Diabetes Self-management Support Research Articles

The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.Graphical abstract

Complementarity of Digital Health and Peer Support: "This Is What's Coming".

This study examined integration of peer support and a Food and Drug Administration-cleared, diabetes management app (DMA) in diabetes self-management support as a scalable model for those with type 2 diabetes mellitus (T2DM). Two lay health Coaches delivered telephone-based self-management support to adults (N = 43) with T2DM recruited through a primary group practice. Those eligible were offered no-cost access to DMA for the entire 6-month study. Coaches introduced DMA and contacted individuals by phone and text with frequency dependent on participant needs/preferences. DMA supported monitoring of blood glucose, carbohydrate intake, and medication use, as well as messaging personalized to participants' medication regimens. Clinical data were extracted from DMA, electronic medical records, and Coaches' records. Structured interviews of 12 participants, 2 Coaches, and 5 project staff were analyzed using deductive pre-identified codes (regarding adoptability, patterns of use, value added, complementarity, and sustainability) utilizing standard procedures for qualitative analysis. Of the 43 participants, 38 (88.4%) enrolled in DMA. In general, participants used both DMA and lay health coaches, averaging 144.14 DMA entries (structured, e.g., medications, and free form, e.g., "ate at a restaurant" and "stressed") and 5.86 coach contacts over the 6-month intervention. Correlation between DMA entries and coach contacts (r = .613, p < 0.001) was consistent with complementarity as were participants' and coaches' observations that (a) DMA facilitated recognition of patterns and provided reminders and suggestions to achieve self-management plans, whereas (b) coaching provided motivation and addressed challenges that emerged. Mean hemoglobin A1c (A1c) declined from 9.93% to 8.86% (p < 0.001), with no pattern of coaching or DMA use significantly related to reductions. Staff identified resources to coordinate coach/DMA interventions as a major sustainability challenge. DMA and peer support for diabetes management are compatible and complementary. Additional practice integration research is needed for adoption and scale-up.

Effect of diabetes self-management education program on glycemic control in diabetic patients attending the family medicine outpatient clinic, Suez Canal University Hospital, Ismailia, Egypt

BackgroundDiabetes mellitus (DM) is a chronic disease with debilitating complications. Patients with diabetes are recommended to take various self-management decisions and carry out complex care activities. Diabetes self-management education (DSME) and support help people with diabetes to take these decisions and activities to improve health outcomes. DSME may serve as the basis to minimize and avoid catastrophic diabetes-related complications and the resulting financial and personal costs associated with this disorder. We aimed to assess the effect of diabetes self-management education program on glycemic control on patients with diabetes. A quasi-experimental pre-post study was conducted at the family medicine clinic in Suez Canal University hospital, Ismailia, Egypt. A total of 116 patients with uncontrolled DM were recruited by a simple random technique after applying the inclusion and exclusion criteria. Participants were subjected to a 12-week health education program (1 session/week). The sessions focused on areas of diabetes self-management based on the American Diabetes Association (ADA) guidelines. The glycosylated hemoglobin (HbA1c) was assessed at baseline and again at the end of the program. Also, self-care activities were evaluated pre-post intervention using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA) instrument which measured the activities related to diet, exercise, blood sugar testing, foot care, and medications.ResultsThe mean age of participants was 47 years (± 11.54), male patients represented 54%. About two-thirds (67%) were from urban areas and came from a middle socioeconomic level. About half of the participants (51.7%) were diagnosed as diabetics for 5–10 years duration. More than half (52.7%) were on combination therapy of insulin and oral antidiabetic drugs. After the intervention program, there was a statistically significant decrease in HbA1c level (p value < 0.001), and 21% of the participants reached the ADA treatment goal for HbA1c below 7.ConclusionAppropriate DSME programs are practical and have a benefit to patients with diabetes.

Unmet basic needs and family functions gaps in diabetes management practice among Indonesian communities with uncontrolled type 2 diabetes: A qualitative study.

