Diabetes Self-management Support Research Articles

The current diabetes education experience: Findings of a cross-sectional survey of adults with type 2 diabetes

ObjectiveTo survey persons with type 2 diabetes (PWD) on their experiences with diabetes education to better understand what it means when a PWD says they have “had diabetes education.” MethodsWe conducted a cross-sectional descriptive study among a convenience sample of adult PWD receiving primary care and/or diabetes self-management education and support in a mid-Atlantic regional US healthcare system. Descriptive, bivariate, and regression analyses were used to describe and explore the diabetes education experience. ResultsParticipants (n = 498) were majority female, African American, and non-Hispanic. Half reported having “had diabetes education.” Of those, 44% had only one session. Education was most often provided in clinical settings by a dietitian (68%) or doctor (51%), in one-on-one (70%) sessions. While most participants reported receiving core diabetes knowledge, fewer reported education on topics that are not related to their daily routine, such as what to do about diabetes medications when sick. ConclusionThe self-reported diabetes education experience varies in content, modality, setting, and education provider. Education receipt is low, and for those who receive education, the amount is low. Practical ImplicationsThe diabetes education experience may fall short of the comprehensive US National Standards-recommended process. Innovative strategies are needed to address these gaps.

Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices.

Nigeria struggles to reframe its traditional acute-care disease approach to health care to accommodate rising needs for chronic disease care. This interpretive descriptive study explored Nigerian healthcare providers' (HCPs) perspectives, experiences, and practices related to self-management support (SMS). Observational and experiential data were gathered from 19 HCPs at two urban hospitals in Southeastern Nigeria (seven physicians, four nurses, five dietitians/nutritionists, and three health educators). There were four themes: (a) compliance-oriented medical model, (b) SMS as advice, informal counseling, and education, (c) navigating the sociocultural terrain, and (d) workarounds. Nigerian HCPs perspectives and SMS practices were characterized by attempts to foster compliance with healthcare instructions within a traditional biomedical model. Participants enhanced patient support using specific strategies to bypass structural system obstacles. These findings demonstrate the need to reevaluate the current understanding of SMS in Nigeria and its practice.

Assessment of Glucose Monitoring Adherence in Medicare Beneficiaries with Insulin-Treated Diabetes.

Background: We investigated the potential associations between race/ethnicity and adherence to prescribed glucose monitoring in a sample of Medicare beneficiaries with diabetes and how adherence to the method used impacted diabetes-related inpatient hospitalizations and associated costs among beneficiaries with intensive insulin-treated diabetes. Methods: This 12-month retrospective analysis utilized Centers for Medicare & Medicaid Services data to identify Medicare beneficiaries who used intensive insulin therapy from January through December 2018 and classified them into four groups: (1) persons using real-time continuous glucose monitoring (rtCGM), (2) persons using any method of blood glucose monitoring (BGM) who followed prescribed use patterns (adherent), (3) persons who were prescribed BGM but were nonadherent in its use, and (4) no record of any form of BGM. Analyses compared these groups and the role that comorbidities (Charlson Comorbidity Index [CCI]), and race/ethnicity played on group assignment, diabetes-related inpatient hospitalizations, and costs. Results: Among the 1,329,061 persons assessed, 38.14% had no record of glucose monitoring and 35.42% were BGM nonadherent. Similarly, among the 629,514 beneficiaries with a CCI risk score of ≥2, 466,646 (74.13%) were either nonadherent to BGM or had no monitoring record. The percentage of White (3.65%) rtCGM adherent beneficiaries was significantly larger than Black (1.58%) and Hispanic (1.28%) beneficiaries, both P < 0.0001. Hospitalizations and costs were higher for Black and Hispanic beneficiaries versus Whites within the risk score ≥ 2 group regardless of glucose monitoring method. Conclusions: Race is associated with increased hospitalizations and costs associated with diabetes care and absence of any form of BGM was associated with higher rates of comorbidities. Persons of color were less likely to use rtCGM despite Medicare coverage. New initiatives that promote diabetes self-management education and support services are needed to improve utilization of glucose monitoring within the Medicare diabetes population.

