Participation In Diabetes Self-management Education Research Articles

Rural-Urban Differences in Self-Reported Participation in Diabetes Self-Management Education.

Rural America faces a dual challenge with a higher prevalence of diabetes mellitus (hereafter, diabetes) and diabetes-related mortality. Diabetes self-management education (DSME) can improve glucose control and reduce adverse effects of diabetes, but certified DSME programs remain disproportionately limited in rural counties than in urban counties. The goal of this study is to examine the proportion of urban and rural adults who report having received DSME using a nationwide, 29-state survey while considering the potential consequences of lower service availability. This cross-sectional study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Residence was defined as urban (metropolitan county) vs rural (non-metropolitan county). Logistic regression, incorporated survey weights, was used to determine the odds of having received DSME by residence. BRFSS is a nationally representative survey, and this study included participants from 29 states that were distributed throughout all regions of the United States. The study sample consisted of 28,179 adults who reported having diabetes, lived in one of the states that administered the diabetes module in 2019, and answered all relevant questions. The main outcome measure was whether a participant had ever received DSME. Participants were considered to have received DSME if they self-reported having ever taken a class on how to manage diabetes themselves. Overall, 54.5% of participants reported having received DSME; proportionately fewer rural residents (50.4%, ±1.1%) than urban residents (55.5%, ±1.0%) reported DSME. Rural disparities persisted after adjusting for demographic, enabling, and need factors (Adjusted Odds Ratio=0.79; CI, 0.71-0.89). By sociodemographic factors, Hispanic persons vs non-Hispanic White persons and single vs married/coupled individuals were less likely to report DSME receipt (both 0.76 [0.62-0.94]). Ongoing national efforts addressing rural disparities in diabetes-related complications should target individuals most at risk for missing current diabetes educational programming and design appropriate interventions.

Diabetes self-management education programs: Results from a nationwide population-based study on characteristics of participants, rating of programs and reasons for non-participation.

Population-based studies of reasons for not participating in diabetes self-management education (DSME) are scarce. Therefore, we investigated what sociodemographic and disease-related factors are associated with participation in DSME, the reasons for not participating in DSME and how participants evaluate DSME. We used data from the nationwide survey "Disease knowledge and information needs-Diabetes mellitus 2017", which included a total of 1396 participants diagnosed with diabetes mellitus (diabetes; n = 394 DSME-participants, n = 1002 DSME-never-participants). Analyses used weighted logistic or multinominal regression analyses with bivariate and multivariable approaches. Participants were more likely to attend DSME if they had a medium (OR 1.82 [95%CI 1.21-2.73]),or high (OR 2.04 [95%CI 1.30-3.21]) level of education, had type 1 diabetes (OR 2.46 [1.24-4.90]) and insulin treatment (OR 1.96 [95%CI 1.33-2.90]). Participants were less likely to attend DSME if they lived in East Germany (OR 0.57 [95%CI 0.39-0.83]), had diabetes for >2 to 5 years (OR 0.52 [95%CI 0.31-0.88] compared to >5 years), did not agree that diabetes is a lifelong disease (OR 0.30 [95%CI 0.15-0.62], had never been encouraged by their physician to attend DSME (OR 0.19 [95%CI 0.13-0.27]) and were not familiar with disease management programs (OR 0.67 [95%CI 0.47-0.96]). The main reasons for non-participation were participant's personal perception that DSME was not necessary (26.6%), followed by lack of recommendation from treating physician (25.7%) and lack of information on DSME (20.7%). DSME-participants found DSME more helpful if they had a medium educational level (OR 2.06 [95%CI 1.10-3.89] ref: low level of education) and less helpful if they were never encouraged by their treatment team (OR 0.46 [95%CI 0.26-0.82]). Professionals treating persons with diabetes should encourage their patients to attend DSME and underline that diabetes is a lifelong disease. Overall, the majority of DSME participants rated DSME as helpful.