Family members play a vital role in both helping and undermining diabetes mellitus selfmanagement practices. This qualitative study aimed to explore the potentially unmet needs of family function to support diabetes self-management (DSM) practices. In-depth interviews and focus group discussions (FGDs) were conducted among different key informants, including uncontrolled T2DM patients, caretakers and healthcare providers (HCPs) at community health centres. An open-ended approach was applied to elicit responses from the key informants. A total of 22 participants were involved in this study. All interview and FGD processes were audiorecorded and transcribed verbatim. The results found that all key informants addressed six core themes, with sub-themes to describe the unmet needs of family function to support DSM practice. The critical unmet needs of family function include: 1) Lack of problem-solving skills to deal with poor diabetes management; 2) Ineffective communication and refusal to share the burden of diabetes management; 3) Lack of affective responsiveness to encourage patients' compliance; 4) Lack of affective involvement in DSM; 5) Insufficient family roles in supporting patients; 6) Poor behaviour control of T2DM. Our findings provide insights into how family function may influence the adoption and maintenance of healthy behaviours among diabetic patients. Since health providers seek new approaches to improve DSM practices, this valuable finding was essential to understand how family function can improve and empower patients in DSM practice.

The Effect of Modified Diabetes Self-management Education and Support on Self-care and Quality of Life among Patients with Diabetic Foot Ulcers in Rural Area of Indonesia

BACKGROUND: Diabetes self-management education and support (DSMES) programs are patient-centered, holistic solution that enables it one of the best approaches for improving medication adherence enhanced coping, empowerment and self-efficacy, quality of life (QoL), and lower rates of depression, in people with type 2 diabetes mellitus (T2DM). In isolation, DSME strategies have not shown significant improvements to self-care and/or reduction of diabetic foot ulcer (DFU). AIM: This study sought to determine the effect of modified DSMES on self-care, DFU severity, and QoL in rural Indonesian patients with DFUs. METHODS: A quasi-experimental design with pre-test and post-test control group design, in Singkawang, West Kalimantan, Indonesia, with a total sample of 60 patients consisting of 30 patients in the intervention group and 30 patients in the control group. The DSMES has been adapted to cover 2 h of content for a period of 8 weeks and the eight-core components of DSMES. The curriculum was culturally adapted revised to incorporate culturally appropriate nature similarities, such as a prominent change to represent changes in glucose counts; to incorporate photos; to incorporate culturally relevant eating habits, such as fish and fruit; to communicate in detail the significance of medication adherence, with an emphasis on metformin’s organic, plant-based characteristics; and to emphasize engagement. Intention-to-treat analyses were conducted to determine the effect of modified DSMES on self-care, DFU severity, and QoL. RESULTS: The DSMES program improved outcomes in three of the three outcome indicators when compared to the control group at T1: In this study, (1) the DFU degree increased by 3.3% points (95% confidence interval [CI]: 0.018–0.194), (2) the diabetes foot self-care behavior score increased by a modest 8.8% points (95% CI: 0.021–0.203), and (3) the QoL increased by 32.7% points (95% CI: 00.075–0.689). The degree of DFU (difference-in-difference [DID] coef. 0.350, 95% CI 0.084–0.572), diabetes foot self-care behavior (DID coef. 0.085, 95% CI 0.065–0.405), and QoL (DID coef. 0.343, 95% CI 0.078–0.436) are all still significantly improved compared to the control at T2. CONCLUSION: The primary outcome analyses indicate that the adapted DSMES was more effective than standard care at improving self-care and QoL and decreasing DFU degree in this sample of Indonesians with DFU, both immediately after and 3 months after the intervention. As nurse educators, it is our responsibility to ensure that we evaluate all of the support options accessible to the patients in our care.

Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews.

The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

Diabetes Self-Management Education and Support Culturally Tailored for African Americans: COVID-19-Related Factors Influencing Restart of the TX STRIDE Study.

