Diabetes Self-management Support Program Research Articles

624-P: Primary Care Education Leads to Improved Diabetes Knowledge and Clinical Practice

Primary care providers (PCPs) are the initial treatment provider for a majority of the more than 100 million adults in the U.S. now living with diabetes or prediabetes. Constant changes in health care delivery and new diabetes therapies make it challenging for PCPs to stay up to date on the latest diabetes guidelines. In addition, only 14% of PCPs refer all patients with type 2 diabetes to diabetes self-management education and support (DSMES) programs despite their evidence base for improving diabetes-related outcomes. The American Diabetes Association (ADA) developed a professional education program designed to broaden the knowledge and usage of the Standards of Medical Care in Diabetes (SOC) among PCPs and increase referrals to evidence-based interventions for the prevention and management of diabetes. Programs provide 6 hours of case-based, accredited, interactive education built around the realities of primary care to a group of 100-200 PCPs. The program covers treatment options, strategies to improve compliance in diabetes management, and prevention of type 2 diabetes. To assess changes in clinical practice, online surveys are administered before and 6 months following the program. From June 2018 to March 2019, 1,183 PCPs participated in one of 9 in-person programs hosted across the country. Six months after the program, 98% of PCPs reported a gain in knowledge related to their clinical practice, and knowledge of pharmacologic treatment options increased 21%. In addition, 56% of PCPs increased their use of the SOC and PCP referrals to DSMES programs increased 16%. Results from the program demonstrate positive impact on PCP knowledge and clinical practice in the primary care setting. PCPs are learning how to optimize patient care in a changing health care landscape, thus increasing the likelihood of improved patient outcomes. Notably, this program has an estimated reach of 2.7 million patients with diabetes and 1.4 million with prediabetes leading to a widespread improvement in care across the country. Disclosure R. Woolley: Employee; Self; American Diabetes Association. E. Colwell: None. E. Ford: None. A. Saxena: None. S. Bradley: None. Funding Abbott Diabetes Care; AstraZeneca; Merck & Co., Inc.; Novo Nordisk

622-P: Systematic Screening and Assessment of Diabetes Prevention and Self-Management Programs That Utilize Telehealth Technology

Background: Remote delivery of health care services through telehealth technology holds promise for expanding access to and engaging individuals in underserved communities. Systematic Screening and Assessment and Evaluability Assessment methods were used to identify and evaluate promising CDC-recognized National Diabetes Prevention Program Lifestyle Change and Diabetes Self-Management Education and Support (DSMES) programs utilizing telehealth technology. Objective: To describe how 8 Lifestyle Change and DSMES programs utilize telehealth technologies effectively to expand access to services in underserved communities. Methods: Eight effective programs were selected to participate in an in-depth study. Information was gathered to understand activities, adaptations, and implementation challenges through in-depth interviews with stakeholders and on-site observation. Results: In all program sites, telehealth technology seamlessly integrated into existing program models to increase patient engagement and experience. Programs offered various tailored products based on the curriculums to reinforce prevention and self-management education. Automation of several program processes reduced burden on health coaches and diabetes educators, and improved data quality and analysis capabilities. Bi-directional communication between providers and programs was key to gaining provider buy-in and increasing referrals. Understanding activities being implemented by effective programs is crucial for expanding use of telehealth technologies. Conclusion: This project provides valuable practice-based evidence for planning and implementing diabetes prevention and management interventions. Disclosure Y. Mensa-Wilmot: None. T. Bonner: None. M.M. Ayala-Perales: None. A. Mensa-Kwao: None. S. Bowen: None. M. Greenberg: None. N. Dawkins-Lyn: None. G.E. Rutledge: None.