Investigating Racial and Ethnic Differences in Diabetes Self-Management Education Among Adults With Diabetes

The purpose of this study was to examine racial and ethnic differences in diabetes self-management education (DSME) participation among adults with diabetes. Population-based, cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System diabetes module were analyzed. Study cohort included 9881 adults age 18 years or older with self-reported diabetes living in 11 US states, Washington, DC, and Puerto Rico. The outcome variable was participation in DSME. Weighted descriptive statistics and multivariable logistic regression were computed to investigate the association between race and ethnicity and participation in DSME, adjusting for self-reported social determinants of health factors (eg, sex, education, employment, health insurance). Overall, 19.3% self-identified as non-Hispanic Black, 16.5% as Hispanic, and 59.9% as non-Hispanic White. Of participants, 44.3% were between 66 and 80 years old, and 50.4% were women. Half (50.1%) reported participating in DSME, and 78.5% had seen clinicians for diabetes-related care 1 to 5 times in the past year. Hispanic participants were less likely to report participation in DSME (28.5%) compared to non-Hispanic Black (60.3%) and non-Hispanic White (53.4%) participants (P < .001). Adults with diabetes who were less likely to participate in DSME tend to be unmarried, have high school or lower-level education, and not exercise regularly. Racial and ethnic differences exist in DSME participation. Because DSME has been shown to improve diabetes outcomes, there is a need to develop strategies promoting equity in DSME participation, particularly among Hispanic populations, to reduce health disparities in diabetes care.

Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study

ObjectiveTo evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress. MethodsWe included 796 ever- and 277 never-DSME participants of the population-based survey “Disease knowledge and information needs - Diabetes mellitus (2017)” from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes. ResultsDSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48–4.33), treatment (2.41; 1.36–4.26), acute complications (1.91; 1.07–3.41) and diabetes in everyday life (1.83; 1.04–3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04–2.18) and acute complications (1.71; 1.71–2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56–8.60) and diabetes care specialists (5.62; 3.61–8.75) as information sources. DSME participation was not associated with disease distress. ConclusionDSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.

Geographic disparities and temporal changes of diabetes prevalence and diabetes self-management education program participation in Florida.

BackgroundAlthough Diabetes Self-Management Education (DSME) programs are recommended to help reduce the burden of diabetes and diabetes-related complications, Florida is one of the states with the lowest DSME participation rates. Moreover, there is evidence of geographic disparities of not only DSME participation rates but the burden of diabetes as well. Understanding these disparities is critical for guiding control programs geared at improving participation rates and diabetes outcomes. Therefore, the objectives of this study were to: (a) investigate geographic disparities of diabetes prevalence and DSME participation rates; and (b) identify predictors of the observed disparities in DSME participation rates.MethodsBehavioral Risk Factor Surveillance System (BRFSS) data for 2007 and 2010 were obtained from the Florida Department of Health. Age-adjusted diabetes prevalence and DSME participation rates were computed at the county level and their geographic distributions visualized using choropleth maps. Significant changes in diabetes prevalence and DSME participation rates between 2007 and 2010 were assessed and counties showing significant changes were mapped. Clusters of high diabetes prevalence before and after adjusting for common risk factors and DSME participation rates were identified, using Tango’s flexible spatial scan statistics, and their geographic distribution displayed in maps. Determinants of the geographic distribution of DSME participation rates and predictors of the identified high rate clusters were identified using ordinary least squares and logistic regression models, respectively.ResultsCounty level age-adjusted diabetes prevalence varied from 4.7% to 17.8% while DSME participation rates varied from 26.6% to 81.2%. There were significant (p≤0.05) increases in both overall age-adjusted diabetes prevalence and DSME participation rates from 2007 to 2010 with diabetes prevalence increasing from 7.7% in 2007 to 8.6% in 2010 while DSME participation rates increased from 51.4% in 2007 to 55.1% in 2010. Generally, DSME participation rates decreased in rural areas while they increased in urban areas. High prevalence clusters of diabetes (both adjusted and unadjusted) were identified in northern and central Florida, while clusters of high DSME participation rates were identified in central Florida. Rural counties and those with high proportion of Hispanics tended to have low DSME participation rates.ConclusionsThe findings confirm that geographic disparities in both diabetes prevalence and DSME participation rates exist. Specific attention is required to address these disparities especially in areas that have high diabetes prevalence but low DSME participation rates. Study findings are useful for guiding resource allocation geared at reducing disparities and improving diabetes outcomes.