PurposeThe purpose of this substudy was to determine the most acceptable way to restart the Texas Strength Through Resilience in Diabetes Education (TX STRIDE) study safely using remote technologies. Following the emergence of COVID-19, all in-person TX STRIDE intervention and data collection sessions were paused.MethodsQualitative descriptive methods using telephone interviews were conducted during the research pause. A structured interview guide was developed to facilitate data collection and coding. Forty-seven of 59 Cohort 1 participants were interviewed (mean age = 60.7 years; 79% female; mean time diagnosed with type 2 diabetes = 11 years).ResultsData categories and subcategories were generated from the interview responses and included: personal experiences with COVID-19, effects of COVID-19 on diabetes self-management, psychosocial and financial effects of COVID-19, and recommendations for program restart. Although some participants lacked technological knowledge, they expressed eagerness to learn how to use remote meeting platforms to resume intervention and at-home data-collection sessions. Six months after the in-person intervention was paused, TX STRIDE restarted remotely with data collection and class sessions held via Zoom. A majority of participants (72.9%) transitioned to the virtual platform restart.ConclusionsQualitative findings guided the appropriate implementation of technology for the study, which facilitated a successful restart. High retention of participants through the study transition provides evidence that participants are invested in learning how to manage their diabetes despite the challenges and distractions imposed by COVID-19.

Acceptability of a self-management support intervention for people living with type 2 diabetes to promote a person-centered approach by nurses: A qualitative study

BackgroundThe diabetes guidelines recommend that healthcare professionals adopt a person-centred approach when they support the self-management of people living with type 2 diabetes. However, nurses seem to have difficulty implementing this approach in their clinical practice. The Person-Centred Approach Diabetes Self-Management Support is an individual intervention to promote the adoption of a person-centred approach among nurses who intervene with people living with type 2 diabetes having self-management difficulties. The intervention includes a tool, the Needs Map, which starts the encounter from the person's needs, concerns, and beliefs and targets intervention strategies according to these factors. ObjectivesTo explore the acceptability of the Person-Centred Approach Diabetes Self-Management Support as an intervention for nurses to support adults living with type 2 diabetes. DesignA qualitative descriptive interpretative approach. SettingsTwo local community service centers in Quebec (Canada) that already provide self-management education and support to people living with type 2 diabetes. ParticipantsTen adults living with type 2 diabetes with self-management difficulties and two nurses. MethodsEach adult met the same nurse twice during a 30-minute individual self-management support session in which the nurse used the new intervention, one to three months apart. Various methods of data collection were used: individual interviews, focus group, and dyadic interviews with persons living with diabetes and nurses as well as observation of self-management support sessions and collection of the Needs Maps elaborated in those encounters. FindingsThe results suggest that the person-centred intervention is generally well accepted by persons and nurses. Five main themes stand out in relation to acceptability: positive experience (feeling listened to and considered, and not feeling judged), consistent with personal values (placing the person at the heart of the intervention), having to adapt to a new way of doing things (ability increases with practice), requires cognitive and emotional effort (questioning oneself, experiencing difficult emotions, and losing one's usual bearings), and more effective than usual interventions (promoting adoption of person-centred approach, relevance of the visual aspect, raising awareness, and mobilising toward action). ConclusionThe intervention seems to have led to the adoption of a person-centred approach by nurses. It would be relevant to explore in future studies if it persists over time and can lead to lasting tangible effects on person self-management as well as various parameters of their health, including their quality of life.

Factors influencing self-care behavior of socio-economically disadvantaged diabetic patients: A systematic review.

Diabetes mellitus and its complications carry broad financial misfortune to the diabetic patients and their family, to the well-being frameworks, and to the public economies through direct clinical expenses and decreased work efficiency. The present study systematically reviewed the possible factors that are influencing self-care behavior of disadvantaged diabetic patients that contribute heavily to the management of this chronic illness. Structured searches were conducted on PubMed, ScienceDirect, and manual searches on Google Scholar for articles published between the years 2000 and 2020. The review was limited to a particular time frame due to the change in WHO criteria for diagnosis and classification of abnormal glucose tolerance. Initially, 96858 articles were identified, and following the screening and full-text reading, 10 studies that met the inclusion criteria were chosen for systematic review. Seven studies had reported the factors influencing self-care behavior among disadvantaged diabetic population. Three studies had reported the importance of intervention strategies and its impact on self-care behavior among them. Findings show that self-care management of socio-economically disadvantaged people entails dimensions including diabetes knowledge, lack of physical activities, social support, lack of access to services, life disruptions, denial of illness, societal attitudes, responsibilities, and treatment costs. It was additionally discovered that diabetes self-management support mediations are successful in drawing in lower economy patients, tending to contending life needs and hindrances to self-care, and encouraging behavior change. Taken together, future methodologically efficacious studies that establish health promoting behaviors and explorations of the factors influencing self-care behaviors of disadvantaged diabetic patients are needed.

