Diabetes Self-management Education And Support Research Articles

Could Online Education Replace Face-to-Face Education in Diabetes? A Systematic Review.

Diabetes Self-Management Education and Support (DSMES) is a critical component of diabetes care. This study aims to examine the effect of online-based educational interventions on diabetes management compared to face-to-face interventions. A systematic review was conducted by searching three databases for studies in English or Spanish between December 2023 and March 2024. The inclusion criteria were studies that compared face-to-face DSMES with online interventions. The follow-up duration of the trials ranged from 1 to 12months. Multidisciplinary teams delivered online DSMES through various means, including Short Message Service (SMS), telephone calls, video calls, websites, and applications. Online DSMES was found to be comparable to face-to-face interventions in terms of glycated hemoglobin (HbA1c) levels in people with type 1 diabetes (T1D). In contrast, online interventions that focus on weight management in people with type 2 diabetes (T2D) have shown a significant reduction in HbA1c compared to face-to-face interventions. Online DSMES was found to be superior in terms of quality of life and cost-effectiveness in both T1D and T2D. None of the analyzed studies explored the differences between individual and group methodologies. The current evidence indicates that online DSMES services provide at least comparable biomedical benefits to face-to-face interventions, suggesting that online interventions could be incorporated into clinical practice as a complement or reinforcement. However, further research is needed to explore the potential benefits and effectiveness of online group sessions in DSMES.

Implementation rate of diabetic self-management education and support for Japanese people with diabetes using the National Database.

People with diabetes are encouraged to receive diabetes self-management education and support (DSMES) appropriately. However, in Japan, the implementation rates of DSMES are not known. DSMES implementation rates were calculated using the National Database of claims data, which included nearly all insurance-covered medical procedures. The study enrolled participants who received regular antidiabetic medications between April 2017 and March 2018. The implementation rates of DSMES-related care were calculated by characteristics, visiting medical facilities and prefectures. In 4,465,513 participants receiving antidiabetic medications (men, 57.8%; insulin use, 14.1%), nutrition guidance (5.6%) was the most frequently provided care type. Insulin users and participants visiting Japan Diabetes Society-certified and large medical institutions had higher implementation rates of nutrition guidance. DSMES-related care might not be provided adequately for Japanese people with diabetes. Further studies are needed to develop an optimal diabetes care system.

Identifying individual social needs during intake for diabetes Self-Management education and support services in the Detroit, Michigan area

The American Diabetes Association has recommended that diabetes self-management education and support (DSMES) teams improve diabetes outcomes by identifying and responding to patients’ social needs. This study examines demographic patterns in how hemoglobin A1c (A1c) is related to individual social needs, reported urgency of those needs, and interest in obtaining assistance. A total of 1125 unique persons who had been referred for DSMES and had completed a social needs screener via our electronic medical record were included. The majority (51.9 %) had an A1c < 8 % at their most recent assessment and most respondents (52.5 %) reported having at least 1 unmet social need (n = 591), Those who reported having at least 1 social need, tended to have higher A1c levels compared with those who reported no social needs (median of 8.0 % versus 7.7 %; p < 0.05). Among Black individuals the associations were stronger (median A1c of 8.2 % among those with versus 7.2 % among those without a reported social need; p < 0.05). However, among White individuals, there was no difference in A1c between these two groups. Among those who reported a social need, those who also reported they needed assistance (35.7 %) tended to have higher A1c levels than those who did not (median 8.3 % versus 7.8 %; p < 0.10). This relationship did not vary by race. Ongoing study of the relationship between unmet social needs and glycemic control is warranted to help identify effective clinical workflows to help providers incorporate consideration of social needs into their medical decision making.