818-P: Mental Health History and DECIDE Self-Management Support Program Outcomes in an African American Sample with T2DM

Objective: To evaluate changes in behavioral and clinical outcomes from the DECIDE (Decision-making Education for Choices in Diabetes Everyday) self-management support program trial among participants with and without a mental health (MH) history. Methods: Participants were urban African American adults with type 2 diabetes (T2DM) (N=182). DECIDE is a problem solving diabetes self-management support program. Participants were randomized to 1 of 4 intervention arms: Self Study (n=46), Individual (n=45), Group (n=46), or Enhanced Print Education (EPE; n=45). Those who screened positive on the Patient Health Questionnaire 2 or reported a mental health diagnosis were coded as having MH history. Outcomes were self-management, knowledge, problem solving, and A1C assessed at baseline and 6 months post intervention, stratified by MH history status. Results: 72 participants (40%) reported a MH history, including depression, bipolar, and schizophrenia. Among those with no MH history, knowledge and problem solving improved at 6 months post intervention in all intervention arms (knowledge: Self Study p<.001, Individual p=.011, Group p=.004, EPE p=.026; problem solving: Self Study p=.023, Individual p=.015, Group p=.010, EPE p=.015). For those with MH history, knowledge and problem solving improved in the Self Study and Individual arms (diabetes knowledge: Self Study p=.018, Individual p=.037; health problem solving: Self Study p=.006, Individual p=.011) but not in the Group or EPE arms (ps≥.10). Although changes in A1C were not significant in any group (ps≥.20), A1C decreased by 1% among those with MH history in the Self Study arm (baseline A1C=9.1%; 6 month A1C=8.1%; p=.20). Conclusion: In an urban minority sample with T2DM, those with a MH history benefited from a diabetes self-management intervention, but delivery modality mattered. Robust improvements in skills and A1C were observed when those with a MH history had self-paced or one-on-one formats rather than group. Disclosure E.A. Vrany: None. A. Jennings: None. F. Hill-Briggs: None. Funding National Heart, Lung, and Blood Institute (R01HL089751, 5T32HL007180)

Efficacy of Augmented Food Pantry Services in Addressing Food Insecurity

Abstract Objectives Almost 1 in 9 Americans obtain food from a food bank or food pantry every year to help make ends meet. Despite this scope and scale, the efficacy of the charitable food system at alleviating food insecurity is still unclear. This study aimed to determine whether food distributed at food pantries as part of a comprehensive diabetes self-management support program, changed food security status for adults with diabetes. Methods This is a secondary, prespecified analysis of a larger randomized, controlled study (the FAITH-DM trial) conducted in 27 food pantries in Detroit MI; Houston, TX; and Oakland, CA (2015–2018). We screened 5329 adults for diabetes, and individually randomized 568 participants with hemoglobin A1c (HbA1c) 7.5% or greater to an immediate 6-month intervention (including bimonthly food, diabetes education, health care referral and glucose monitoring) or to receive the intervention after a 6-month delay (cross-over design). For this analysis, primary outcome was food insecurity, measured at baseline, 6 months and 12 months, using the 10-item USDA food security modules scaled as a continuous Rasch score and then compared using difference-in-differences analyses. Results Participants were racially/ethnically diverse (51% Latino/Hispanic, 33% African American), with a mean age of 55 (range 23–86) and predominantly female (69%). In both trial phases, food security scores improved for individuals receiving the intervention and worsened for those not receiving the intervention. On a 12-point Rasch scale, differences between groups ranged from 0.627 points in Phase 1 (95% CI: –1.16, –0.099, P = .02) to 0.879 in Phase 2 (95% CI: –1.46, –0.303, P = 0.003). Conclusions Preliminary results of this cross-over design suggest a causal relationship between healthy food interventions at food banks and improving food security for adults with diabetes. Funding Sources Funding for the Feeding America Intervention Trial for Health—Diabetes Mellitus (FAITH-DM) was provided by Feeding America, the Laura and John Arnold Foundation, the Urban Institute via a Robert Wood Johnson Foundation grant, National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award P30DK092924, and Centers for Disease Control and Prevention under award 3U48DP004998–01S1. Support for RAR by HRSA QSCERT-PC Program (grant no. T32HP30037).

Cost-Effectiveness of a Diabetes Self-Management Education and Support Intervention Led by Community Health Workers and Peer Leaders: Projections From the Racial and Ethnic Approaches to Community Health Detroit Trial.