The Influence of Baseline Hemoglobin A1c on Digital Health Coaching Outcomes in Adults With Type 2 Diabetes: Real-World Retrospective Cohort Study.

BackgroundDigital health coaching is an increasingly common diabetes self-management support strategy for individuals with type 2 diabetes and has been linked to positive mental and physical health outcomes. However, the relationship between baseline risk and outcomes is yet to be evaluated in a real-world setting.ObjectiveThe purpose of this real-world study was to evaluate trends in digital health coaching outcomes by baseline hemoglobin A1c (HbA1c) to better understand which populations may experience the greatest clinical and psychosocial benefit.MethodsA retrospective cohort study design was used to evaluate program effect in a convenience sample of participants in a 12-week digital health coaching program administered by Pack Health. Participants were referred through their health care provider, payer, or employer. The program included patient-centered lifestyle counseling and psychosocial support delivered via telephone, text, and/or email. Self-reported HbA1c and weight were collected at baseline and completion. Physical and mental health were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form and the Diabetes Distress Scale-2. Changes in HbA1c, weight, BMI, and physical and mental health were analyzed within three participant cohorts stratified by baseline HbA1c level.ResultsParticipants with complete HbA1c data sets (n=226) were included in the analysis. The sample population was 71.7% (162/226) female, with 61.5% (139/226) identifying as white and 34.1% (77/226) as black. Most participants (184/226, 81.4%) reported a baseline HbA1c ≥7%, and 20.3% (46/226) were classified as high risk (HbA1c >9%). Across HbA1c cohorts, the mean baseline BMI was 35.83 (SD 7.79), and the moderate-risk cohort (7% ≤ HbA1c ≤ 9%) reported the highest mean value (36.6, SD 7.79). At 12 weeks, patients reported a significant decrease in HbAlc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P<.001). Across cohorts, BMI improved by 0.82 (P<.001), with the moderate-risk cohort showing the greatest reduction (−0.88; P<.001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P<.001) and mental health improved 3.3 points (P<.001). However, the lowest-risk cohort showed the greatest improvements in diabetes distress (−0.76; P=.005).ConclusionsAcknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline HbA1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high HbA1c experienced the greatest HbA1c reduction and individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching.

The Effects of Diabetes Self-Management Education and Support Program in Thailand: A Systematic Review and Meta-Analysis

Background: Diabetes is a growing health problem worldwide. Diabetes self-management education and support (DSMES) program is a crucial component in promoting self-care in all people with diabetes. However, the practice in certain countries, including Thailand, is not yet standardized, thus the effectiveness of such program is unknown. Objective: To evaluate the effectiveness of DSMES in Thailand. The outcomes were glycemic control, lipid levels, body mass index (BMI), quality of life (QoL), and diabetes knowledge. Materials and Methods: The authors searched PubMed, Scopus, and ProQuest databases since their inception until March 2019 for randomized controlled trials conducted in Thailand that evaluated outcomes of DSMES programs. Meta-analyses were performed to pool mean differences (MD) of the outcomes. Results: Seven studies, with 1,523 participants, were included. DSMES programs were conducted in different healthcare settings by health professionals from multiple disciplines. The results revealed that participants receiving DSMES had significantly lower hemoglobin A1c, MD –0.66% (95% CI –0.90 to –0.42), and FBG levels, MD –15.88 mg/dL (95% CI –20.95 to –10.79), than those who did not. Lipid levels, BMI, QoL, and diabetes knowledge, however, did not significantly differ. Conclusion: Meta-analysis results showed that DSEMS is effective in improving glycemic control and should be promoted to combat the burden of this important health problem in Thailand. Keywords: Diabetes self-management education and support; DSMES; Glycemic control; Meta-analysis; Thailand

Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study.

BackgroundIndividuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated.ObjectiveThis study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use.MethodsWe conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations.ResultsWe conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A1c control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate cues into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized.ConclusionsThe participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content.

Perceptions of African American Adults With Type 2 Diabetes on Family Support: Type, Quality, and Recommendations.

The overall purpose of the study was to explore perceptions of family support in diabetes self-management among African American adults with type 2 diabetes. A qualitative study using focus group methodology and individual interviews was conducted. Thirty-seven African American adults with type 2 diabetes were recruited in the Midwest, United States. Data were analyzed using qualitative content analysis. Themes emerged from the perspectives of the social interdependence theory. Positive family support included emotional support, instrumental support, and specific information or advice on diabetes management strategies. Positivity, family communication, and healthy eating/meal planning were perceived as helpful family behaviors. Negative support was perceived as intentional or unintentional behaviors. Family members' help in decision-making included goal setting with family member(s) and help in making decisions on diet and exercise. Recommendations included exercise and nutritional programs, support groups, family involvement, and materials and resources. Motivations for attending diabetes programs included involving family members, sharing success stories, seeing positive results, encouraging and caring, and providing incentives. Intervention programs for African Americans should specifically target challenges in family support, healthy eating, and physical activity at an interpersonal level. Health care providers should assess family roles and family support to facilitate diabetes self-management for African Americans.

829-P: Improving Diabetes Self-Management with a Peer-to-Peer Mentoring Program: Final Results of a Pilot Program at a Safety Net Health Care System

New York City Health + Hospitals (NYC H+H) is the largest safety net healthcare system in the nation, serving more than one million patients each year. Most of NYC H+H’s patients are low-income and people of color, who, in NYC as in the rest of the nation, bear a disproportionate burden of chronic diseases. At NYC H+H, 18% of patients have diagnosed diabetes, and nearly 23,000 (39%) of the 59,000 patients monitored in NYC H+H’s diabetes registry have poorly controlled diabetes (A1c ≥ 8). In an effort to support these patients’ diabetes management between their regular visits, NYC H+H launched a pilot program of InquisitHealth, a one-on-one peer mentoring service that matches patients with mentors who have controlled their own diabetes and received training to become peer coaches. Several small, randomized, controlled trials have demonstrated the program’s effectiveness in reducing A1c, but there is limited evidence of its effectiveness in a real-word setting. The key aims of this pilot program were to: 1) bridge the gap between patients and providers outside of clinic visits, 2) increase patient education on and support for diabetes self-management, and 3) improve patients’ diabetes outcomes as evidenced by reductions in A1c. The pilot program enrolled 336 patients at two NYC H+H facilities for a twelve-month intervention. Among the first 180 patients enrolled at one large acute care hospital, the mean reduction in A1c from baseline to six months following enrollment was 1.08. As compared to propensity score-matched control patients at a similar non-participating hospital in the NYC H+H network, participants experienced a greater reduction in A1c of 0.61 (-1.08 vs. -0.47, p&amp;lt;0.01). Results from the 12-month final analysis of all participants will be presented. Disclosure R. Kalyanaraman marcello: None. J. Dolle: None. S. Kaur: None. S. R. Patterson: None. N. Davis: None. Funding National Institutes of Health (UL1TR001445)

466-P: Cultural Adaptation of a Diabetes Self-Management Education and Support Telehealth Intervention for Rural Colorado

