maps/modules. Our team of certified lifestyle coaches/diabetes educators/Conversation Map® Trainers used shared decision-making and problem-solving approaches to improve glycemic control and diabetes self-management. We hypothesized that iDSMES would improve diabetes outcomes in PWD. Fourteen PWD (12F/2M) with a BMI of 25 or above underwent the iDSMES in a group with their lifestyle coaches using the Zoom® platform. We collected their fasting blood glucose, weight, blood pressure, and physical activity minutes at each session (every three weeks) and assessed their Hemoglobin A1c quarterly. Nine PWD completed the iDSMES and lost an average of 8.8% of their initial body weight (a total of 203lbs) . We observed a 1% decrease in their A1c, 10mg/dL decrease in fasting blood glucose, and mm Hg decrease in systolic and diastolic blood pressure, respectively. There was also a 110-minute increase in their physical activity. A year-long iDSMES distance learning program effectively enhances lasting lifestyle changes to improve diabetes self-management in PWD. A 5-year follow-up is warranted to assess factors affecting the maintenance of accomplished lifestyle changes. Disclosure H.Sallam: None. W.Pan: None. M.L.Ferguson: None. W.Lee: None. K.H.Mckinney: None. H.Serag: None. Funding Texas Department of State Health Services (#HHS000740800001)

IDF21-0099 Development of self-management program with carbohydrate counting for Type 1 Diabetes delivered during Covid-19 pandemic

Background: There is a lack of data on effectiveness of diabetes self-management education and support (DSMES) programs for South Asian adults with type 1 diabetes mellitus (T1DM). Aim: This formative research was conducted to explore existing practices on the said subject and gather information for planning an enhanced usual care (EUC) intervention program. The suggestions were incorporated for the intervention to be delivered especially during Covid-19. Method: We conducted in-depth semi-structured interviews with endocrinologists, dieticians, diabetes educators and adults with T1DM for this qualitative formative research. The participants were selected from a mix of public and private health facilities. Thematic analysis using inductive and deductive approach was undertaken. Results: In total, 28 in-depth interviews were conducted, 18 with health care professionals and 10 with adult individuals with T1DM. The results demonstrated deficiencies in the implementation of a structured self-management program for diabetes owing to several patient and healthcare system-related factors in usual practice. A detailed nutritional counselling was provided at all sites by a qualified dietitian, however, carbohydrate counting was not routinely practiced. The content of this formative research revolved around two broad domains hence explored: (a) evaluation of the existing usual care and gaps in implementation of a structured DSMES program, and (b) development of approaches that will help in formulation of an intervention package and its effective delivery to the participants. Principles of FUSED and COM-B models were also reported to be significant components for the success and refinement of such interventions. During the pandemic, the challenges reported in diabetes management were in maintaining monitoring chart of blood glucose levels due to lack of monitoring strips, procurement of insulin, procurement of diabetes supplies and management of disease condition during acute complications with lack of hospital facilities. Blood sampling was reported to be halted due to complete lockdown and restricted red zones. For effective delivery of such EUC interventions, it was suggested to conduct the sessions via video conferencing apps. Similarly, the follow-ups and reinforcement during this period were suggested to continue via telephonic calls, audio clips, video calls, video clips and SMS modes. As a part, it was suggested to relax blood glucose monitoring, the insulin of same type but different brands were suggested to be prescribed among choices available in local area and other mentioned challenges were suggested to be continuously looked after and provide timely advice for the same emphasizing sick day rules. Further, it was suggested to get the blood tests performed from reliable (accredited) labs at the recommended intervals. Discussion: This research study comprehensively investigated the existing practices among diabetes-health care professionals caring for persons living with T1DM, deficiencies in carbohydrate counting meal-planning technique and rendered insights towards development of a scientific DSMES program.