Gender differences in social support for diabetes self-management: A qualitative study among veterans

ObjectiveDescribe the role of social support in veterans’ diabetes self-management and examine gender differences. MethodsWe conducted semi-structured interviews among veterans with diabetes from one Veterans Health Administration Health Care System. Participants described how support persons influenced their diabetes self-management and perspectives on a proposed self-management program incorporating a support person. We used thematic analysis to identify salient themes and examine gender differences. ResultsAmong 18 women and 18 men, we identified four themes: 1) women felt responsible for their health and the care of others; 2) men shared responsibility for managing their diabetes, with support persons often attempting to correct behaviors (social control); 3) whereas both men and women described receiving instrumental and informational social support, primarily women described emotional support; and 4) some women’s self-management efforts were hindered by support persons. Regarding programs incorporating a support person, some participants endorsed including family/friends and some preferred programs including other individuals with diabetes. ConclusionsNotable gender differences in social support for self-management were observed, with women assuming responsibility for their diabetes and their family’s needs and experiencing interpersonal barriers. Practice implicationsGender differences in the role of support persons in diabetes self-management should inform support-based self-management programs.

Impact of a community-based diabetes self-management support program on adult self-care behaviors.

Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; P-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.

Perceived Impacts, Facilitators and Barriers, and Recommendations to Support Diabetes Self-Management for Older Persons in Canada Through the Aging, Community and Health Research Unit – Community Partnership Program (ACHRU-CPP)

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention

To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.

The impact of enhancing self-management support for diabetes in Community Health Centers through patient engagement and relationship building: a primary care pragmatic cluster-randomized trial.

Type 2 diabetes (T2DM) self-management support (SMS) programs can yield improved clinical outcomes but may be limited in application or impact without considering individuals’ unique social and personal challenges that may impede successful diabetes outcomes. The current study compares an evidence-based SMS program with an enhanced version that adds a patient engagement protocol, to elicit and address unique patient-level challenges to support improved SMS and diabetes outcomes. Staff from 12 Community Health Center (CHC) clinical sites were trained on and delivered: Connection to Health (CTH; 6 sites), including a health survey and collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 sites), including additional relationship building training/support. Impact of CTH and EE-CTH on behavioral self-management, psychological outcomes, and modifiable social risks was examined using general linear mixed effects. Clinics enrolled 734 individuals with T2DM (CTH = 408; EE-CTH = 326). At 6- to 12-month postenrollment, individuals in both programs reported significant improvements in self-management behaviors (sugary beverages, missed medications), psychological outcomes (stress, health-related distress), and social risks (food security, utilities; all p < .05). Compared with CTH, individuals in EE-CTH reported greater decreases in high fat foods, salt, stress and health-related distress; and depression symptoms improved within EE-CTH (all p < .05). CTH and EE-CTH demonstrated positive behavioral, psychological, and social risk impacts for T2DM in CHCs delivered within existing clinical work flows and a range of clinical roles. Given the greater improvements in psychological outcomes and behavioral self-management in EE-CTH, increased attention to relationship building strategies within SMS programs is warranted.

Peer support and social networking interventions in diabetes self-management in Kenya and Uganda: A scoping review.

BackgroundDiabetes mellitus is a growing worldwide health challenge especially in sub-Saharan Africa. While the use and effectiveness of diabetes self-management interventions is well documented in high-income countries, little information exists in sub-Saharan Africa. Therefore, this study attempted to synthesize information in the literature on the use and efficacy of peer support and social networking in diabetes self-management in Kenya and Uganda.ObjectiveThe purpose of this scoping review is to summarize research on the extent of use and efficacy of peer support and social networking interventions in diabetes self-management in Kenya and Uganda.DesignWe searched PubMed, ScienceDirect and Cochrane Library databases for articles reporting peer support and social networking interventions in Kenya and Uganda published in English between 2000 and September 2021. Key words encapsulated three major themes: peer support, social networking and self-management. Hand searches were also conducted to select eligible papers. Data was extracted using a form prepared and piloted in line with PRISMA-ScR guidelines.ResultsThirteen peer reviewed articles were selected for analysis. Eleven studies reported peer support interventions while two focused on social networks in diabetes self-management. Peer support and social networking interventions incorporated microfinance and group medical visits, diabetes self-management education, telephone support and Medication Adherence Clubs. Most interventions were delivered by multidisciplinary teams comprising nurses and other professionals, peer educators, peer leaders and community health workers. Most interventions were effective and led to improvements in HbA1c and blood pressure, eating behaviors and physical activity and social support.ConclusionsThe limited studies available show that peer support and social networking interventions have mixed results on health and other outcomes. Importantly, most studies reported significant improvements in clinical outcomes. Further research is needed on the nature and mechanisms through which peer support and social network characteristics affect health outcomes.