To simulate the long-term cost-effectiveness of a peer leader (PL)-led diabetes self-management support (DSMS) program following a structured community health worker (CHW)-led diabetes self-management education (DSME) program in reducing risks of complications in people with type 2 diabetes (T2D). The trial randomized 222 Latino adults with T2D to 1) enhanced usual care (EUC); 2) a CHW-led, 6-month DSME program and 6 months of CHW-delivered monthly telephone outreach (CHW only); or 3) a CHW-led, 6-month DSME program and 12 months of PL-delivered weekly group sessions with telephone outreach to those unable to attend (CHW + PL). Empirical data from the trial and the validated Michigan Model for Diabetes were used to estimate cost and health outcomes over a 20-year time horizon from a health care sector perspective, discounting both costs and benefits at 3% annually. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). Over 20 years, the CHW + PL intervention had an ICER of $28,800 and $5,900 per quality-adjusted life-year (QALY) gained compared with the EUC and CHW-only interventions, respectively. The CHW-only intervention had an ICER of $430,600 per QALY gained compared with the EUC intervention. In sensitivity analyses, the results comparing the CHW + PL with EUC and CHW-only interventions were robust to changes in intervention effects and costs. The CHW + PL-led DSME/DSMS intervention improved health and provided good value compared with the EUC intervention. The 6-month CHW-led DSME intervention without further postintervention CHW support was not cost effective in Latino adults with T2D.

A Diabetes Self-Management Education/Support (DSME/S) Program in Reference to the Biological, Psychological and Social Aspects of a Patient with Type 2 Diabetes Mellitus: A Systematic Review

Introduction: Various efforts have been made to improve the self-care management of patients with type 2 diabetes mellitus (T2DM). One of them is by using a Diabetes Self-Management Education and Support (DSME/S) program. DSME/S produces positive effects in relation to patient behavior and health status. This is a systematic review of randomized controlled trials published where the aim was to evaluate the impact of the DSME/S program in term of biological. psychological and social aspects.Methods: The articles were searched for using the PRISMA approach from within Scopus, Sage Journal, ProQuest, Google Scholar and PubMed to identify the relevant English publications on DSME over the last 5 years (2013-2018). In total, 15 studies met the inclusion criteria.Results: The articles included at least one result that covered the biological, psychological, and social aspects that are more general and relevant for T2DM patients who received the DSME program. DSME had a positive impact on T2DM, namely the reduction of HbA1c, blood glucose, LDL, cholesterol, blood pressure, weight, waist circumference, decreased distress, anxiety and increased self-efficacy and self-empowerment.Conclusion: It can increase the social and family support, improve self-management motivation, increase knowledge and improve the behavior of T2DM patients. The findings of our review showed that DSME has a positive impact on the biological, psychological and social aspects of type 2 diabetes mellitus.

Perceived impact of caregiver’s participation in diabetes education classes on implementation of self-care behaviors

ObjectiveThe objective of this study was to describe the experiences of participants in a community pharmacist–delivered diabetes self-management education and support (DSMES) program. Specifically, we explored (1) self-efficacy and barriers to implementing self-care behaviors and (2) the participants’ perception of the impact that caregiver participation in DSMES classes has on achievement of 6-month personal health goals. MethodsTen semistructured interviews were conducted in person or by telephone with participants who completed DSMES between July 2014 and December 2017. The Health Belief Model of health behaviors was used to frame the interview tool with questions exploring the concepts of perceived benefits, perceived barriers, and self-efficacy. Interviews were audio recorded and transcribed by a medical transcription service for analysis in qualitative data software. Coding was completed after data collection. ResultsMeal planning and movement were the most commonly identified barriers to implementation of self-care behaviors, and the emotional aspect of diabetes emerged as a challenge of self-efficacy for most participants. Negative effects of a caregiver’s participation were not reported. The most common goals chosen by participants included reaching target hemoglobin A1c and losing 5%-10% of body weight. All participants reported positive progress toward or success of at least some of their goals, and most attributed that to healthier eating and increasing exercise. All participants believed that caregiver participation in the education program had a positive impact on their ability to implement behavior changes. Participants identified having caregiver support to implement changes in eating habits and meal planning was the most important of all self-care behaviors. ConclusionParticipants concluded having a caregiver attend DSMES with them had a positive impact on their ability to succeed with implementation of self-care behaviors. These findings support the incorporation of caregivers into the DSMES model.

Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support.

The purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs. The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors. Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened. Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.