Identifying factors affecting diabetes education program participation within a metro Detroit integrated health system

Diabetes self-management education and support (DSMES) can help people achieve optimal disease control, yet these services often remain underutilized. People referred to these programs by their provider can become disengaged in the program at several key steps. This study applies Classification and Regression Tree analysis to 3796 people with diabetes at a single health system based in the Detroit metropolitan area who were referred for DSMES provided by the health system to determine demographic patterns of those who were successfully contacted to schedule program intake appointments, those who did not attend their intake appointment, and those who began but did not complete their personalized DSMES program. White people > 43 years of age, those with a prior A1C value > 8.9 and those with Medicaid insurance had the highest rate of not being successfully contacted for their intake appointment. Those who did not attend their intake appointment tended to have Medicaid insurance, be younger than 48 years, and have A1C > 8.1. Within the Medicare or private insurance groups, those who did not attend were more likely to be female, of Black race and not partnered. Older males with a lower A1C (≤8.3%) had the lowest rate (34.0%) of failing to complete their DSMES plan. The data showed that almost half of those referred were not successfully contacted. The overall low completion rate of 13.2% confirms the need to examine factors predictive of participation and completion. This study highlights process improvement changes to improve personalization of outreach and engagement.

The Effect of Modified Diabetes Self-management Education and Support on Self-care and Quality of Life among Patients with Diabetic Foot Ulcers in Rural Area of Indonesia

BACKGROUND: Diabetes self-management education and support (DSMES) programs are patient-centered, holistic solution that enables it one of the best approaches for improving medication adherence enhanced coping, empowerment and self-efficacy, quality of life (QoL), and lower rates of depression, in people with type 2 diabetes mellitus (T2DM). In isolation, DSME strategies have not shown significant improvements to self-care and/or reduction of diabetic foot ulcer (DFU). AIM: This study sought to determine the effect of modified DSMES on self-care, DFU severity, and QoL in rural Indonesian patients with DFUs. METHODS: A quasi-experimental design with pre-test and post-test control group design, in Singkawang, West Kalimantan, Indonesia, with a total sample of 60 patients consisting of 30 patients in the intervention group and 30 patients in the control group. The DSMES has been adapted to cover 2 h of content for a period of 8 weeks and the eight-core components of DSMES. The curriculum was culturally adapted revised to incorporate culturally appropriate nature similarities, such as a prominent change to represent changes in glucose counts; to incorporate photos; to incorporate culturally relevant eating habits, such as fish and fruit; to communicate in detail the significance of medication adherence, with an emphasis on metformin’s organic, plant-based characteristics; and to emphasize engagement. Intention-to-treat analyses were conducted to determine the effect of modified DSMES on self-care, DFU severity, and QoL. RESULTS: The DSMES program improved outcomes in three of the three outcome indicators when compared to the control group at T1: In this study, (1) the DFU degree increased by 3.3% points (95% confidence interval [CI]: 0.018–0.194), (2) the diabetes foot self-care behavior score increased by a modest 8.8% points (95% CI: 0.021–0.203), and (3) the QoL increased by 32.7% points (95% CI: 00.075–0.689). The degree of DFU (difference-in-difference [DID] coef. 0.350, 95% CI 0.084–0.572), diabetes foot self-care behavior (DID coef. 0.085, 95% CI 0.065–0.405), and QoL (DID coef. 0.343, 95% CI 0.078–0.436) are all still significantly improved compared to the control at T2. CONCLUSION: The primary outcome analyses indicate that the adapted DSMES was more effective than standard care at improving self-care and QoL and decreasing DFU degree in this sample of Indonesians with DFU, both immediately after and 3 months after the intervention. As nurse educators, it is our responsibility to ensure that we evaluate all of the support options accessible to the patients in our care.