The Effect of Diabetes Self-management Education Provided by Certified Diabetes Educator Compared to Usual Diabetes Education on Glycemic Level and Stage of Behavior Change in Adult with Types 2 Diabetes Mellitus

Objective: To explore the effect of diabetes self-management education and support (DSMES) provided by Siriraj certified diabetes educators (CDE) compared to usual diabetes education (DE) on glycemic level and stage of behavior change in patients with type 2 diabetes mellitus (T2D). Materials and Methods: Patients with T2D having A1C 8-12% were recruited between 2019-2020 to receive DSMES from CDE. Patients received the usual DE from healthcare professionals in 2016 were randomly selected from their medical records. Results: 76 patients were enrolled in each group. Mean±SD age was 59.4±11.5 years. After receiving DSMES and DE, A1C decreased dramatically at 3 months in both groups without significant difference between the groups (9.4±1.1% to 8.0±1.2% vs. 9.5±1.1% to 8.1±1.5%, respectively). However, the DEMES group can further decrease A1C to 7.8±1.2% while A1C in the usual DE group increased to 8.5±1.6% at 12 months (p=0.028). In the DSMES group, most patients can move to the next stage of behavior change and reported a better QOL (89.4±11.6 vs. 92.6±12.2, p=0.018). Conclusion: The receipt of DSMES from CDE significantly improved the level of A1C, the stage of behavior change, and QOL. Its benefit on the glycemic level can last at least one year.

Exploring Technology's Influence on Health Behaviours and Well-being in Type 1 Diabetes: a Review.

Maintaining positive health behaviours promotes better health outcomes for people with type 1 diabetes (T1D). However, implementing these behaviours may also lead to additional management burdens and challenges. Diabetes technologies, including continuous glucose monitoring systems, automated insulin delivery systems, and digital platforms, are being rapidly developed and widely used to reduce these burdens. Our aim was to review recent evidence to explore the influence of these technologies on health behaviours and well-being among adults with T1D and discuss future directions. Current evidence, albeit limited, suggests that technologies applied in diabetes self-management education and support (DSME/S), nutrition, physical activity (PA), and psychosocial care areas improved glucose outcomes. They may also increase flexibility in insulin adjustment and eating behaviours, reduce carb counting burden, increase confidence in PA, and reduce mental burden. Technologies have the potential to promote health behaviours changes and well-being for people with T1D. More confirmative studies on their effectiveness and safety are needed to ensure optimal integration in standard care practices.

Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: the CUT-DM with CGM for Latinx randomised controlled trial study protocol

IntroductionThe prevalence of type 2 diabetes (T2D) is increasing in the Latinx community. Despite telehealth and technology becoming more available, these resources are not reaching the Latinx population. Diabetes education...

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis.

Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks. This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme. Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks. The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad. Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.

Effects of family-based diabetes self-management education and support programme on support behaviour amongst adults with type 2 diabetes in Western Ethiopia

Support from family and peers may enhance the outcomes of diabetes management. This study reported the preliminary effect of a family-based diabetes self-management education and support (DSMES) programme on the perceived support status of people with diabetes and the family’s caregiver support behaviour amongst dyads living in Western Ethiopia. A 1:1 two-armed pilot randomised controlled trial (RCT) was conducted. A total of 76 dyads were recruited using the convenience sampling method and randomly assigned to either intervention or control groups. The control group continued the usual care, whereas the intervention group continued the usual care and additionally received a 12-h social cognitive theory (SCT)-guided, family-supported DSMES programme in the community. Generalised estimating equations models were computed to test the preliminary effects of the DSMES programme on the outcomes. P-value < 0.05 was set as statistically significant. The pilot RCT shows a statistically significant between-group difference in the changes in support needed at T1 (d = 0.88) and T2 (d = 1.35) and support received at T1 (d = 0.88) and T2 (d = 1.44). The DSMES programme has outperformed usual care with a medium effect size at T1 (d = 0.54) and a large effect size at T2 (d = 0.97) on the family’s supportive behaviour. Although the intervention group was not statistically significant at T1 (d = 0.43), a large effect size was obtained at T2 (d = 0.97) on the family’s non-supportive behaviour. A SCT-guided, family-supported DSMES programme produced a promising positive effect on enhancing the support needed and support received from their family/friends, and it also improved the family’s supportive behaviour. Thus, family support could be incorporated into DSMES programmes for diabetes management in Western Ethiopia. The trial was registered by the Chinese Clinical Trial Registry (http://www.chictr.org.cn); Registration number: ChiCTR2000040292.