690-P: Building a Healthy Temple: A Faith-Based Diabetes Self-Management Support Program

Background and Objective: Type 2 diabetes disproportionally affects Hispanics. Diabetes self-management is key to preventing its life threating complications. Most Hispanics affiliate with churches, presenting a promising venue for delivering diabetes self-management support (DSMS) program. “Faith-placed” (FP) programing refers to health intervention implemented in church setting; while "faith-based" (FB) signifies integrating spirituality with health interventions. Building a Healthy Temple DSMS Program integrates spirituality with DSMS to improve diabetic outcomes. Setting and Subjects: Predominantly Hispanic churches in Texas; Diabetic churchgoers. Methods: This 13-week cluster-RCT assigned 18 churches to: 1) FB Group receiving a Health Sermon, 6-session DSMS, and 6-session Healthy Bible Study delivered by trained church lay leaders; or 2) FP Group receiving 6-session DSMS accompanied by a 7-session partial attention control curriculum delivered by outside professionals. Key outcome measures included HbA1c, BMI, waist circumference (WC), DSM Self-efficacy and diabetes quality of life (DQL) using the Problem Areas in Diabetes Scale (PAID). Data are collected at baseline, 6, 9, and 12 months. Intervention effects were determined using Linear mixed-effect models, controlled for age, gender and baseline corresponding outcome measures. Preliminary Results: To date, 3 FP (n=48) and 3 FB churches (n=49) have delivered interventions and collected 9 month data. Post intervention, the FB Group appears to have a lower HbA1c than the FP Group (6.56 vs. 6.79; p=0.095). Single-group sub-analyses showed that only the FB Group sustained a 4% HbA1c reduction at 9 months (p<0.05), and a 16% increase in DSM Self-efficacy scores at 6 and 9 months (p<0.05). Compared to baseline, both groups significantly reduced WC and PAID scores (i.e., improved DQL) at 6 and 9 months. Conclusions: Integrating spirituality with DSMS could lead to improved diabetes outcomes among Hispanic diabetic churchgoers. Disclosure S.R. Wilmoth: None. L. Carrillo: None. M. Pan: None. D. Chavarria: None. B. Wilhite: None. D. Parra-Medina: None. M. He: None. Funding American Diabetes Association (1-17-ICTS-029 to M.H.)

53-LB: Availability of Diabetes Self-Management Education and Support Programs in United States Counties

Authors developed an interactive map visualizing county level availability of Diabetes Self-Management Education and Support (DSMES) site or program locations. Location data were overlaid with diabetes prevalence data and socio-economic status data. Over 4200 locations were geocoded including 3471 sites (American Diabetes Association recognized) and 802 program locations (American Association of Diabetes Educators accredited). Counties were characterized as having or not having DSMES class locations. Counties were additionally characterized based on tertiles of diabetes prevalence and socio-economic disadvantage (using the Area Deprivation Index (ADI) score). This analysis showed that 48 percent of U.S. counties (1515/3142 counties and county equivalents) had a DSMES program with at least one site or program location. Approximately 39% of counties in the highest diabetes prevalence tertile (greatest diabetes burden) had DSMES programs compared to 53% in the middle tertile of diabetes prevalence and 54% in the lowest tertile of diabetes prevalence. Approximately 26% of counties in the tertile with highest ADI scores (representing greatest socio-economic disadvantage) had DSMES programs compared to 48% in the middle tertile and 69% percent in the tertile with the lowest ADI scores (least socio-economic disadvantage). This interactive map is a tool that can be used at a national level and by state and local health departments and others to prioritize establishment and expansion of programs in underserved counties with higher rates of diabetes prevalence and greater socio-economic disadvantage. Disclosure B. Jayapaul-Philip: None. S. Dai: None. E. Woghiren: None. G.E. Rutledge: None.

