Diabetes Self-management Education Delivery Research Articles

State health departments leverage pharmacy partnerships across the nation to advance diabetes care initiatives

BackgroundIn 2018, the Centers for Disease Control and Prevention (CDC)’s Division of Diabetes Translation (DDT) initiated a 5-year cooperative agreement funding opportunity with departments of health in every state and the District of Columbia. The funded recipients pursued activities that strengthened diabetes management and type 2 diabetes prevention interventions within their jurisdictions. An option to involve the pharmacy sector in their diabetes-related interventions was available. ObjectivesThis research aims to understand who public health departments partnered with in the pharmacy sector and identify the types of activities pursued together to expand access to diabetes-related interventions. MethodsA review of annual work plans and progress reports submitted to CDC by recipients during the first 4 years of the funding cycle was conducted. Descriptions of work conducted in partnership with pharmacies, pharmacists, or pharmacy organizations were flagged for review, coding, and analysis. ResultsOf the 51 public health department recipients, 48 collaborated with pharmacy partners within their jurisdictions. Activities were developed and carried out in ways that utilized the pharmacy workforce to support public health diabetes initiatives, such as the development and delivery of diabetes self-management education and support and type 2 diabetes prevention programs in pharmacies (68.8%), delivery of diabetes-related training for the pharmacy workforce (91.7%), and support of billing and sustainability efforts for pharmacy-based diabetes services (52.1%). ConclusionState public health department diabetes program personnel cultivated productive relationships with a variety of members of the pharmacy workforce. Through these partnerships, they leveraged one another's resources, expertise, and mutual determination to prepare and carry out diabetes-related interventions within their states. This document provides pharmacists and pharmacy decision-makers with foundational knowledge that can lead to increased engagement with public health partners to expand diabetes management and prevention services in pharmacy settings.

Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study.

The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.

Diabetes self-management education for adults with type 2 diabetes via telehealth in conjunction with remote patient monitoring: a best practice implementation project.

The purpose of this evidence implementation project was to promote evidence-based practices regarding the delivery of diabetes self-management education via telehealth in conjunction with remote patient monitoring within the University of Mississippi Medical Center, Center for Telehealth. Diabetes self-management education plays a critical role in supporting self-care behaviors that can improve glycemic control, but certain patient populations have poor access to this service. Telehealth offers an innovative approach to addressing geographical and socioeconomic barriers to diabetes self-management education. This evidence implementation project used the JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) framework for promoting evidence-based healthcare. A baseline audit was conducted to identify areas of strengths where best practices were already being implemented and areas of opportunity for improvement. The project team aligned on practical and sustainable interventions for delivering optimal diabetes self-management education via telehealth. Postimplementation audits were conducted to determine success of the interventions. Baseline audits revealed an average compliance of 47.7% with five best practices for diabetes self-management education for adults with type 2 diabetes via telehealth. After strategies to improve compliance were implemented, compliance improved to 80%. The objectives of this project were realized. The team was able to promote evidence-based practices regarding the delivery of education via telehealth in conjunction with remote patient monitoring, as evidenced by a measurable improvement in adherence to best practices. The primary intervention focused on individualization of education based on patient-specific needs.

Effects of Nurse-Led diabetes Self-Management education on Self-Care knowledge and Self-Care behavior among adult patients with type 2 diabetes mellitus attending diabetes follow up clinic: A Quasi-Experimental study design

IntroductionThe prevalence of type II diabetes is growing globally. Nurse-led diabetes self-management education (DSME) plays an important role in DM treatment because it enhances diabetic self-care knowledge and practice, which in turn improves clinical outcomes. PurposeTo assess the effect of DSME on self-care knowledge and behavior among adult people with type II diabetes attending diabetic follow-up clinics in selected hospitals. MethodsAn institution-based quasi-experimental study design was used, and a systematic random sampling technique was used to select 360 patients, out of whom 321 patients participated and 278 completed the study. Participants were assigned to the interventional or control group, and DSME was delivered monthly for six months for the interventional groups. The data was collected by trained nurses using structured interviews. ResultsAn independent t-test showed that there was no significant difference in all of the outcomes before intervention; however, there was a statistically significant higher mean score difference in self-care knowledge and self-care behavior after the delivery of DSME (p < 0.05). Before the intervention, 96 (62.7%), 39 (25.5%), and 18 (11.8%) of participants in the intervention group had low, medium, and high knowledge, respectively. After the intervention, the level of participant knowledge in the low range for an interventional group decreased from 62.7% to 20.6%, and the high range increased from 11.8% to 54%. In addition, 129 (84.3%) and 24 (15.7%) of participants from the intervention group before the intervention had poor and good self-care behaviors, respectively, while 30 (23.6%) and 97 (76.4%) of participants from the intervention group after the intervention had poor and good self-care behaviors, respectively. ConclusionThe study concluded that there was a significant improvement in the mean score of self-care knowledge and self-care behavior after nurse-led DSME; hence, the implementation of DSME in health facilities can improve diabetes self-care management.