The Effects of Diabetes Self-Management Education and Support Program in Thailand: A Systematic Review and Meta-Analysis

Background: Diabetes is a growing health problem worldwide. Diabetes self-management education and support (DSMES) program is a crucial component in promoting self-care in all people with diabetes. However, the practice in certain countries, including Thailand, is not yet standardized, thus the effectiveness of such program is unknown. Objective: To evaluate the effectiveness of DSMES in Thailand. The outcomes were glycemic control, lipid levels, body mass index (BMI), quality of life (QoL), and diabetes knowledge. Materials and Methods: The authors searched PubMed, Scopus, and ProQuest databases since their inception until March 2019 for randomized controlled trials conducted in Thailand that evaluated outcomes of DSMES programs. Meta-analyses were performed to pool mean differences (MD) of the outcomes. Results: Seven studies, with 1,523 participants, were included. DSMES programs were conducted in different healthcare settings by health professionals from multiple disciplines. The results revealed that participants receiving DSMES had significantly lower hemoglobin A1c, MD –0.66% (95% CI –0.90 to –0.42), and FBG levels, MD –15.88 mg/dL (95% CI –20.95 to –10.79), than those who did not. Lipid levels, BMI, QoL, and diabetes knowledge, however, did not significantly differ. Conclusion: Meta-analysis results showed that DSEMS is effective in improving glycemic control and should be promoted to combat the burden of this important health problem in Thailand. Keywords: Diabetes self-management education and support; DSMES; Glycemic control; Meta-analysis; Thailand

466-P: Cultural Adaptation of a Diabetes Self-Management Education and Support Telehealth Intervention for Rural Colorado

Diabetes impacts rural populations at higher rates compared to their urban counterparts. Diabetes self-management education and support (DSMES) is an evidence-based standard of care for people with diabetes. Yet, in rural areas, DSMES is often not available, culturally relevant, or integrated into primary care practices where many people receive diabetes care. This study uses a community-based participatory research (CBPR) approach to adapt the language, tools, and delivery of a DSMES program for use in Spanish and English-speaking populations in the High Plains Research Network in rural eastern Colorado. Boot Camp Translation (BCT) is a CBPR method that combines medical, research, and local community member expertise to create locally relevant language, messages and materials to promote discussion and action around a medical condition. For this study, community partners included 13 diverse community members (including bilingual Spanish-speakers, patients, caregivers, and healthcare providers). The group identified a particular need to increase awareness of the connection between diabetes and mental health, specifically depression, and diabetes burnout. Language and tools to address stigma and normalize the connection, talking points to initiate discussions with care teams, and calls for practices to increase screening for depression among patients with diabetes, are under development. Additional themes identified include incorporating nutrition information for food that is culturally appropriate and locally available, and integrating DSMES within the primary care practices where people with diabetes receive their care. Community engagement is crucial to support DSMES program adoption in rural communities. Disclosure T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. B. Kwan: None. J. Neuberger: None. K. Curcija: None. S. Burke: None. L. K. Zittleman: None. J. S. Simonetti: Consultant; Self; Rhythm Pharmaceuticals, Research Support; Self; Rhythm Pharmaceuticals . Funding National Institute of Nursing Research; National Institutes of Health (1R56NR019466-01)

474-P: Durable Reductions in A1C and Diabetes Distress with a One-Day Hybrid DSMES Intervention