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.

Understanding how self-management education and support programmes for type 2 diabetes are expected to change behaviour: A document analysis of two programmes.

Attendance at diabetes self-management education and support (DSMES) programmes for type 2 diabetes is associated with positive outcomes, but the impact on some outcomes is inconsistent and tends to decline over time. Understanding the active ingredients of effective programmes is essential to optimise their effectiveness. This study aimed to (1) retrospectively identify behaviour change techniques (BCTs), mechanisms of action (MoAs) and intervention functions in two DSMES programmes, the Community-Oriented Diabetes Education and the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed and (2) examine variation in content between programmes. A multiple case study approach, including a documentary analysis of the programme materials, was conducted. Materials were coded using the BCT Taxonomy v1, the Mode of Delivery Ontology v1 and the Intervention Source Ontology v1. The Behaviour Change Wheel guidance and the Theory and Techniques tool were used to identify intervention functions and MoAs. Programme stakeholders provided feedback on the findings. Thirty-four BCTs were identified across the programmes, with 22 common to both. The identified BCTs were frequently related to 'goals and planning', 'feedback and monitoring' and 'natural consequences'. BCTs were linked with 15 MoAs, predominantly related to reflective motivation ('beliefs about capabilities' and 'beliefs about consequences') and psychological capability ('knowledge'). BCTs served six intervention functions, most frequently 'education', 'enablement' and 'persuasion'. Although both programmes included several BCTs, some BCTs were rarely or never used. Additional BCTs could be considered to potentially enhance effectiveness by addressing a wider range of barriers.

Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: a convergent mixed methods study.

To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity. This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES and dietitian visits. Feasibility benchmarks assessed were acceptability (> 50 % participants satisfied), demand (> 50 % used program components) and implementation (75 % adherence, 80 % retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants and key staff. Enrollment, recruitment and retention rates were summarised; qualitative data were analysed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display. Food bank and Federally Qualified Health Center in the Southwestern U.S. English- or Spanish-speaking adults with T2DM and food insecurity. In total, 247 patients with T2DM and food insecurity were recruited, seventy-one expressed interest and twenty-five consented. Twenty-one participants completed study measurements. 71 % (n 15) received six home food deliveries and ≥ 1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion - most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g. timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention. The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.

COVID-19 Impact Predicts Diabetes Distress Among Individuals With Type 2 Diabetes.

The purpose of this study was to determine whether COVID-19 impact and Diabetes Self-Management Education and Support (DSMES) service attendance predicted diabetes distress among individuals with type 2 diabetes during the pandemic. Eighty-six adults with type 2 diabetes who either attended (n = 29) or did not previously attend (n = 57) DSMES services completed a cross-sectional survey. Participants' mean age was 57 ± 12.3 years, 50% were female, and 71.3% were diagnosed with diabetes >5 years. The Coronavirus Impact Scale was used to measure impact of the pandemic on daily life. The Diabetes Distress Scale was used to measure distress overall and within 4 subscales (emotional burden, interpersonal distress, physician-related distress, regimen distress). Separate multiple linear regressions were conducted for each outcome, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis. Higher COVID-19 impact predicted higher diabetes-related distress for all subscales and overall. Only the subscale for interpersonal distress was predicted by DSMES attendance, which decreased with DSMES attendance. This study identifies a link between the effects of the COVID-19 pandemic and diabetes distress. The findings highlight the negative impact of the pandemic on diabetes distress and the importance of DSMES services for diabetes-related distress. Interventions are needed to reduce psychological distress among this population during public health crises.