Diabetes impacts rural populations at higher rates compared to their urban counterparts. Diabetes self-management education and support (DSMES) is an evidence-based standard of care for people with diabetes. Yet, in rural areas, DSMES is often not available, culturally relevant, or integrated into primary care practices where many people receive diabetes care. This study uses a community-based participatory research (CBPR) approach to adapt the language, tools, and delivery of a DSMES program for use in Spanish and English-speaking populations in the High Plains Research Network in rural eastern Colorado. Boot Camp Translation (BCT) is a CBPR method that combines medical, research, and local community member expertise to create locally relevant language, messages and materials to promote discussion and action around a medical condition. For this study, community partners included 13 diverse community members (including bilingual Spanish-speakers, patients, caregivers, and healthcare providers). The group identified a particular need to increase awareness of the connection between diabetes and mental health, specifically depression, and diabetes burnout. Language and tools to address stigma and normalize the connection, talking points to initiate discussions with care teams, and calls for practices to increase screening for depression among patients with diabetes, are under development. Additional themes identified include incorporating nutrition information for food that is culturally appropriate and locally available, and integrating DSMES within the primary care practices where people with diabetes receive their care. Community engagement is crucial to support DSMES program adoption in rural communities. Disclosure T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. B. Kwan: None. J. Neuberger: None. K. Curcija: None. S. Burke: None. L. K. Zittleman: None. J. S. Simonetti: Consultant; Self; Rhythm Pharmaceuticals, Research Support; Self; Rhythm Pharmaceuticals . Funding National Institute of Nursing Research; National Institutes of Health (1R56NR019466-01)

62-OR: Fostering Sustainability through Diabetes Self-Management Support in African-American Churches: Results of the Praise Diabetes Project

A gap exists between diabetes self-management education (DSME), DSMS practices, and the infrastructure needed to foster sustainability of improved outcomes, particularly in low-resource communities. We determined the relative effectiveness of 3 parallel DSMS approaches in improving A1c and diabetes distress (DD). Moderate DD was 2.0-2.9 and high DD was ≥ 3.0. 370 individuals [mean age: 64.6 years, 74% female, 100% African American (AA), mean A1c: 7.7%±1.9, 22.8% with moderate DD] from 21 AA churches in southeast Michigan and northwestern Ohio, took part in a cluster randomized trial from 2016-2020. Data were collected at baseline, 6, 9, 21, and 33 months. Churches were randomized to one of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS (n=123), PL DSMS (n=127), or PN DSMS (n=109)]. Twenty-one PNs and 28 PLs were trained to facilitate DSMS at each church. Sustained reduction in A1c was observed in all groups (PNPL: -0.2%, p=0.68; PN: -0.2%, p=0.13). PL had borderline statistically significant reductions (-0.3%, p=0.08). The proportion of participants with A1c &amp;lt; 7% also improved over time in each group (PNPL: 57.3 vs. 60.7%, p=0.21; PL: 57.3 vs. 62.7%, p=0.44; PN: 40.9 vs. 44.1%, p=0.66), but not significantly. Of those who achieved A1c &amp;lt; 7% following DSME (9-month follow-up), 81.3% of participants, across all groups, sustained the goal at 33 months. PN had the most participants with sustained glycemic control (PNPL: 81.6%, PL: 76.7%, PN: 86.9%). Significant improvements in mean DD scores were observed from baseline to 33 months in all groups (PNPL: 2.1 vs. 1.8, p=0.05; PL: 2.0 vs. 1.7, p=0.004). Moreover, there was a 50% reduction in the proportion of participants with moderate DD in PL (31.7% vs. 12.2%) and PN (27.5% vs. 15%) and severe DD in PN (10% vs. 5%). Varied approaches to DSMS within the context of existing community infrastructures (AA churches) fostered the sustainability of improvements in diabetes-related outcomes. Disclosure G. Piatt: None. A. M. Provenzano: None. R. Nwankwo: None. D. Hall: None. K. A. Kloss: None. J. M. Hawkins: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. Funding National Institutes of Health (R01DK103733)

7-OR: Racial/Ethnic Differences in Barriers to Type 1 Diabetes (T1D) Self-Management between Non-Hispanic Black and Hispanic Young Adults (YA)

