Diabetes Self-management Education Program Research Articles

Formative research to develop diabetes self-management education and support (DSMES) program for adults with Type 1 Diabetes

Background and aimThere is a lack of data on effectiveness of diabetes self-management education and support (DSMES) programs for South Asian adults with type 1 diabetes mellitus (T1DM). This formative research was conducted to explore existing practices on the said subject and gather information for planning an intervention program. Methods and materialsWe conducted in-depth semi-structured interviews with endocrinologists, dieticians, diabetes educators and adults with T1DM. The participants were selected from a mix of public and private health facilities. Thematic analysis using inductive and deductive approach was undertaken. The intervention was developed and refined using the principles of FUSED and COM-B models. ResultsIn total, 28 in-depth interviews were conducted, 18 with health care professionals and 10 with adult individuals with T1DM. The results demonstrated deficiencies in the implementation of a structured self-management program for diabetes owing to several patient and healthcare system-related factors. A detailed nutritional counseling was provided at all sites by a qualified dietitian, however, carbohydrate counting was not routinely practiced. The interviews of this formative research revolved around: (a) evaluation of the existing usual care and gaps in implementation of a structured DSMES program, and (b) development of themes that will help in formulation of an intervention package and its effective delivery to the participants. ConclusionThis research study comprehensively investigated the existing practices among diabetes-health care professionals caring for persons living with T1DM and rendered insights towards development of a scientific DSMES program.

Improving Diabetes Outcomes with a Multimodal Intervention for Less Advantaged Adults with Type 2 Diabetes

If proper self-management behaviors are not maintained, diabetes may lead to reduced quality of life (QoL), decreased engagement in everyday activities, disabling health complications, and even death. Less advantaged adults with limited income, lower education, and fewer resources find diabetes self-management (DSM) particularly challenging due to healthcare and social inequalities. DSM education is important to understanding diabetes-related behaviors and improving QoL. There are few evidence informed DSM education programs directed specifically at less advantaged adults. The purpose of this study was to develop and test feasibility and preliminary efficacy of a novel virtual intervention that merged prior evidence-informed yoga, occupational therapy, and nutrition education (MY-OT-ED) practices. Five participants were recruited throughout communities near the research university for a nine-week DSM education program that was held twice a week. DSM-related health and QoL measures were tested at baseline, immediately after MY-OT-ED, and six to eight weeks following the intervention. Primary outcomes studied included QoL, DSM, diabetes distress, and diabetes self-efficacy. Percent change was calculated to assess if any significant DSM-related changes occurred. Positive changes were found in all outcomes following the nine-week intervention and were maintained at follow-up. While limitations of the study were noted, results provide preliminary evidence that MY-OT-ED was feasible, acceptable, and has the potential to improve diabetic outcomes for less advantaged adults.

Effectiveness of Diabetes Self-management Education Against Diet Behavior in Patients Type 2 Diabetes Mellitus: A Literature Review

BACKGROUND: Diabetes mellitus (DM) is a disease that describes a problem with insulin deficiency and the inability of the pancreas to produce enough insulin. The World Health Organization predicts that the number of people with DM type II in Indonesia will increase to 12 million by 2030. AIM: This study looks at Journals on diabetes selfmanagement education (DSME) on DM patients in improving dietary behavior. METHODS: This study uses an online journal database that provides free articles and journals in PDF such as: ProQuest, EBCSO, PubMed, Elsevier, Scinapse, MDPI, and Google Scholar. Literature was collected from the past 10 years, namely, 2010–2020 using the following set of keywords: “DSME,” “DSME Program Evaluation,” and “Diabetes Self-Care Education.” RESULTS: DSME intervention can improve the condition of DM patients if it is routinely carried out. In addition, the DSME intervention was able to control hemoglobin A1c levels and control blood sugar. This intervention still needs to be developed, considering that various forms of education in DM patients have been carried out such as using text messages, leaflets, illustrated pictures or leaflets, by telephone, video, handbooks, or direct education. These investigations can be developed into empirical research. CONCLUSIONS: The application of DSME interventions can help improve the conditions experienced by DM type II sufferers if it is routinely carried out.