Promoting Diabetes Self-Management in a Psychiatric Hospital.

Type 2 diabetes and psychiatric illnesses have a bidirectional association, influencing each other in direct but independent ways. People with psychiatric illnesses are more likely than the general population to develop type 2 diabetes, in part because antipsychotic medications affect the metabolic system, disrupting glucose metabolism, and also because they lack diabetes self-management education and self-care skills. This study assessed the effectiveness of diabetes self-management education and support (DSMES) in patients with mental illness and diabetes using the Diabetes Self-Management Questionnaire. Analysis of paired responses to the pre- and post-DSMES survey questions showed a statistically significant increase in diabetes self-management knowledge after participation in the education sessions. These results emphasized the importance of DSMES in strengthening patients' knowledge and skills, with additional support from their psychiatrist and medical team.

117-OR: Provider Perspectives on Diabetes Education for Emerging Adults (EAs)

Emerging adulthood, the developmental stage between 18 to 25 years, is a critical time when individuals with type 1 diabetes mellitus (T1DM) assume self-care responsibility and transfer to adult care. Current diabetes self-management education and support (DSMES) has been cited for not meeting the needs of EAs. Models addressing this problem need to be explored. This study was designed to gain perspectives on current DSMES delivery from DM providers. Methods: Health care professionals (HCPs, n=52, 40% endocrinologists, 34% diabetes care and education specialists) who provide adult care to EAs with T1DM completed an online survey designed to gain insights on the provision of DSMES to EAs. Results: Most HCPs (60%) were unsure or disagreed that EAs with T1DM received sufficient DSMES while in pediatric care. 74% felt strongly that their patients had not received adequate education to successfully transfer to adult care. In terms of frequency of DSMES, when asked 52% HCPs answered at every visit, 35% said annually, and 13% when a change in care was identified. Most HCPs (80%) agreed that one-to-one, in person visits are the best format for DSMES, but also agreed that telehealth (73%) could be used to augment DSMES delivery. Interestingly, 93% HCPS agreed that there was a role for a peer support. In considering use of CGM data and self-management, uniformly HCPs (99%) felt confident in their ability to interpret CGM data and reported reviewing downloads with EA at every visit (98%), however HCPs (92%) were not confident that EAs can self-manage diabetes in response to their CGM data. Conclusion: Efforts to engage EAs for improved participation in DSMES need to be explored for effective self-management. Disclosure N. Mehrotra: None. J.S. Krall: Research Support; Sanofi, Becton, Dickinson and Company. J. Ng: Research Support; Sanofi-Aventis U.S. L.M. Siminerio: Advisory Panel; Abbott. Research Support; Becton, Dickinson and Company, Sanofi.

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 &amp;lt; 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, &amp;gt; 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)

566-P: SEE-Diabetes in a Different Light—Content Validation of a Patient-Centered Diabetes Self-Management Education Aid for Older Adults

Diabetes self-management education and support (DSMES) is a significant component of diabetes care. However, our previous study indicated a lack of patient-centered DSMES during clinic visits. Therefore, we developed a patient-centered DSMES education aid named SEE-Diabetes (Support-Engage-Empower-Diabetes) to facilitate providers and patients in making shared decisions (Figure 1). We aimed to validate the content of SEE-Diabetes by interviewing 11 diabetes patients aged 65 and older, and 8 providers. Participants were asked to evaluate SEE-Diabetes statements incorporated in the Patient Education section by answering focused questions. The participants were asked if the statements were easy to read, helpful, and if they provided additional value to address the concerns, needs, and preferences of older people with diabetes. They were also asked if they would use SEE-Diabetes to improve their diabetes care. Thematic analysis revealed most participants agreed that it was easy to read and understand. Most of them found it very helpful, added value to the clinic note, and would use it to help take care of their diabetes. However, one patient shared it was unnecessary for long-term diabetes patients. Some providers shared concerns about lack of time. Future studies will evaluate the usability and feasibility of SEE-Diabetes as an educational tool in clinical practice. Disclosure S.Dejhansathit: None. P.Narindrarangkura: None. M.A.Day: None. S.A.Boren: None. U.Z.Khan: None. E.J.Simoes: None. M.Kim: None.