Background: YA with T1D of non-Hispanic Black and Hispanic race-ethnicity face unique challenges to diabetes self-management, yet little research acknowledges potentially distinct lived experiences and needs between these racial/ethnic groups. Methods: We recruited Black and Hispanic YA with T1D from adult and pediatric diabetes centers at Montefiore Medical Center in the Bronx, NY to conduct individual semi-structured interviews focusing on barriers and facilitators to diabetes self-management. Interviews were performed telephonically or in person, and recorded and transcribed. A modified inductive coding approach was used to analyze the data for common themes until thematic saturation was achieved. Results: We interviewed 39 YA with T1D (18-25 yrs, 26% Black, 74% Hispanic, mean HbA1c 10.3%). Common T1D self-management barriers between Black and Hispanic YA centered on normative development, including competing priorities and peer acceptance of T1D. Differences in self-management barriers were related to culture and lived experience. Black YA reported major challenges related to social determinants of health, such as food insecurity, insurance lapses, and racial bias in the healthcare system. Meanwhile, Hispanic YA reported challenges related to culture and family, such as difficulty incorporating ethnic food into diabetes dietary guidelines and navigating household intergenerational conflict on management of T1D. Conclusions: Black and Hispanic YA with T1D share common challenges to T1D self-management related to stage of development, but key differences exist between these racial/ethnic groups that should inform future interventions. For Black YA with T1D, addressing social determinants of health is an urgent initial need to help support diabetes self-management while for Hispanic YA, family and food-related conflict management is a priority. Disclosure M. Finnan: None. G. Crespo-ramos: None. S. Agarwal: None. Funding National Institutes of Health (K23DK115896)

854-P: A Statewide Needs Assessment to Inform Best Practices for the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH)

Background: Funded by the Ohio Department of Medicaid, the Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites the 7 medical schools in Ohio to improve outcomes and reduce disparities in hypertension and type 2 diabetes (T2D). The purpose of this needs assessment was to identify high priority educational topics for the dissemination of evidenced-based best practices. Methods: Questions surveyed collaborative members’ familiarity with guidelines, educational topics, and barriers to care. Results: A total of 111 out of 123 members completed the needs assessment (90.2% response rate). Half (49.5%, n=55) were familiar with the 2017 ACC/AHA guidelines for hypertension, whereas only 36.9% (n=41) were familiar with the 2020 ADA guidelines. The 3 topics of most interest were: 1) social determinants of health (SDOH, 55.9%, n=62), 2) lifestyle approaches to T2D (40.5%, n=45), and 3) new therapies for T2D (32.4%, n=36). Fifty-nine members (53.2%) provided direct clinical care; the others worked in research and public health. Providers estimated 25% of their T2D patients had A1C values &amp;gt;9.0%. Providers listed the 3 most common patient self-care barriers as: 1) lack of patient motivation (65.5%, n=38), 2) lack of patient education (60.3%, n=35), and 3) limited formularies and prior authorizations (41.4%, n=24). The 3 most common reasons for clinical inertia were: 1) lack of patient education (50.0%, n=29), 2) competing priorities (46.6%, n=27), and 3) lack of patient motivation (44.8%, n=26). Providers felt payers could help them with: 1) transportation (61.0%, n=68), 2) coverage of diabetes self-management education and support (DSMES, 59.4%, n=66), and 3) obtaining glucose monitors (45.9%, n=51). Conclusions: Top priorities for future evidence-based best practices are SDOH, patient engagement, and addressing complexity of care. Payers should prioritize increased coverage for DSMES and simplification of ordering monitoring supplies. Disclosure E. A. Beverly: None. G. D. Solomon: None. M. B. Holliday: None. J. Lewis: None. A. Nevar: None. S. M. Swiatkowski: None. M. W. Konstan: None. S. D. Bolen: None. K. M. Dungan: Advisory Panel; Self; Eli Lilly and Company, Tolerion, Inc., Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Elsevier, Novo Nordisk, Other Relationship; Self; UpToDate, Research Support; Self; Abbott, Sanofi-Aventis, Viacyte, Inc. J. T. Wright: None. A. Caron: None. M. Clemons: None. S. Aldrich renner: None. K. Gawlik: None. M. Sajatovic: Consultant; Self; Alkermes, Janssen Pharmaceuticals, Inc., Otsuka America Pharmaceutical, Inc., Other Relationship; Self; Springer Press, Johns Hopkins University Press, Oxford Press, UpToDate, Research Support; Self; Alkermes, Nuromate, Otsuka America Pharmaceutical, Inc. G. Rao: None. Funding Ohio Medicaid Technical Assistance and Policy Program (G-2021-05-0069)