Rural-urban differences in uptake of diabetes self-management education among Medicare beneficiaries: Results from the 2016 to 2018 Medicare Current Beneficiary Survey.

To assess rural-urban differences in participation rates of diabetes self-management education and associated factors among Medicare beneficiaries with type 2 diabetes (T2DM). Data were from the 2016 to 2018 Medicare Current Beneficiary Survey (MCBS). Participation in diabetes self-management education was self-reported. The study sample included 3,799 beneficiaries aged 65 years and older with self-reported T2DM. Logistic regression was used to assess the association of participation in diabetes self-management education and residential location. Sampling weights embedded in the MCBS were incorporated into all analyses. Overall, the participation rate of diabetes self-management education was 46.8% (95% CI: 44.4%-49.2%). The rate was 40.3% for beneficiaries in rural areas, 48.0% for suburban areas, and 47.3% for urban areas. About 31% of beneficiaries newly diagnosed with diabetes did not participate within the past year. Controlling for other covariates, beneficiaries in rural areas were less likely to have participated in diabetes self-management education (AOR = 0.73, 95% CI: 0.55-0.95) than those living in urban areas. Asian Americans were less likely to have participated (AOR = 0.49, 95% CI: 0.28-0.84) than Whites. Those who were older, with lower education, and lower income levels were less likely to have participated (P < .05). Recent MCBS data indicate that more than half of Medicare beneficiaries with T2DM did not participate in diabetes self-management education, and the participation rate in rural areas was 7 percentage points lower than that ​in urban areas. The study findings highlight challenges to maximize the benefits of participating in diabetes self-management education, particularly in rural areas.

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

Trends and Rural-Urban Differences in Participation in Diabetes Self-management Education Among Adults in North Carolina: 2012-2017.

This study aimed to report recent trends in self-reported diabetes self-management education (DSME) participation rates among adults in North Carolina and to compare these rates between rural and urban residents. Data for this analysis were obtained from the NC Behavioral Risk Factor Surveillance System (BRFSS) for the years 2012, 2013, 2015, and 2017, when the survey included the diabetes module. Respondents were classified as having participated in DSME if they answered "Yes" to the question, "Have you ever taken a course or class in how to manage your diabetes yourself?" We used the Rural Urban Continuum Code to classify urban and rural residence. The study sample included 4368 adults 18 years or older with self-reported diabetes. We assessed the changes in DSME participation from 2012 to 2017. We used multiple logistic regression modeling to assess the association between rural residence and DSME participation. All analyses were conducted in Stata 14 and accounted for the survey design of the BRFSS. Statistical significance was set at P < .01. Overall, the DSME participation rates decreased slightly in the study period, from 55.8% in 2012 to 55.6% in 2013 to 56.5% in 2015 to 52.1% in 2017. By rural-urban residence, the rates were 52.3% versus 57.8% in 2012, 54.0% versus 56.5% in 2013, 48.8% versus 62.0% in 2015, and 46.7% versus 56.1% in 2017. The multiple logistic regression model results showed that rural residents were less likely to have participated in DSME (adjusted odds ratio = 0.78; 95% confidence interval, 0.64-0.94) than urban residents. Adults with higher income and education levels were also more likely to have participated in DSME (P < .01). The recent BRFSS data showed that the DSME participation rate declined slightly in North Carolina. There were persistent rural-urban disparities in DSME participation, with rural residents showing lower rates, and the gaps seemed to be widening. Continuous efforts are needed to bring more American Diabetes Association/American Association of Diabetes Educators programs to rural communities and assist persons with diabetes to participate in DSME training to reduce the burden of diabetes. Furthermore, those in rural areas may need additional support.