To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education.

Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.

A Comparison of Two Diabetes Self-Management Education Programs for the Reduction of Participant A1c Levels.

Compare the effectiveness of two educational teaching methods for diabetic patients. Quasi-experimental study comparing two interventions using a pretest/post-test design. Three clinics within a western U.S. regional health system. 818 adult diabetic participants (60.5 mean age, 52% female) attended one to four sessions between 2013-2017, and had A1c tests within 180 days of first attended session and 30 to 365 days after last attended session. A group-based, highly interactive learning experience (n = 561) and a traditional, lecture-style class (n = 257). Pre and post measures of A1c. Paired t-tests measured change within each group pre-post intervention. Two-sample t-tests measured mean change pre-post intervention between the two groups. Multivariable linear regression measured mean change in A1c between groups, adjusted for pre-test scores and controlling for demographic variables. Both interactive and traditional teaching interventions were effective at significantly reducing patient A1c levels by 1.3 (p < 0.001) and 1.0 (p < 0.001) points respectively. The between groups difference in A1c was not significant, t(512) = 1.66, p = 0.0985, but when controlling for age, pre-A1c and days post-A1c, the interactive intervention was significantly (p < 0.05) more effective reducing patient A1c levels by 0.19 points than the traditional intervention. Group-based, interactive diabetes self-management education programs may be an effective model for reducing patient A1c levels.

Diabetes Educational Intervention in Society to Improve (DESI) Quality of Life

Background: Diabetes self-management education (DSME) is globally recognized as an integral part of diabetes management and in majority of the developed countries, it is delivered by trained diabetes educators. Unfortunately, in India, it is still not considered an essential part of diabetes management. Materials and Methods: A self-structured diabetes education program, of a 75-min duration, was developed over a period of six months. To assess the knowledge, before and after the implementation of the education program, a validated questionnaire, Diabetes Knowledge Questionnaire 24 (DKQ24) was used. Results: A total of 50 patients (34 males; 74%) were recruited in the study. The mean age of the study participants was 54.98 ± 12.02years, with a mean duration of diabetes 12.34 ± 8.76years and mean HbA1c 8.1 ± 1.49%. A statistically significant (P &lt; 0.05) improvement in the proportion of correct responses (14 out of 24 questions; 58.3%) was seen after the implementation of the DSME program. Conclusion: There is limited research available in India on DSME. To meet the need of a structured diabetes education program in India, we have evolved one such program (duration of 75 min) within a period of six months. We anticipate this program to have enough potential in developing countries in the long run.

Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study.

Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes. The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour. Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one's personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management. In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.

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

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

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

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

Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review.

Background Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals. Methods Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity. Results The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed. Conclusion Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.

The effect of providing usual care only for control subjects on the reliability of results obtained by controlled clinical trials assessing the benefits of diabetes self-management educational programs

Diabetes self-management (DSM) is a crucial part in the management of diabetic patients. Most randomized controlled clinical trials reported significant benefits by diabetes self-management education (DSME) on DSM behaviors and metabolic control. Although the randomized clinical trials are the gold standard method in assessing the effectiveness of any intervention, including DSME interventions, the outcomes of these studies may reflect exaggerated effects; because in most of these studies, subjects in control group receive usual (standard) care with no any DSME. The lack of such education in the control group had many drawbacks: ( 1 ) make blindness impossible; at which non blinded studies may result in false-positive findings; ( 2 ) it may be unethical to recruit patients for participation in DSME studies as control subjects, most of these studies with long periods of follow up, without any direct benefit to them during the study period; the lack of direct benefit to control subjects in any clinical trial may results in high attrition (drop-out) rate. The high attrition rate in clinical trials especially in the control group can lower the statistical power of the study results; thus, the DSME program would appear to have positive effects even if the program had no real benefit. This problem of the DSME exaggerated effects can be solved partially through providing control subjects with education about some DSM behaviors or comparing the effect of DSME through different educational approaches (for example DSME by didactic vs interactive approach).