869-P: Patient-Provider Video Visit Use and HbA1c Control among Patients with Diabetes

Video telemedicine can offer patients direct real-time convenient access to clinicians without arranging transportation or work time-off, improving access to diabetes care and self-management support. We examined the association between video visit use and hemoglobin A1c (HbA1c) among patients with diabetes. In a longitudinal study, within a large integrated delivery system where patients were first able to self-schedule real-time physician video visits in 2016, we used the clinical registry to identify patients with diabetes (2015), and followed their video visit use and subsequent HbA1c values over time (2016-2019). Using linear regression with patient-level fixed effects (within-patient changes), adjusting for calendar year and month and time-changing patient mobile portal access, we measured the association between use of video visits as a time-changing variable and the patient’s yearly HbA1c values (in subsequent calendar years after video visit use). We then stratified analyses by baseline HbA1c value: &amp;lt;8%, ≥8%, no value (defined as lower patient engagement). Among 204,301 patients with diabetes, 50% were 65 years or older, 48% were women, and 45% were of white race/ethnicity. Overall, 95% of patients had a baseline HbA1c value, 24% had HbA1c values ≥8%. Patient use of video visits was associated with an overall statistically significant reduction in HbA1c value by 0.15% (95% CI: 0.11%-0.19%). Among those with baseline HbA1c values ≥8%, using video visits was associated with a HbA1c value reduction of 0.22% (95% CI: 0.12%-0.32%), and among patients with lower baseline engagement (i.e., no baseline HbA1c measurement), using video visits was associated with a HbA1c reduction of 0.39% (95% CI: 0.07%-0.71%). Use of video visit was associated with improved glycemic control among patients with diabetes, with greater improvements found among patients with worse baseline control and lower engagement. Video visits may offer convenient health care access to improve diabetes management. Disclosure M. Reed: None. A. Gopalan: None. I. Graetz: None. L. Hsueh: None. J. Huang: None. E. Muelly: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085070)

473-P: Feasibility and Acceptability of a Direct-to-Home Diabetes Self-Management Education and Support Telemedicine Program (DSMES) with High-Risk Patients in a Rural, Underserved Area

Ongoing support is critical to DSMES effectiveness, but difficult to realize, particularly in underserved areas with limited resources. The purpose of this study, initiated February 2020, was to evaluate the feasibility and acceptability of Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support (TREAT-ON), a DSMES model delivered primarily through direct-to-home videoconferencing. Methods: High risk patients with diabetes (A1c &amp;gt;9% or unplanned care) from rural federally qualified health centers were referred to TREAT-ON. Participants completed an initial face-to-face or virtual visit with a Diabetes Care and Education Specialist (DCES) to assess needs and develop self-management treatment plan and behavioral goals. Planned follow-up visits, used to support achieving and sustaining goals and outcomes, were conducted through videoconferencing. To assess feasibility and acceptability over first 3-months of participation, visit frequency, duration, completion rates, and technology issues were tracked and patients completed the Telehealth Usability Questionnaire (TUQ). Results: Participants (n=25) were 60% female, 92% White, mean age 47.6±13.6y, mean A1c 11.5±1.8% and 76% had Medicare or Medicaid. They participated in 3 video visits, on average, lasting a mean of 35 minutes/visit. Of all scheduled video visits (n=99), 71% were successfully completed and 23% had technology issues (difficulty setting up system, connectivity issues). The TUQ revealed that participants were highly satisfied with the TREAT-ON videoconferencing approach (4.7/5), finding it useful (4.5/5), easy to learn/use (4.5/5), reliable (4.3/5), with quality interface (4.6/5) and interaction (4.7/5). Conclusion: This telehealth DSMES model offers a promising approach to improve opportunities for ongoing support to vulnerable individuals in underserved communities. Disclosure J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. J. Ng: Research Support; Self; Sanofi-Aventis. P. A. Johnson: None. S. L. Reynolds: None. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. Funding National Institute of Diabetes And Digestive and Kidney Diseases (R34DK123370)