The effectiveness of time efficient diabetes self-management education and support (DSMES) interventions that include both group and individual sessions is lacking. This study tested the impact of the Diabetes One-Day Education and Care (D1D) Program on A1C and diabetes distress.D1D is an 8-hour DSMES hybrid (group and individual sessions) program delivered by an interdisciplinary team. Group sessions focused on the AADE7 self-care behaviors and included an interactive lunch with chef demonstration. Three 30-minute individual session were with a nurse practitioner/endocrinologist, pharmacist, dietitian, nurse, and/or exercise specialist. A1C and diabetes distress were collected at baseline, 3- and 6-months.Participants (N=213) were 59% female, 85% White, with an average age of 56.4±16 years and average diabetes duration of 11.7±11.3 years. Most participants had type 2 diabetes (80%). Compared to baseline (8.2% ±2.1), A1C levels were significantly lower at 3-months (7.6±1.6%, p<.001) and 6-months (7.6±1.5%, p=.001). Compared to baseline (60.8 ±20.3), diabetes distress levels were significantly lower at 3-months (-11.3, p<001) and 6-months (-10.30, p<001).D1D is a one-day hybrid DSMES program that demonstrated durable reductions in A1C and diabetes distress.View largeDownload slideView largeDownload slide DisclosureM. L. Litchman: Research Support; Self; Abbott Diabetes. S. Fisher: None. X. Wang: None. R. K. Delaney: None. J. Neuberger: None. A. Reeder: None. S. R. Jones: None. J. S. Simonetti: Consultant; Self; Rhythm Pharmaceuticals, Research Support; Self; Rhythm Pharmaceuticals . M. Wahl: None. A. Fagerlin: None.FundingLarry H. & Gail Miller Family Foundation

Factors Predicting Adequate Glycemic Control after Participation in Diabetes Self-Management Education and Support Program: The Role of Behavioral Change

Objective: To explore the predictors of achieving adequate glycemic control at a 6-months follow-up in patients with type 2 diabetes (T2D) who participated in the diabetes self-management education and support (DSMES) program. Materials and Methods: A retrospective cohort study of T2D patients who completed the DSMES program (an initial visit and a 3-month follow-up) at Ramathibodi Hospital between 2014 and 2017 was conducted. Behavioral goals were set at the initial visit and whether these were achieved by the patients was assessed at a 3-month follow-up. Diabetes history, baseline, and 6-month hemoglobin A1C (HbA1c) values were collected. Multiple logistic regression analyses were performed to determine independent predictors of adequate glycemic control at 6-month, defined as HbA1c of less than 7% or less than 7.5% in those younger than 65 years or those 65 years or older, respectively. Results: Ninety-two patients were included, with a mean (SD) age 60.7 (10.9) years, an average diabetes duration of 9.1 (9.5) years and 51.1% were using insulin. Seventy-six patients (82.6%) reported that they achieved behavioral goals as set at the initial visit, and 56.5% had adequate glycemic control at 6-month. Multiple regression analysis adjusting for age, baseline HbA1c, and insulin use revealed that behavioral goal achievement at three months was independently associated with HbA1c achievement at six months (OR 3.473, 95% CI 1.005 to 12.001), while higher baseline HbA1c was associated with a lower likelihood of achieving adequate glycemic control (OR 0.727, 95% CI 0.540 to 0.979). Conclusion: Behavioral goal achievement was an independent predictor of adequate glycemic control in participants of the DSMES programs, suggesting that adherence to behavioral changes can improve clinical outcomes. Goal setting skills should be adopted by diabetes educators and incorporated as a key part of DSMES process. Keywords: Factors predicting glycemic control, Diabetes self-management education, Behavioral goal achievement, Diabetic educators

Early Insights From a Digitally Enhanced Diabetes Self-Management Education and Support Program: Single-Arm Nonrandomized Trial.

BackgroundTranslation of diabetes self-management education and support (DSMES) into a digital format can improve access, but few digital programs have demonstrated outcomes using rigorous evaluation metrics.ObjectiveThe aim of this study was to evaluate the impact of a digital DSMES program on hemoglobin A1c (HbA1c) for people with type 2 diabetes.MethodsA single-arm, nonrandomized trial was performed to evaluate a digital DSMES program that includes remote monitoring and lifestyle change, in addition to comprehensive diabetes education staffed by a diabetes specialist. A sample of 195 participants were recruited using an online research platform (Achievement Studies, Evidation Health Inc). The primary outcome was change in laboratory-tested HbA1c from baseline to 4 months, and secondary outcomes included change in lipids, diabetes distress, and medication adherence.ResultsAt baseline, participants had a mean HbA1c of 8.9% (SD 1.9) and mean BMI of 37.5 kg/m2 (SD 8.3). The average age was 45.1 years (SD 8.9), 70% were women, and 67% were White. At 4-month follow up, the HbA1c decreased by 0.8% (P<.001, 95% CI –1.1 to –0.5) for the total population and decreased by 1.4% (P<.001, 95% CI –1.8 to –0.9) for those with an HbA1c of >9.0% at baseline. Diabetes distress and medication adherence were also significantly improved between baseline and follow up.ConclusionsThis study provides early evidence that a digitally enhanced DSMES program improves HbA1c and disease self-management outcomes.