Sociodemographic Factors Associated with Participation in Diabetes Education among Community-Dwelling Adults with Diabetes

PurposeThis study investigated the sociodemographic factors associated with participation in diabetes self-management education (DSME) among community-dwelling adults with diabetes.Materials and MethodsData from 23400 people aged ≥30 years who were diagnosed with diabetes from the nationwide 2016 Korea Community Health Survey were analyzed. The relationship between sociodemographic factors and participation in DSME was examined by logistic regression analysis. The study sample was classified according to the type of institution providing DSME: hospitals/medical clinics (HMCs) and/or public health institutions (PHIs).ResultsOf the total sample population with diabetes, 27.2% had attended DSME programs, including 21.9% at HMCs, 4.0% at PHIs, and 1.3% at both types of institutions. As age increased and educational level and monthly household income decreased, the odds ratios (ORs) of participation in DSME decreased in a fully adjusted model. Respondents living in rural areas had lower ORs for attending DSME compared to those living in urban areas [OR, 0.85; 95% confidence interval (CI), 0.80–0.91]. Service/sales workers and mechanical/manual workers had lower ORs for attending DSME (OR, 0.84; 95% CI, 0.71–0.99; and OR, 0.81; 95% CI, 0.69–0.94, respectively) compared to professional/managerial workers. However, in the subgroup of participants receiving education at PHIs, the likelihood of participation in DSME increased as age increased, and respondents living in rural areas had higher ORs compared to those living in urban areas (OR, 1.73; 95% CI, 1.51–1.98).ConclusionCustomized DSME programs targeting socioeconomically vulnerable groups, including residential region and reimbursement of DSME by public insurance, are needed to resolve the inequalities in participation in DSME.

EFFECTS OF COGNITIVE DECLINE ON DIABETES SELF-MANAGEMENT EDUCATION AND CARE

People with diabetes experience a faster cognitive decline and have a greater risk for future dementia diagnoses. Cognitive impairment can negatively influence diabetes management activities. Diabetes self-management education (DSME) can enhance diabetes control, but limited evidence exists about the differential effects of DSME based on cognitive status. This study examines the moderation effects of cognition on the relationship between participation in DSME and diabetes management among older adults using Georgia 2017 BRFSS data (N=496). Primary outcomes were diabetes self-management (e.g., self-blood glucose monitoring, self-feet check, and physical activity) and clinical care (e.g., seeing a health professional for diabetes and A1C, feet, and eye exams). Multiple logistic regression models examined the effects of DSME and self-reported cognitive decline on diabetes care. Based on the Anderson-and-Newman Framework, all regression models were adjusted for predisposing (age, sex, race, ethnicity, and education), enabling (income, marital status, and health plan), and need (insulin treatment) factors. About 48% of participants participated in a DSME, and about 16% reported experiencing cognitive decline. DSME participation was positively associated with self-blood glucose monitoring (p=0.014), physical activity (p=0.024), seeing a health professional for diabetes (p=0.002), and feet exam (p=0.043), but cognitive decline was not significantly associated with most diabetes care (p>0.05). Further, no significant difference in DSME impact on diabetes care based on reported cognitive decline was observed (p>0.05). Findings suggest that DSME can benefit diabetes care among people with and without cognitive decline. Future research can expand upon impacts of rates and degrees of cognitive decline on program benefits.

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

Effectiveness of Diabetes Self-Management Education in Community Health.

Diabetes self-management education (DSME) programs utilize a multidisciplinary, skills-based approach allowing participants to make self-management choices and follow a comprehensive plan of care, improving their glycemic control. The purpose of this quality improvement project was to evaluate the effectiveness of DSME on the reduction of hemoglobin A1c (HgbA1c) and body mass index (BMI) in overweight/obese community health center patients. The free program met 2 hours weekly for 6 consecutive weeks. A retrospective chart review was conducted to compare baseline to post-session HgbA1c and BMI 12 weeks after completion of the program. Pre- and post-session surveys were also conducted to assess improved diabetes knowledge and confidence. Mean HgbA1c decreased by 1.6% (p = .003) 12 weeks after completion of the program; however, BMI remained unchanged (p = .582). Diabetes knowledge and confidence also improved significantly following DSME (p = .000 and p = .001, respectively). The study demonstrated that a reduction in HgbA1c levels and an increase in diabetes knowledge and confidence can occur in low income, community health center patients following participation in DSME. Community health center patients who have access to free DSME can improve their health, self-efficacy, and diabetes self-management practices.

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.