568-P: Predictors of Engagement and Adherence in a Text Messaging Diabetes Intervention for Hispanics

Mobile health delivery of diabetes self-management education and support (DSME/S) can reduce barriers among racial/ethnic minority populations (e.g., Hispanics) , but little is known about how participant characteristics shape adherence and engagement with mHealth interventions. The current study examined this using data from Dulce Digital-Me, a randomized trial that tested an adaptive mHealth DSME/S intervention among 3Hispanic adults with poorly managed type 2 diabetes from a Federally Qualified Health Center in San Diego, CA. In addition to core educational content, participants in three intervention arms received text messages with ecological momentary assessment (EMA) of health behaviors and prompts to check their blood glucose (BG) over 24 weeks. Linear regression models examined associations of age, sex, diabetes duration, health literacy (Single Item Literacy Scale) , and diabetes distress (Diabetes Distress Scale-17) at baseline with the percentage of EMA and BG checks completed, controlling for study arm. Average participant age was 52.6 years ± 11.5; 70% were female. Younger age (B=-.88) , longer diabetes duration (B=.51) , lower health literacy (B=-4.7) , and lower diabetes distress (B=-6.7) predicted significantly higher EMA completion, while only lower distress (B=-4.5) predicted higher BG check completion (all ps&amp;lt;.05) . Follow-up analyses revealed that those with moderate distress tended to have higher completion rates than those with low or high diabetes distress. Overall, these results were in line with prior research in predominantly non-Hispanic samples, with the exception of health literacy, where we typically see a positive association with mHealth engagement. This finding may reflect that our intervention content was written for populations of lower literacy levels. Future qualitative research should expand on these findings to explore who adheres to and engages most with mHealth DSME/S. Disclosure T.Clark: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. K.L.Savin: None. H.Sandoval: None. S.R.Spierling bagsic: None. L.Gallo: None. Funding National Institutes of Health (NCT03130699)

Scalable solution for delivery of diabetes self-management education in Thailand (DSME-T): a cluster randomised trial study protocol

IntroductionType 2 diabetes mellitus is among the foremost health challenges facing policy makers in Thailand as its prevalence has more than tripled over the last two decades, accounting for considerable...

665-P: Diabetes Self-Management Education (DSME): What Will It Take to Improve Participation?

Despite evidence that DSME is a critical component of diabetes (DM) care, participation remains low. Innovative methods to improve attendance need to be explored. The purpose of this study was to evaluate the impact of a primary care (PC)-based DSME delivery model on DSME referrals and participation. Using a non-randomized design, diabetes educators (DEs) and PC practices were assigned to the intervention group (IG; 3 DEs, 6 practices) or control (CG; 2 DEs, 6 practices). IG practices applied patient-centered medical home elements to DSME delivery and had direct access to a DE. The CG employed traditional DSME delivery (PC patients referred to hospital-based DE). To examine DSME referrals and participation, medical record data were extracted for patients with DM, 18-75y, presenting to PC practices over 18 months (n=4,894; 59% IG, mean age 58.7y, 50.8% male) and compared between study groups. IG practices referred a higher percentage of patients to DSME compared to CG (18.4% v 13.4%; p&amp;lt;0.0001). Of those referred, IG patients were more likely to attend DSME than CG (34.9% v 26.1%; p=0.02). This equated to a total of 6.8% IG and 3.5% CG patients participating in DSME. Adjusted multiple logistic regression modeling found that IG practices were 1.8 times more likely to refer patients to DSME than CG (Confidence Level 1.4-2.2). Other factors that predicted referrals were female (Odds Ratio=1.3, CL 1.1-1.6), obesity (OR=1.6, CL 1.3-2), and higher A1c (OR=1.4, CL 1.3-1.4). Older patients were less likely to be referred (OR=0.98, CL 0.975-0.999). Similar adjusted regression modeling found that IG patients were 1.7 times more likely to participate in DSME than CG (CL 1.1-2.6); lower A1c also predicted DSME attendance (OR=0.9, CL 0.8-0.999). This study demonstrates the positive influence of a PC-based intervention on DSME referral and participation. However, modest improvements in DSME rates, even with targeted efforts to address barriers, raise questions as to what is truly needed to drive meaningful change. Disclosure J. Krall: None. J. Kanter: None. K. Ruppert: None. V.C. Arena: None. F.X. Solano: None. L.M. Siminerio: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases

Can Practice Redesign Improve Diabetes Self-Management Education (DSME) Referrals?