Validation of newly developed culturally specific diabetes self-management education and support program for Iraqi type 2 diabetes mellitus patients.

BACKGROUND:Diabetes self-management (DSM) is the cornerstone in diabetes mellitus (DM) management. Unfortunately, the practice of DSM by Iraqi type 2 DM (T2DM) patients is poor that mainly resulted from their poor knowledge about the required DSM behaviors. This lack of knowledge may be attributed to the lack of DSM education and support (DSMES) program in Iraq. Thus, this study was conducted with aim of developing and validating a culturally specific DSMES program for Iraqi T2DM patients.MATERIALS AND METHODS:The development and validation of the DSMES program was done according to the Hilda Taba model. Content validity of the program was done by a panel of 6 health-care experts in management of Iraqi DM patients. Face validity was confirmed by conducting a pilot study for six adults with uncontrolled T2DM at the National Diabetes Center, Baghdad, Iraq. Both the experts and patients were asked to evaluate the developed program in regard to its contents, design, and supporting material (booklet). The evaluation was done by filling in a questionnaire that based on a 5-point scale. Items with a score ≥4 by <70% of the experts and patients were subjected to revision and further assessment.RESULTS:No total disagreement for any item was expressed by all participants (experts and patients). Content and face validity was ensured through obtaining a positive feedback from all participants at which all items about the program had scores of ≥4 by at least 75% of participants.CONCLUSION:The developed culturally based DSMES program is highly suitable for educating Iraqi T2DM patients.

623-P: Phone-Based Diabetes Education Improves Diabetes Knowledge and Patient–Provider Conversations

Diabetes education and support has been shown to effectively improve health outcomes among people with type 2 diabetes (PWD). However, PWD report limited time with healthcare providers (HCPs) to have meaningful discussions about diabetes management and prevention of complications. Less than half of PWD have ever had a conversation with their HCP about their increased risk for heart attack and stroke. In addition, evidenced-based diabetes self-management education and support programs (DSMES) are considerably underutilized. A phone-based education series was created to connect PWD across the country with a new diabetes expert each month. Through the platform, listeners can ask their questions, hear the questions of others, and receive live responses. The program aims to increase knowledge of diabetes management, improve patient-provider conversations, and drive enrollment into DSMES. To assess the program’s impact, phone-based surveys were conducted one day prior to events, immediately following, and one-month post events. From November 2018 to November 2019, each event averaged 509 participants, with over 2,700 unique participants across all events. Wilcoxon signed-rank tests were performed to determine paired differences. Across events, diabetes-related knowledge increased 12% on average from before events to after events. Within a month following the program, 14% more participants had a conversation with their HCPs about the link between heart disease and diabetes. In addition, the percent of participants who enrolled in DSMES increased 10%. The evidence demonstrates that a phone-based platform provides an effective avenue for increasing diabetes knowledge and empowering PWD to have better conversations with their HCPs. The platform can serve as an important resource for reaching populations that face barriers in access to diabetes care and support. Short recordings from the live events are created into a free podcast series, further expanding program reach. Disclosure R. Woolley: Employee; Self; American Diabetes Association. Z. White: Employee; Self; American Diabetes Association. S. Robinson: Employee; Self; American Diabetes Association. J. Mandelson: Employee; Self; American Diabetes Association. K. Mueller: None.