697-P: Final Outcomes of a 5-Year National Effort to Increase Awareness, Availability, Referrals, and Coverage for the CDC-Recognized Diabetes Prevention Programs and DSMES Programs

CDC’s State Public Health Actions 1305 Cooperative Agreement funded all 50 state health departments and DC for 5 years to increase the use of diabetes self-management education and support (DSMES) programs and the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) through strategies such as implementing referral policies in health care systems. Objectives: (1) Describe activities implemented by states to increase awareness, access, utilization, and coverage of DSMES and CDC-recognized LCPs; (2) share findings from baseline to year 5 for CDC-recognized LCPs and DSMES-related activities, and (3) describe facilitators and barriers to implementing prevention and management programs. Qualitative and quantitative data were abstracted from state health departments’ annual evaluation and progress reports and health impact statements. Qualitative data were analyzed using thematic analysis. Quantitative data were analyzed to determine year-to-year percent change from baseline to Year 5. Common activities implemented by recipients included establishing new programs, securing insurance coverage for programs, and using marketing strategies to educate patients about the National DPP LCP and DSMES programs. Outcomes from baseline to year 5 will be shared on the total number of American Diabetes Association recognized/American Association of Diabetes Educators accredited DSMES programs and the number of people who had at least one encounter with a program. Key facilitators for and challenges to increasing program utilization for DMSES and the National DPP will be shared. Findings provide relevant data on best practices to support and scale the National DPP and DSMES programs for improved health outcomes in diabetes. Findings will inform the implementation of sustainable strategies for National DPP and DSMES programs and shape future technical assistance to recipients. Disclosure A. Mensa-Kwao: None. Y. Mensa-Wilmot: None. K.D. Farris: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.

Building a Healthy Temple: a Diabetes Self-management Support Program in Hispanic Faith Community Settings

Building a Healthy Temple: a Diabetes Self-management Support Program in Hispanic Faith Community Settings

Patient Engagement in Type 2 Diabetes: A Collaborative Community Health Initiative.

Purpose The purpose of this study was to describe the effects of an innovative rural community-based, diabetes self-management education and support (DSMES) program on patient behaviors and outcomes. Methods A 12-month pre-post study design with physiological data collection at program initiation, 16 weeks, and 6 and 12 months postenrollment was used for program assessment. The program consisted of an American Diabetes Association-accredited curriculum provided by the hospital and interfaced with a YMCA curriculum promoting lifestyle change. The 28-session program was delivered over a 1-year period. Results The sample size was 115. Participants were primarily white and female, with a mean age of 57 years. Mean body mass index (BMI) at program initiation was 37; mean A1C was 8.5 (69.4 mmol/mol). Significant reductions were obtained in weight, BMI (at 16 weeks), and A1C (at 6 months); these reductions were sustained at 12 months. Medication intake was significantly reduced, and diabetes-related emergency department visits were below national averages. Conclusions Results support the positive impact of a year-long, community-based, healthy behavior, DSMES program on health outcomes and overall costs of care delivery in the rural setting.

National Snapshot of State Health Department Outcomes and Lessons Learned from Implementing Diabetes Self-Management Education and Support Programs and National Diabetes Prevention Programs

In 2013, CDC developed the State Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke, a five-year cooperative agreement which combined the efforts of four divisions to fund 50 state health departments (SHDs) to implement strategies to work through health systems and communities to prevent chronic disease and reduce complications from multiple chronic diseases. The Division of Diabetes Translation recommended several strategies to support type 2 diabetes prevention and diabetes management. The strategies focused on 1) increasing referrals to CDC-recognized lifestyle change programs operating under the National Diabetes Prevention Program (National DPP); 2) securing the program as a covered benefit for state or public employees and Medicaid beneficiaries; and 3) increasing referrals to, coverage for, and availability of diabetes self-management education and support (DSMES) programs. Quantitative analysis of SHD performance measures data shows that from baseline to year 4, there was an increase in access to and participation in DSMES and the National DPP. Qualitative analysis of SHD workplans identified program accreditation, technical assistance, partnerships, reimbursement for DSMES, and flexible scheduling for patients as key facilitators for increased DSMES program utilization. SHD grantees reported reimbursement availability, practice/provider referral policies, and having standard curricula as facilitators to implementing the National DPP lifestyle change program. Disclosure G.E. Rutledge: None. M. Anand: None. Y. Mensa-Wilmot: None.