Diabetes Self-Management Education (DSME) and Diabetes Preventive Care Practices among People With and Without Vision Impairment

Objective: To examine whether participating in Diabetes Self-Management Education (DSME) was associated with increased diabetes preventive care practices among those with and without self-reported vision impairment (VI). Background: Over 30 million people in the United States have diagnosed diabetes. DSME is a vital component of care, facilitating the knowledge and skills needed to improve self-care for diabetes. Those with VI are more likely to have diabetes than those without, highlighting a need to examine DSME participation and preventive care practices among those with and without VI. Methods: We used data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large ongoing landline and cellular telephone based survey. The question “Have you ever taken a course or class in how to manage your diabetes yourself?” was asked in 37 states plus the District of Columbia and Guam. In a logistic regression, we examined if the association between DSME and 9 preventive care practices was significantly modified by VI status. Results: Regardless of VI status, respondents with diabetes who participated in DSME had a greater predicted probability of engaging in each preventive care practice than those who did not. Compared to respondents with VI who did not participate in DSME, those with VI who participated in DSME had a significantly greater predicted probability of having administered a daily glucose check (83.7% vs. 59.3%) and having had an annual visit to a health care professional for their diabetes (95.3% vs. 82.1%). Conclusions: Participants with VI who received DSME have increased predicted probability of engaging in certain self-care practices compared to those with VI who did not receive DSME. This highlights the importance of people with diabetes and VI acquiring the appropriate tools to positively affect their own health. Disclosure S. Sekar: None. R.B. Gerzoff: None. J.B. Saaddine: None. M.M. Saunders: None.

PDB42 - Economic Impact of Diabetes Self-Management Education

Recent studies had shown evidence of the benefit of Diabetes Self-Management Education (DSME) on diabetic glycaemic control and cost of diabetes care. However, the impact of DSME on drug utilization cost and total medical cost among Medicare diabetes patients is not well known. We aim to examine the impact of DSME on total medical cost, diabetes-related total medical cost, total prescription cost and total anti-diabetes cost. This study is a pooled cross-sectional study design using 2006, 2008, 2010 and 2012 Medicare Current Beneficiary Survey (MCBS) data. Participants were aged 65 and older who were diagnosed of diabetes, and do not have End-Stage Renal Disease (ESRD) and disability. Our study analyzed economic impact of DSME on cost measuring approaches such as total medical cost, diabetes-related total medical cost, total prescription cost and total anti-diabetes cost using Generalized Linear Modelling. All estimation was analysed using SAS 9.4. A total of 3,033 eligible diabetics were identified of which 35.15 % (n=1,066) had DSME (DSME group) and 64.85% (n=1,937) never had DSME (Control group). Majority of the participants were aged between 65-74 in both DSME group (55.12%) and control groups (47.91%). Majority of participants were female in both DSME group (52.42%) and control groups (51.12%) and majority were Hispanic-Whites DSME group (79.17%) and control group (73.88%). The result of our bivariate analysis showed that total prescription cost significantly varies across DSME group and control group at (alpha=0.05). We found that compared to the control group, the DSME group had 16.35% [CI: -0.26, -0.10] lower total medical costs on average and 12.83% [CI: -0.208, -0.066] lower total prescription drug on average after adjusting for other variables. Use of DSME is associated with lower total medical cost and lower total prescription medical cost. Given our findings, we recommend more promotion, patient’s enrolment and participation in DSME.

Influences on Diabetes Self-Management Education Participation in a Low-Income, Spanish-Speaking, Latino Population.

Objective.To investigate influences on participation in diabetes self-management education (DSME) classes in a low-income, Spanish-speaking, Latino population.Methods.Fifteen patients from an Oregon clinic participated in semi-structured interviews designed to understand influences on their participation in DSME classes, and the authors conducted a thematic analysis.Results.Four themes characterized the data: 1) limited resources, 2) culture, 3) relationship with diabetes, and 4) relationship with clinic. Barriers to class attendance included lack of time, childcare, and transportation; male participants’ shame of illness and lack of interest in health; and difficulty contacting participants by telephone. Motivators of class attendance included interest in being healthy for the sake of family; interest in nutrition; knowledge of the effects of diabetes on self, friends, and family; and positive experiences with group support and self-efficacy in class.Practice implications and conclusion.Participation in DSME classes in this low-income, Spanish-speaking, Latino population was influenced by many factors. Understanding these factors is an important step toward creating classes that are successful in increasing attendance rates for this and similar populations. Creative, targeted approaches to designing DSME classes for low-income, Spanish-speaking, Latino patients and similar populations are needed. These may include classes that remove the barriers of shame and lack of interest for male participants; focus on family involvement, celebration of culturally appropriate foods, group support, and self-efficacy; are accessible to resource-limited participants; and use alternative methods to recruit hard-to-reach participants.