Noninferiority of Telemedicine Delivered Compared With In-person Diabetes Self-Management Education and Support (DSMES) During Covid-19 Pandemic in Thailand.

This study aimed to compare the clinical outcomes and program satisfaction of diabetes self-management education and support (DSMES) for type 2 diabetes patients delivered by telehealth during COVID-19 pandemic to in-person delivery during pre-COVID-19. A retrospective case-controlled study was conducted (95 telehealth and 95 on-site). Differences in hemoglobin A1c (HbA1c) reductions between groups were analyzed by linear mixed-effects models, and satisfaction was collected. Compared with baseline, at the three-month follow-up, the HbA1c reductions of the telehealth and on-site DSMES were 1.20 ± 0.15% and 1.21 ± 0.15%, respectively (P < .001), whereas these were 1.28 ± 0.16% and 1.18 ± 0.15% at six-month follow-up, respectively (P < .001). There were no significant differences in HbA1c reduction between the two groups (P = .967 and .674 at three- and six-month follow-up). Majority of participants in both groups had high program satisfaction (telehealth 98.7% vs on-site 95.1%, P = .269). In conclusion, DSMES delivered via telehealth is as effective in lowering HbA1c as that delivered in-person, with a high satisfaction rate.

Health Extension for Diabetes: Impact of a Community-Based Diabetes Self-Management Support Program on Older Adults' Activation.

The goals of this study were to determine whether completion of a community-based diabetes self-management support (DSMS) program delivered through a university Cooperative Extension network increased Patient Activation Measure (PAM) scores and to examine predictors of improvement in PAM score in individuals participating in the DSMS. The Health Extension for Diabetes (HED) is a 4-month program delivered via a paraprofessional extension agent in partnership with an established diabetes self-management education and support program. The study population included 148 adults (median age 69 years; interquartile range 60-74 years) with diabetes recruited from local community organizations. Data for the analysis were collected before and after participation in the intervention as part of a longitudinal study, using the PAM and Self-Efficacy for Diabetes instruments. Descriptive statistics were gathered, and hypothesis tests and simple and multivariable regression analyses were conducted. The mean PAM score increased by 6.58 points, with a 5-point change considered clinically significant. From pre- to post-intervention, PAM scores significantly decreased for 23 participants, decreased for 6, did not change for 14, increased for 21, and significantly increased for 84. Higher pre-intervention PAM scores, younger age, greater educational attainment, and higher baseline self-efficacy scores were associated with increased post-intervention PAM scores when not controlling for potential covariates. Age was no longer associated with higher PAM scores after controlling for covariates. Community-based DSMS interventions can be effective in generating positive change in individuals' activation. HED provides a feasible and accessible DSMS option that addresses key diabetes self-management components while effectively improving individuals' activation. It is recommended that people living with diabetes attend a DSMS program such as HED to increase their ability to effectively self-manage various components of their chronic condition.

Effectiveness-implementation trial comparing a family model of diabetes self-management education and support with a standard model

BackgroundDiabetes self-management education and support (DSMES) is an effective approach for improving diabetes self-care behaviors to achieve improved glycemic management and other health outcomes. Engaging family members may improve outcomes, both for the person with diabetes (PWD) and for the family members. However, family models of DSMES have been inconsistently defined and delivered. We operationalize Family-DSMES to be generalizable and replicable, detail our protocol for a comparative effectiveness trial comparing Standard-DSMES with Family-DSMES on outcomes for PWDs and family members, and detail our mixed-methods implementation evaluation plan. MethodsWe will examine Family-DSMES relative to Standard-DSMES using a Hybrid Type 1 effectiveness-implementation design. Participants are ≥18 years old with type 2 diabetes mellitus and hemoglobin A1c ≥7.0%, recruited from rural and urban primary care clinics that are part of an academic medical center. Each participant invites a family member. Dyads are randomly assigned to Family- or Standard-DSMES, delivered in a small-group format via telehealth. Data are collected at baseline, immediately post-intervention, and 6-, 12-, and 18-months post-intervention. Outcomes include PWDs' hemoglobin A1c (primary), other biometric, behavioral, and psychosocial outcomes (secondary), and family members' diabetes-related distress, involvement in the PWD's diabetes management, self-efficacy for providing support, and biometric outcomes (exploratory). Our mixed-methods implementation evaluation will include process data collected during the trial and stakeholder interviews guided by the Consolidated Framework for Implementation Research. ConclusionResults will fill knowledge gaps about which type of DSMES may be most effective and guide Family-DSMES implementation efforts. RegistrationThe trial is pre-registered at clinicaltrials.gov (#NCT04334109).