Assessing the Evaluability of Type 2 Diabetes Prevention and Diabetes Management Interventions Focusing on Underserved Populations

Rates of diabetes and diabetes-related health complications continue to rise among African American and Latino populations. Additional research and evaluations of the National Diabetes Prevention Program (National DPP) and diabetes self-management education and support (DSMES) programs are essential for identifying and disseminating best practices to help underserved populations prevent type 2 diabetes and manage diabetes. Authors implemented a systematic screening and assessment methodology to identify and examine National DPP and DSMES programs in underserved communities that demonstrated high participation rates and improved outcomes within African American and Latino populations. This study describes the screening methods used to identify programs and lessons learned from promising and innovative practices shown to be effective in recruitment and retention of African American and Latino populations into the National DPP and DSMES. Of the 9 National DPP and 9 DSMES programs that met the inclusion criteria, 4 of each were selected for evaluability assessments. Lessons learned regarding recruitment, retention, cultural tailoring, effectiveness of evidence, and organizational capacity were identified. Specific strategies that supported program success included community partnerships, instructor or coaches/participant racial concordance, holding classes in multiple locations, and including more group sessions. A panel of diabetes subject matter experts reviewed information on program design, implementation, and data collection capacity to recommend 4 programs to participate in a rigorous evaluation. Disclosure K.D. Farris: None. T. Bonner: None. G.E. Rutledge: None. B. Smith: None.

Implementing Key Drivers for Diabetes Self-Management Education and Support Programs: Early Outcomes, Activities, Facilitators, and Barriers.

Implementing Key Drivers for Diabetes Self-Management Education and Support Programs: Early Outcomes, Activities, Facilitators, and Barriers.

Cooking Classes: A Diabetes Self-Management Support Intervention Enhancing Clinical Values

Purpose The purpose of this study is to examine the relationship between Healthy Teaching Kitchen (HTK) attendance among veterans who are diagnosed with type 2 diabetes mellitus (T2DM) and clinical outcomes as measured by A1C and blood pressure. Methods This retrospective chart review collected data from veterans with T2DM who participated in the Diabetes Self-Management Support (DSMS) HTK program at the Louis Stokes Cleveland VA Medical Center (LSCVAMC) between February 2013 and May 2016. Data collected included demographic information, frequency of DSMS HTK attendance, 3 A1C values, and 3 blood pressure values. Each subject was assigned to 1 of 4 quartiles based on frequency of DSMS HTK attendance. Results A1C values of all groups improved over time, regardless of DSMS HTK attendance quartile. However, as total DSMS HTK class attendance increased, there was a significant decrease in the A1C difference score. Conclusions Participation in a DSMS program that focuses on healthy, economical cooking skills may lead to a significant improvement in A1C regardless of frequency of attendance. However, individuals with more frequent attendance may experience additional improvement in glycemic control.

Use of Complementary Health Approaches Among Diverse Primary Care Patients with Type 2 Diabetes and Association with Cardiometabolic Outcomes: From the SF Bay Collaborative Research Network (SF Bay CRN).

To describe use of complementary health approaches (CHAs) among patients with type 2 diabetes, and independent associations between CHA use and Hemoglobin A1c (A1C) and lower-density lipoprotein (LDL) cholesterol. Participants were enrolled onto the SMARTSteps Program, a diabetes self-management support program conducted between 2009 and 2013 in San Francisco. At the 6-month interview, CHA use in the prior 30 days was estimated using a 12-item validated instrument. Demographic and diabetes-related measures A1C were assessed at baseline and 6-month followup. AIC and LDL values were ascertained from chart review over the study period. Medication adherence was measured using pharmacy claims data at 6 and 12 months. Patients (n = 278) completed 6-month interviews: 74% were women and 71.9% were non-English speaking. Any CHA use was reported by 51.4% overall. CHA modalities included vitamins/nutritional supplements (25.9%), spirituality/prayer (21.2%), natural remedies/herbs (24.5%), massage/acupressure (11.5%), and meditation/yoga/tai chi (10.4%). CHA costs per month were $43.86 (SD = 118.08). Nearly one third reported CHA (30.0%) specifically for their type 2 diabetes. In regression models, elevated A1C (>8.0%) was not significantly associated with overall CHA use (odds ratio [OR] = 1.78; 95% confidence interval [CI], 0.7 to 4.52) whereas elevated LDL was (OR = 3.93; 95% CI, 1.57 to 9.81). With medication adherence added in exploratory analysis, these findings were not significant. CHA use is common among patients with type 2 diabetes and may be associated with poor cardiometabolic control and medication adherence.