37-LB: Impacts and Influencing Factors of an Internet-Supported Diabetes Management Program in Beijing

Purpose: The aim of the study is to examine the impact of an Internet supported diabetes management program and to analyze the influencing factors of the improvement. Methods: The Internet Diabetes Shared Care Program (IDSC) in Peking University Shougang Hospital was an application of DSMES (Diabetes Self-Management Education and Support) with Internet technologies. Interdisciplinary care team including diabetologist, nurses, dietitians and diabetes educators provide individualized consultation in hospital every 3 months, and continuous online lifestyle coaching via smartphone applications. Change of (HbA1c), BP, LDL-c, BMI at baseline and at last visit were compared. Multiple linear regression analysis were applied to analyze the data. Results: Total of 349 patients (female 51%) were enrolled from 2018 to 2022 with average age 56.98±10.61 years, duration of DM 9.59±8.23 years. Patients were followed in the IDSC program for 1.78±0.90 years. At baseline, 41.8% used insulin. After the program. the HbA1c decreased 1.29±2.22%(8.41±2.23% vs 7.12±1.30%, t=10.32, P=0.000), BMI decreased 0.43±2.50 kg/m2(25.98±3.99kg/m2 vs 25.56±3.83 kg/m2, t=3.10, P=0.002). Multiple linear regression found and patient age (β=-0.036, P=0.001), followed duration (β=-0.349, P=0.004), baseline HbA1c achieved ≤7% (β=-2.477, P=0.000) and weekly communication with diabetes educators (β=0.828, P=0.013)were the impact factors for glycemic improvement. Conclusion: The Internet supported diabetes management program significantly improved the glycemic control of DM patients, in which age, weekly communication and continuous care are essential factors for glycemic improvements. Disclosure Y. Wu: None.

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.

Feasibility and Preliminary Behavioral and Clinical Efficacy of a Diabetes Education Chatbot Pilot Among Adults With Type 2 Diabetes.

Diabetes self-management education and support (DSMES) improves diabetes outcomes yet remains consistently underutilized. Chatbot technology offers the potential to increase access to and engagement in DSMES. Evidence supporting the case for chatbot uptake and efficacy in people with diabetes (PWD) is needed. A diabetes education and support chatbot was deployed in a regional health care system. Adults with type 2 diabetes with an A1C of 8.0% to 8.9% and/or having recently completed a 12-week diabetes care management program were enrolled in a pilot program. Weekly chats included three elements: knowledge assessment, limited self-reporting of blood glucose data and medication taking behaviors, and education content (short videos and printable materials). A clinician facing dashboard identified need for escalation via flags based on participant responses. Data were collected to assess satisfaction, engagement, and preliminary glycemic outcomes. Over 16 months, 150 PWD (majority above 50 years of age, female, and African American) were enrolled. The unenrollment rate was 5%. Most escalation flags (N = 128) were for hypoglycemia (41%), hyperglycemia (32%), and medication issues (11%). Overall satisfaction was high for chat content, length, and frequency, and 87% reported increased self-care confidence. Enrollees completing more than one chat had a mean drop in A1C of -1.04%, whereas those completing one chat or less had a mean increase in A1C of +0.09% (P = .008). This diabetes education chatbot pilot demonstrated PWD acceptability, satisfaction, and engagement plus preliminary evidence of self-care confidence and A1C improvement. Further efforts are needed to validate these promising early findings.

Factors Associated With Receipt of Diabetes Self-Management Education and Support for Type 2 Diabetes: Potential for a Population Health Management Approach.

Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020. In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt. Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not. Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.