Effectiveness of the Family Portal Function on the Lilly Connected Care Program (LCCP) for Patients With Type 2 Diabetes: Retrospective Cohort Study With Propensity Score Matching.

BackgroundDiabetes is a major health concern worldwide. Family member engagement in diabetes self-management education programs can improve patients’ diabetes management. However, there is limited evidence that the family portal on diabetes management apps is effective in the glycemic control of patients with diabetes.ObjectiveWe aimed to evaluate the effectiveness of family support through the family portal function on Lilly Connected Care Program (LCCP) platform.MethodsThis retrospective cohort study included patients with type 2 diabetes recruited to the LCCP platform from September 1, 2018, to August 31, 2019. Propensity score matching was used to match family (group A) and non–family (group B) portal use groups with similar baseline characteristics. The patients were followed up with for 12 weeks. The main objectives were differences in mean fasting blood glucose, proportion of patients achieving fasting blood glucose target <7mmol/L, mean postprandial blood glucose, proportion of patients achieving postprandial blood glucose target <10mmol/L, proportion of patients achieving both fasting blood glucose <7mmol/L and postprandial blood glucose <10mmol/L, self-monitoring of blood glucose frequency at week 12 and the number of diabetes education courses patients completed during the 12 weeks. Moreover, logistic regression analysis was used to explore the baseline factors which may be associated with the use of family portal, and odds ratios with 95% confidence intervals were calculated.ResultsA total of 6582 adult patients (aged ≥18 years) with type 2 diabetes who were receiving insulin therapy were enrolled in the study. Overall, 6.1% (402/6582) of the patients chose to engage their family members to use the family portal. Two groups of 394 patients were well-matched regarding baseline characteristics. After matching, mean fasting blood glucose and postprandial blood glucose at week 12 were significantly lower in group A than in group B (fasting blood glucose: 7.12 mmol/L, SD 1.70 vs 7.42 mmol/L, SD 1.88, respectively, P=.02; postprandial blood glucose: 8.56 mmol/L, SD 2.51 vs 9.10 mmol/L, SD 2.69, respectively, P=.002). When comparing group A to group B, the proportion of patients achieving both fasting blood glucose <7mmol and postprandial blood glucose <10mmol/L at week 12 (46.8% vs 39.4%, respectively, P=.04), self-monitoring of blood glucose frequency at week 12 (8.92 times per week, SD 6.77 vs 8.02 times per week, SD 5.97, respectively, P=.05) and number of diabetes education courses completed in 12 weeks (23.00, IQR9.00-38.00 vs 15.00, IQR 4.00-36.00, respectively, P<.001) was higher. Additionally, multivariate logistic regression analysis showed that higher age (OR=0.987, 95% CI 0.978-0.996, P=.006) and higher baseline fasting blood glucose (OR=0.914, 95% CI 0.859-0.972, P=.004) were correlated with less use of the family portal function, while increased baseline self-monitoring of blood glucose frequency (OR=1.022, 95% CI 1.012-1.032], P<.001) as well as increased education courses (OR=1.026, 95% CI 1.015-1.036, P<.001) were associated with more use of the family portal function.ConclusionsFamily support through the LCCP family portal is effective for glycemic control and self-management behavior improvement in type 2 diabetes patients.

Mandated Benefits for Diabetes Education and the Availability of Accredited Programs and Certified Diabetes Educators.

States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of "flexible" reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.