From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia.

To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3months followed by bi-weekly telephone contacts in the last 9months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p=0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3months (-0.21; 95% CI: -0.35, -0.08; p=0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p=0.023) compared to usual care. Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC. The study was registered on clinicaltrials.gov (NT02804620).

Increasing Access to Diabetes Education in Rural Alabama Through Telehealth.

The high prevalence of diabetes in Alabama and the limited diabetes education available to patients in that state suggest that new interventions are needed. To that end, the authors developed a project to assess whether the use of telehealth technology to deliver diabetes self-management education and support (DSMES) in a small group setting is an effective and acceptable way to increase access to such education by underserved individuals. Certified diabetes educators, RNs, and telehealth services at three rural county health departments in Alabama implemented a DSMES program. Data were collected from participant registration forms, pre- and postintervention surveys, and telehealth surveys to assess participants' baseline and postintervention diabetes knowledge, self-care, and sense of self-efficacy. Blood pressure, glycated hemoglobin (HbA1c) levels, and weight were also measured before and after the intervention. Forty-two people attended the DSMES program and participated in its evaluation. The findings demonstrated that for this sample, telehealth was an effective and acceptable way to conduct DSMES. The substantial improvements in health status, coupled with the fact that most participants had never participated in a DSMES program before, highlight the untapped potential of such programs to increase access to diabetes education in underserved areas.

Current and Emerging Trends in Diabetes Care and Education: 2021 National Practice and Workforce Survey.

The purpose of the National Practice Survey is to understand current trends related to the diabetes care and education specialist's integration into the full care team beyond formal diabetes self-management education and support services. The 2021 National Practice Survey (NPS2021) contained 61 questions for all respondents with an additional 56 questions pertaining to specific diabetes care and education segments. An anonymous survey was administered online to respondents who are diabetes care and education specialists or a part of the diabetes care team. Email lists were obtained from the Association of Diabetes Care & Education Specialists (ADCES) and the Certification Board for Diabetes Care and Education (CBDCE). Approximately 39,258 emails were sent, and 3357 were undeliverable, with 3797 surveys completed between February 9 to April 6, 2021, resulting in an 11% response rate. The response rate may have been affected by the COVID-19 public health emergency. Diabetes care and education specialists represent an interprofessional specialty of nurses, dietitians, physicians, pharmacists, health educators, and others. Many respondents reported holding either certification as a Certified Diabetes Care and Education Specialist (CDCES) or being Board Certified in Advanced Diabetes Management (BC-ADM). In addition, there appears to be a slight increase in those trained as a Lifestyle Coach to provide the National Diabetes Prevention Program (CDC Recognized National DPP) compared to NPS2017. Most respondents reported being Caucasian/White (84%), followed by Hispanic or Latinx (7%) and African American/Black and Asian/Asian American (at 4% each), like in previous surveys. Respondents reported diverse care delivery models, including traditional and nontraditional services, and expanded models of care such as population health/risk stratification models, the Chronic Care Model, Accountable Care Organizations, managed care, and others. The NPS2021 describes DCES workforce opportunities and challenges. Identifying and addressing those that impact the specialty's sustainability, diversity, and growth will guide strategies for the future workforce and their practice settings. Opportunities identified include embracing diabetes community care coordinators for person-centered delivery of care and education services and supporting frontline health care team members to increase competence and expertise in the prevention of type 2 diabetes, diabetes care, and education/support for related chronic diseases. In addition, as health care evolves, it creates opportunities for the DCESs to demonstrate a broader, key role as part of the diabetes care team.

A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample.

Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information–Motivation–Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.