DSME is considered an essential component of diabetes care, but participation is abysmal. Referral processes and traditional delivery models may serve as barriers. The purpose of this study was to deploy a model that relied on elements of the patient-centered medical home (PCMH) and direct delivery of DE services in primary care (PC) and evaluate its impact on PC provider (PCP) referrals to DSME. Methods: Using a non-randomized controlled design, DEs and PC practices were assigned to the intervention group (IG; 3 DEs, 6 practices) or control (2 DEs, 6 practices). Practices in the IG were introduced to DSME Position Statement (PS) referral algorithm and PCMH elements and negotiated application for their practice, including frequency of direct delivery of DSME in PC. Traditional DSME delivery (no direct link between DE and PC) served as control. To examine DSME referrals, data were extracted from medical records for all patients with DM, age 18-75y, who presented to their PCP over 12 months (n=4,508; 60.7% IG) and compared between study groups. Results: Mean age was 59.8y, and primarily male 51.2%. The IG referred a higher percentage of patients compared to the control group (12.6% vs. 7.9%; p&amp;lt;0.0001). Using logistic regression modeling, it was found that after adjusting for age, gender, race, A1c, obesity, and micro/macrovascular comorbid conditions, the IG was 1.9 (Confidence Level 1.5-2.4) times more likely to refer patients to DSME. Other factors found to predict referrals were female (Odds Ratio=1.3, CL 1.1- 1.6), obesity (OR=2.7, CL 2.2-3.3) and higher A1c (OR=3.2, CL 2.6-3.9). Older patients were less likely to receive a referral (OR=0.99, CL 0.978-0.995). Conclusions: Findings suggest that the intervention positively influenced DSME referral rates within PC, a critical step towards improving patient participation in DSME and meaningful improvements in diabetes outcomes. Further study of DSME referral types, PS referral algorithm influence, and utilization patterns is warranted. Disclosure J. Krall: None. J. Kanter: None. V.C. Arena: None. K. Ruppert: None. F.X. Solano: None. L.M. Siminerio: None.

Is diabetes self-management education still the Cinderella of diabetes care?

This paper reflects on the status of diabetes self-management education (DSME) as a branch of diabetology in Europe and discusses some opportunities for better supporting DSME delivery. DSME (also commonly known as Therapeutic Patient Education) has been evolving as a therapy for diabetes for decades. As a continent, Europe is fortunate to have nurtured many pioneers in DSME, and currently has many experts in the field progressing the knowledge base and striving to improve access to DSME for people with diabetes. While there is a wide variety of DSME programmes being delivered throughout Europe, for most people diabetes education is not truly embedded in routine clinical care, being seen as more of an optional add-on to conventional therapies. In comparison to drugs and devices, DSME lacks investment, and funding for DSME research lags far behind other therapies. The rigour with which forms of DSME are developed and evaluated varies, and there is a lack of European quality standards. To try to address some of these deficiencies, greater pan-European collaboration and leadership is required.

Integrating Undergraduate Patient Partners into Diabetes self-management education: Evaluating a free clinic pilot program for the Underserved.

Diabetes self-management education (DSME) improves glycemic control and health outcomes in patients with diabetes. A process evaluation of a two-year pilot intervention examined the feasibility and acceptability of undergraduate volunteers as Patient Partners to foster DSME participation among the underserved.Design setting, and participants. In the setting of a student-run free clinic, 22 patients enrolled in DSME were paired with 16 undergraduate volunteers. During the DSME courses, Patient Partners assisted patients during classes, called patients weekly, and accompanied patients to clinic appointments.Key process evaluation results. Average attendance at DSME classes was 79.4% and 94.7% for patients and Patient Partners, respectively. Sixty-three percent of phone calls were successful and Patient Partners attended 50% of appointments with their patients. Focus groups demonstrated resounding acceptability of the Patient Partner role. Volunteer undergraduate Patient Partners are a beneficial adjunct to DSME delivery in the resource-constrained environment of a student-run free clinic.

Who Can Provide Diabetes Self-Management Support in Primary Care?