Participation in a Diabetes Self-Management Class Among Adults With Diabetes, New Jersey 2013-2015.

Identifying patient groups with low participation in diabetes self-management education can inform efforts to improve its use. Data from the 2013–2015 Behavioral Risk Factor Surveillance System were used to assess variation in participation in a diabetes self-management class in New Jersey. Nonparticipation varied significantly by race/ethnicity (P < .001), education (P < .001), health care coverage (P = .04), county (P < .001), years since diagnosis (P < .001), and whether a diabetes provider visit occurred in the past year (P = .002). Attention is warranted in identifying participation barriers among patients who live in certain counties, have less education, are without health care coverage, have been diagnosed with diabetes more recently, visit a provider less often, or belong to certain racial/ethnic minority groups.

7. Individual, System, and Program Interactions that Create Barriers to Participation in Diabetes Self-Management Education

7. Individual, System, and Program Interactions that Create Barriers to Participation in Diabetes Self-Management Education

Ethnic Disparity in Diabetes Self-Management Class Utilization, Behavioral Risk Factors Surveillance System 2012

AbstractWe examined diabetes self-management class utilization in a study sample of adult BRFSS 2012 participants with diabetes (n=34,665). This study assessed demographic variables that might be associated with class utilization, specifically sex, age, income, having health insurance (yes or no), and ethnicity (Hispanic and non-Hispanic) on diabetes self-management class utilization. Participation in diabetes self-management class was 53.8% overall. Male sex, age greater than 49 years, income &lt;$25,000 per year, and lack of health insurance were each significantly associated with decreased class utilization. Hispanics (n=2,962) were 43% less likely to have taken a class compared to non-Hispanics (n=31,703) (OR 0.57, CI:0.53-0.62, p&lt;0.001) with 41.2% of Hispanics and 55% of non-Hispanics reporting that they had taken a diabetes self-management class. This disparity remained after adjusting for sex, age, income, and health insurance (OR 0.60, CI:0.55-0.65, p&lt;0.001). Efforts to enhance participation in diabetes self-management education are needed, particularly in Hispanic communities.

Factors Associated with Participation in Diabetes Education: The Korea National Health and Nutrition Examination Survey 2007 to 2009.

BackgroundA recent study revealed that the participation rate in diabetes education among diabetic patients was only about 50% in Korea. We investigated the factors associated with participation in diabetes education.MethodsThe study included 1,255 patients (≥19 years old) diagnosed with diabetes drawn from the total Korea National Health and Nutrition Examination Survey 2007 to 2009 population comprising 30,705 individuals. We compared age, sex, and age- and sex-adjusted clinical characteristics in patients who had received diabetes education versus those who had not.ResultsOf the 1,255 patients, 19.8% (n=248) had received diabetes education. Patients in the group who received diabetes education were younger, diagnosed at an earlier age, had a longer diabetes duration and were more likely to be using insulin therapy compared with the group who did not receive diabetes education (P<0.001). The group who received diabetes education included fewer manual workers (P<0.001) but more college graduates (P=0.004) compared with the group who did not receive diabetes education. Logistic regression analysis revealed that longer diabetes duration increased the likelihood of receiving diabetes education (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.06; P=0.004). Junior high school (OR, 0.47; 95% CI, 0.24 to 0.91; P=0.026) and elementary school education levels (OR, 0.34; 95% CI, 0.17 to 0.65; P=0.001) versus college graduation were inversely correlated with participation in diabetes self-management education. Non-insulin therapy reduced the likelihood of receiving diabetes education (OR, 0.37; 95% CI, 0.21 to 0.64; P<0.001).ConclusionLonger diabetes duration, insulin therapy, and higher education level were positively associated with the completion of diabetes education.