Exploring barriers and facilitators to pharmacist-provided diabetes self-management education and support

BackgroundPharmacists have the necessary clinical experience and medication knowledge to effectively provide diabetes self-management education and support (DSMES); however, barriers exist to DSMES implementation by community pharmacists. ObjectiveThe aim of this study is to explore DSMES from the community pharmacists’ perspectives, identify barriers and facilitators to pharmacist DSMES implementation, and guide development of pharmacist-provided DSMES programs in Idaho. MethodsImplementation climate, the theoretical framework for this project, is focused on how community pharmacists in Idaho perceive they will be supported by patients, health care providers, and insurers in DSMES implementation. Pharmacist investigators with qualitative research experience conducted semistructured interviews with 6 licensed community pharmacists from Idaho via Zoom between March and June 2020. Recordings were transcribed verbatim and analyzed using HyperRESEARCH 4.5.1. Themes, patterns, and dominant concepts that emerged from respondents’ about DSMES were explored, labeled, and categorized into modifiable and nonmodifiable barriers and facilitators. This study was granted expedited approval by the Idaho State University Investigational Review Board. ResultsRelevant themes included current scope of practice, barriers, and facilitators. Subthemes related to the current scope of pharmacy practice included unclear roles and responsibilities and legislative constraints to practice. For barriers, subthemes included cost of set-up, billing and coding education, and the sustainability of services based on current reimbursement models. For facilitators, subthemes included the need for additional collaborations (external and internal), technology access, and trained pharmacy staff. ConclusionPharmacists are underutilized health care providers, capable of providing DSMES services if provided the necessary resources. This work identifies barriers and facilitators to pharmacist-led DSMES that can be considered by others when implementing DSMES or other disease management services.

Cultural adaptation of a diabetes self-management education and support (DSMES) programme for two low resource urban settings in Ghana, during the COVID-19 era

BackgroundType 2 diabetes is a significant public health problem globally and associated with significant morbidity and mortality. Diabetes self-management education and support (DSMES) programmes are associated with improved psychological and clinical outcomes. There are currently no structured DSMES available in Ghana. We sought to adapt an evidence-based DSMES intervention for the Ghanaian population in collaboration with the local Ghanaian people.MethodsWe used virtual engagements with UK-based DSMES trainers, produced locally culturally and linguistically appropriate content and modified the logistics needed for the delivery of the self-management programme to suit people with low literacy and low health literacy levels.ConclusionsA respectful understanding of the socio-cultural belief systems in Ghana as well as the peculiar challenges of low resources settings and low health literacy is necessary for adaptation of any DSMES programme for Ghana. We identified key cultural, linguistic, and logistic considerations to incorporate into a DSMES programme for Ghanaians, guided by the Ecological Validity Model. These insights can be used further to scale up availability of structured DSMES in Ghana and other low- middle- income countries.

Equity in the Provision of Diabetes Self-Management Education and Support.

Diabetes self-management education and support (DSMES) interventions must be accessible to all people with diabetes. To address equity in the delivery of DSMES, interventions should consider the unique needs of various populations. This article outlines the needs of a wide range of populations, including people with diabetes who are racially or ethnically diverse; have limited English proficiency or literacy; are deaf or hard of hearing; are blind or have low vision; are neurodiverse; live with learning disabilities or intellectual or developmental disabilities; have dementia or cognitive impairment; or are of sexual and/or gender minority. The authors discuss how best to tailor DSMES to meet the needs of these diverse groups.

SEE-diabetes, a patient-centered diabetes self-management education and support for older adults: Findings and information needs from providers’ perspectives

Background and aimsDiabetes self-management education and support (DSMES) can improve clinical and health outcomes of people with diabetes. However, DSMES has been underutilized because of many barriers. We aimed to develop a patient-centered educational aid, SEE-Diabetes (Support-Engage-Empower-Diabetes), that facilitates shared decision-making about DSMES between patient and provider during the follow-up visit. We investigated the information needs to inform the design of the SEE-Diabetes from the providers’ perspective. MethodsWe conducted an online survey (N = 42) and three focus groups (N = 13) involving providers who have experience managing diabetes in older patients. Survey collected demographics and assessed knowledge of DSMES. During the subsequent focus groups, participants evaluated the Assessment and Plan section of three clinic notes of older people with diabetes. We also demonstrated the potential workflow of DSMES documentation using SEE-Diabetes during clinical practice. ResultsThe survey showed 60% of providers were familiar with DSMES. Focus group findings showed clinic notes should convey concise information at an appropriate reading level, numbered problems, and less medical jargon to improve the readability of clinic notes. Application of SMART (Specific, Measurable, Attainable, Relevant, Time-bound) goals was suggested to deliver effective diabetes self-care information. ConclusionsProviders should consider adopting validated DSMES guidelines along with goal-setting strategies to provide patient-centered care. The research team will integrate the provider recommendations when we develop SEE-Diabetes.