The purpose of this comparative effectiveness study is to compare diabetes self-management support (DSMS) approaches and determine who can be most effective in helping patients maintain/improve clinical outcomes, self-care behaviors, distress, and satisfaction following diabetes self-management education (DSME) delivered in primary care. After receiving DSME, 141 participants were randomized to receive DSMS delivered by a trained supporter: educator, peer, practice staff, or usual education during a 6-month follow-up period. DSMS groups were compared to determine which supporter helped participants to maintain/improve A1C, blood pressure, lipids, weight, self-care, and distress. DSMS satisfaction was also examined. There was a significant improvement in A1C, empowerment, aspects of self-care, and distress following DSME at 6 weeks. Those in the educator DSMS group best sustained improved A1C while those in the other DSMS groups maintained glycemic improvements but began to show trends toward worsening. No significant differences or clear trends were seen in other clinical, behavioral, or psychosocial outcomes. The Program Reinforcement Impacts Self-Management (PRISM) study demonstrates that following DSME, participants maintained improved glycemia, lipid, weight, and self-care behaviors and reductions in distress throughout the delivery of DSMS interventions regardless of DSMS supporter. All of the participants reported satisfaction with DSMS. These findings reaffirm the critical role of educators but suggest that others may serve as DSMS supporters. Results suggest that DSME delivered in primary care is effective and multiple DSMS agents are reasonable. As patient-centered self-management approaches are being explored in primary care, delivery of DSME and DSMS becomes paramount.

A methodological review of faith-based health promotion literature: advancing the science to expand delivery of diabetes education to Black Americans.

Non-traditional avenues, such as faith-based organizations (FBOs), must be explored to expand delivery of diabetes self-management education (DSME) to benefit Black Americans with type 2 diabetes (T2D). The purpose of this study was to methodologically review the faith-based health promotion literature relevant to Blacks with T2D. A total of 14 intervention studies were identified for inclusion in the review. These studies detailed features of methods employed to affect health outcomes that DSME similarly targets. Analysis of the faith-based studies' methodological features indicated most studies used (1) collaborative research approaches, (2) pre-experimental designs, (3) similar recruitment and retention strategies, and (4) culturally sensitive, behaviorally oriented interventions with incorporation of social support to achieve positive health outcomes in Black Americans. Findings indicate FBOs may be a promising avenue for delivering DSME to Black Americans. Informed by the findings, a focused discussion on advancing the science of faith-based interventions to expand delivery of DSME to Black Americans with diabetes is provided.

Access to Diabetes Self-management Education

To examine factors related to access to diabetes self-management education (DSME), including services delivered and sought; patient, physician, and program barriers to access; educator outreach and expansion efforts; and perceptions of alternative DSME delivery strategies. Internet surveys were completed by 1169 adults with diabetes (661 with prior DSME, 508 with no prior DSME) from a national community survey panel, 1871 educators who were AADE members, and 629 physicians (212 diabetes specialists, 417 primary care practitioners) from a national physician survey panel. Physicians want patients to receive more self-management support, but some report that patients are told to do things with which the physician does not agree. Provider (physician and educator)-delivered DSME is more highly regarded among those who have received it than among those who have not received it. Physicians generally have positive perceptions of provider-delivered DSME, and educators see physicians as key to encouraging DSME use in patients. Some physicians are concerned about losing patients sent to DSME, and 11% of patients report changing physicians as a result of DSME. Most DSME programs have grown recently as a result of recruiting efforts and adding new programs/services; most programs plan more such efforts. Patients prefer traditional DSME sources/settings and are moderately accepting of media sources. Additional efforts are required to guarantee that all people with diabetes receive the DSME they need. This will require increased referral by physicians, increased follow-through by patients, and increased availability of DSME in forms that make it appealing to patients and physicians.

Access to Diabetes Self-management Education

The purpose of this study is to explore issues related to access to diabetes self-management education (DSME), including supply and demand, educator outreach and expansion efforts, patient and physician barriers to access, and acceptability of alternative DSME delivery strategies. Telephone focus groups were conducted with 17 diabetes educators, 18 primary care physicians who treat adults with diabetes, and 14 adults with type 1 or type 2 diabetes (8 in a group for those who had received diabetes education and 6 in a group for those who had not). DSME programs develop new services to attract additional patients but do little outreach, and budget struggles are common. Some physicians establish good relationships with DSME programs, but others are critical of the available programs and experience conflicts over the role of educators vis-à-vis that of the physician. Physicians do not refer all patients to DSME and are perceived by educators and patients as not providing enough encouragement to attend DSME. Patients generally have positive experiences with DSME but do not discuss these experiences with their physicians. Patients are receptive to alternative strategies for DSME delivery (community settings, electronic media), but physicians are concerned about meeting standards, and educators want to make sure that they are available to support alternative education strategies. Future advocacy efforts should seek implementation of policies to guarantee that all people with diabetes can receive the DSME they need.