Outcomes of diabetes self-management education on glycemic control among diabetic patients (Menoufia family medicine clinic)

ObjectiveTo assess the outcome of a diabetes self-management education (DSME) program in terms of the level of glycosylated hemoglobin (HbA1c) and diabetes self-care behaviors.BackgroundDiabetes self-care behaviors related to food choices, physical activity, proper medication intake and regular blood glucose monitoring in type II diabetes mellitus have a potential impact on diabetic management.Patients and methodsA quasi-experimental pretest and posttest interventional study was carried out on 74 uncontrolled type 2 diabetes patients attending the Manshet Sultan family health center, Menoufia Governorate, from May 2019 to December 2019. A matched control group was selected from the same center and was provided usual diabetes care. A DSME program was conducted for the intervention group as one session weekly for 6 weeks. Evaluation of the outcome of the program was performed after 3 months of follow-up by measuring the HbA1c level and by diabetes self-care assessment.Results and conclusionThere were significant improvements in the HbA1c level before and after implementation of DSME sessions (9.8 ± 1.79, 8.8 ± 1.4) (P < 0.05). Significant improvements occurred in three domains of diabetes self-care assessment including dietary, blood glucose management, and health care use, but there was no improvement in the physical activity domain. There was no improvement in the HbA1c level in the control group at baseline and at the end of the study. This study revealed promising results of DSME sessions and their effect on better diabetes self-care behavior and HbA1c level (P < 0.05).

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

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

Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand.

The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand. The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients. A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand. Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05). The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.

How well a culturally adapted diabetes self-management education program (DSME) improves the glycemic control and distress among diabetes patients?

How well a culturally adapted diabetes self-management education program (DSME) improves the glycemic control and distress among diabetes patients?

Effect of locally-contextualized nurse-led diabetes self-management education on psychosocial health and quality of life: A controlled before-after study

Our study evaluated the potential of nurse-led, locally contextualized diabetes self-management education (DSME) to modify psychosocial symptoms and health-related quality of life (HRQoL) in a resource-limited setting. Thus, a controlled, two-group, before-after study was conducted among people with type 2 diabetes mellitus (T2DM). At the baseline, 116 participants were randomly assigned to the intervention, and 104 to the comparison group. The intervention consisted of six interactive DSME sessions administered by nurses for six months.At the endline, data from 78 (67%) intervention and 64 (62%) comparison group participants were included in the final analysis. Statistically, no significant differences were observed in depressive symptoms, stress, and HRQoL. Even though statistically not significant the proportion of participants who had eye examination at the endline was slightly greater in the intervention group, which is clinically significant in reducing the risk of diabetes retinopathy complication. Moreover, intervention group participants reported the DSME sessions to be helpful for the management of stress and depressive symptoms. We discuss different reasons that may explain the non-significant findings, most specifically, gaps in the adaptation of the education materials for a resource-limited setting, and modifications for low-literacy. Despite the non-significant findings in this part of our study, our overall project paved a way to design and test contextualized DSME programs in resource-limited settings of Africa.This clinical trial was retrospectively registered on ClinicalTrials.gov (Identifier: NCT03185689) on June 14, 2017. https://clinicaltrials.gov/ct2/show/NCT03185689

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...

Health Beliefs, Self-Care Behaviors and Quality of Life in Adults with Type 2 Diabetes.

AimDiabetes mellitus is a lifelong metabolic disease accompanied by acute and chronic complications and requires continuous medical care. The aim of this study is to investigate the effect of the diabetes self-management educational intervention given to individuals with type 2 diabetes on their health beliefs, self-care activities, and quality of life.MethodA single group randomized quasi-experimental study with the pre- and post-intervention design was conducted in two family health centers (n=60). The self-care activities, health beliefs, and quality of life of patients with type 2 diabetes were investigated.ResultsThe mean pre- and post-intervention blood glucose subscale scores were 1.57±0.91 and 3.22±1.06, respectively. The mean pre- and post-intervention social/vocational issues subscale scores were 29.26±5.54 and 33.26±3.19, respectively. The mean scores of the quality of life increased in the primary school graduates and in those who previously had no diabetes intervention after the intervention program. It was determined that the mean body mass index values of the participants decreased after the intervention.ConclusionIt is recommended to organize and implement periodic diabetes self-management educational intervention programs in family health centers and in centers providing diabetes health care to improve health beliefs and to increase self-care activities and quality of life in individuals with diabetes.