Internet-based Self-Management Support for Patients With Well-Controlled Type 2 Diabetes: A Real-Life Study.

BackgroundLittle attention has been paid to self-management support of patients with well-controlled type 2 diabetes mellitus (T2DM). Most studies evaluated the addition of self-management support to regular diabetes care, but self-management as an alternative for part of regular diabetes care has hardly been studied. In this study, we offered patients with well-controlled T2DM the opportunity to perform the 3 quarterly monitoring sessions at home using an Internet-based self-management program, resulting in online personalized advice.ObjectiveThe aim of our study was to assess the reach and feasibility of an Internet-based diabetes self-management support program for patients with well-controlled T2DM, addressing both primary care providers’ (PCPs) opinions and patients’ willingness to participate in such a support program.MethodsPCPs assessed patients’ eligibility for Internet-based self-management, and patients were offered the opportunity to participate. Characteristics of eligible and ineligible patients were compared, as well as those of participants and nonparticipants, also with regard to quality of life, treatment satisfaction, and illness perceptions. Multivariate logistic regression models were performed and odds ratios (ORs) calculated with 95% CIs.ResultsAlmost half (128/282, 45.4%) of the patients with well-controlled T2DM were considered ineligible by their PCPs mainly because of cognitive impairment and language barriers (8.2% and 8.9%). Older patients (OR for each year 1.06, 95% CI 1.03-1.09, P<.001), non–Western European patients (OR 3.64, 95% CI 1.67-7.92, P=.001), and patients with a longer diabetes duration (OR for each year 1.56, 95% CI 1.04-2.34, P=.03) were more often regarded as ineligible. Of the 154 patients considered eligible, 57 (37.0%) consented to participate and 30 (10.6%) started the program. Of 57 participants, 45 returned the 3 questionnaires; 21 of 97 nonparticipants returned the questionnaires. Nonparticipants less often thought that their disease would last their entire life (median 8.0 vs 10.0, P=.03) and they were more satisfied with their current treatment than participants (DTSQ total score 44.0 vs 40.0, P=.05). There was no significant difference in quality of life between the 2 groups.ConclusionsPCPs considered half of their patients with well-controlled T2DM incapable of Internet-based self-management mainly because of cognitive impairment and language barriers; of the selected patients, about 1 out of 3 was willing to participate. Older patients, non–Western European patients, and patients with a higher BMI were less likely to participate. Predominantly, practical issues (such as Internet problems) hindered implementation of the Internet-based self-management program.

Behavioral Programs for Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-analysis.

Behavioral programs may improve outcomes for individuals with type 2 diabetes mellitus, but there is a large diversity of behavioral interventions and uncertainty about how to optimize the effectiveness of these programs. To identify factors moderating the effectiveness of behavioral programs for adults with type 2 diabetes. 6 databases (1993 to January 2015), conference proceedings (2011 to 2014), and reference lists. Duplicate screening and selection of 132 randomized, controlled trials evaluating behavioral programs compared with usual care, active controls, or other behavioral programs. One reviewer extracted and another verified data. Two reviewers independently assessed risk of bias. Behavioral programs were grouped on the basis of program content and delivery methods. A Bayesian network meta-analysis showed that most lifestyle and diabetes self-management education and support programs (usually offering ≥ 11 contact hours) led to clinically important improvements in glycemic control (≥ 0.4% reduction in hemoglobin A1c [HbA1c]), whereas most diabetes self-management education programs without added support-especially those offering 10 or fewer contact hours-provided little benefit. Programs with higher effect sizes were more often delivered in person than via technology. Lifestyle programs led to the greatest reductions in body mass index. Reductions in HbA1c seemed to be greater for participants with a baseline HbA1c level of 7.0% or greater, adults younger than 65 years, and minority persons (subgroups with ≥ 75% nonwhite participants). All trials had medium or high risk of bias. Subgroup analyses were indirect, and therefore exploratory. Most outcomes were reported immediately after the interventions. Diabetes self-management education offering 10 or fewer hours of contact with delivery personnel provided little benefit. Behavioral programs seem to benefit persons with suboptimal or poor glycemic control more than those with good control. Agency for Healthcare Research and Quality. (PROSPERO registration number: CRD42014010515).