Diabetes Self-management Training Research Articles

Improving Diabetes Equity and Advancing Care (IDEA) to optimize team-based care at a safety-net health system for Black and Latine patients living with diabetes: study protocol for a sequential, multiple assignment, randomized trial

BackgroundDiabetes is the eighth leading cause of death in the USA. Inequities driven by structural racism and systemic oppression have led to racial/ethnic disparities in diabetes prevalence, diagnosis, and treatment. Diabetes-self management training (DSMT), remote glucose monitoring (RGM), and tailored support from a community health worker (CHW) have the potential to improve outcomes. This study will examine the implementation of these interventions in a safety-net healthcare setting.MethodsUsing implementation science and racial equity principles, this study aims to (1) evaluate the appropriateness; (2) measure fidelity; and (3) compare the effectiveness of varying the combination and sequence of three interventions. An exploratory aim will measure sustainability of intervention adherence and uptake. This mixed-methods trial employs a sequential, multiple assignment randomized trial (SMART) design, patient focus group discussions, and staff interviews. Eligible Black/Latine patients will be recruited using patient lists extracted from the electronic medical record system. After a detailed screening process, eligible patients will be invited to attend an in-person enrollment appointment. Informed consent will be obtained and patients will be randomized to either DSMT or RGM. At 6 months, patients will complete two assessments (diabetes empowerment and diabetes-related distress), and HbA1c values will be reviewed. “Responders” will be considered those who have an HbA1c that has improved by at least one percentage point. “Responders” remain in their first assigned study arm. “Nonresponders” will be randomized to either switch study arms or be paired with a CHW. At 6 months participants will complete two assessments again, and their HbA1c will be reviewed. Twelve patient focus groups, two for each intervention paths, will be conducted along with staff interviews.DiscussionThis study is the first, to our knowledge, that seeks to fill critical gaps in our knowledge of optimal sequence and combinations of interventions to support diabetes management among Black and Latine patients receiving care at a safety-net hospital. By achieving the study aims, we will build the evidence for optimizing equitable diabetes management and ultimately reducing racial and ethnic healthcare disparities for patients living in disinvested urban settings.Trial registrationClinicalTrials.gov: NCT06040463. Registered on September 7, 2023.

Outcomes of Medicare-covered diabetes self-management training for cancer survivors with diabetes.

This study aimed to examine the impact of utilization of the Medicare-covered Diabetes Self-Management Training (DSMT) on the likelihood of receiving preventive care and on outcomes among cancer survivors with diabetes. We conducted a retrospective cohort study using 1999-2019 Texas Cancer Registry-Medicare linkage data for beneficiaries diagnosed with prostate, colorectal, or breast cancer for ≥5 years. We used propensity score matching to estimate the beneficiaries' probability of receiving DSMT and matched it with non-users. The observed DSMT outcomes were hospitalization, ER visit, eye exam, HbA1c test, foot exam, nephropathy, and all-cause mortality. DSMT utilization was set at attending 1, 2, and 3 or more sessions. Conditional Cox proportional hazard regression was built to determine the association between DSMT use and each respective outcome, unadjusted and adjusted for patients' covariates. A total of 79,271 beneficiaries (65% had diabetes-related complications, and 41% were either prostate or breast cancer survivors) were included. We found that (1) DSMT users had more eye exams (HR=1.27), HbA1c tests (HR=1.47), foot exams (HR=1.21), and nephropathy visits (HR=1.11), and less hospitalization (HR=0.86) and overall mortality (HR=0.70) (p≤0.01 each vs. non-users); (2) among DSMT users, 56% attended one session, 24% attended 2 sessions, and 20% attended 3 or more sessions; (3) attending 2 or ≥3 DSMT sessions was associated with more eye exams (HR=1.14), HbA1c tests (HR=1.12), and foot exams (HR=1.24). DSMT is instrumental to preventing or delaying complications of diabetes in cancer survivors and reducing their overall mortality. The findings may inform future efforts to promote the value of DSMT for cancer survivors. Medicare-covered DSMT offers a great value to cancer survivors with diabetes.

Utilization of diabetes self-management program among breast, prostate, and colorectal cancer survivors: Using 2006-2019 Texas Medicare data.

Cancer treatment is associated with inferior health outcomes such as diabetes. Medicare provides Diabetes Self-Management Training (DSMT) program to beneficiaries to achieve normal metabolic control and reduce the risk of micro and macro-vascular complications. This study aimed to examine the trend of DSMT utilization among cancer survivors and assess individual characteristics associated with it. The data for this study was from Texas Cancer Registry-Medicare linkage data of patients with prostate, breast, or colorectal cancer diagnosed in 1999-2017. Outcome variables include the number of first-time DSMT users, the number of total users, and the average number of DSMT utilization in minutes. We performed logistic regression and gamma regression to obtain a multivariable-adjusted odds ratio for the association between DSMT utilization and individual characteristics. The number of first-time users has slowly increased over the years (from 99 to 769 per 1,000) but suddenly dropped after 2016. The number of all users (first-time and follow-up users) has increased (from 123 to 1,201 per 1,000) and plateaued after 2016. Determinants including Hispanic ethnicity (O.R. = 1.10) and Medicare-Medicaid dual eligibility (O.R. = 1.25) are positively associated with both the initiation and retention of the DSMT. A barrier to both initiation and retention of DSMT is living in a metropolitan area (O.R. = 0.90). Multi-level strategies to enhance accessibility and availability of DSMT programs for Medicare beneficiaries are highly recommended. Examining the determinants of initiation and retention of DSMT over 14 years provides insights on strategies to meet the needs of cancer survivors and reduce the burden of diabetes on them.

549-P: Assessing Feasibility of a Diabetes Mellitus Program Using Behavioral Economics to Optimize Outreach and Self-Management Support with Technology—The DM-BOOST Project

Introduction: The DM-BOOST intervention was developed to enhance engagement with diabetes self-management training (DSMT). Participants received peer-written text message tips with nudges to reply with personal preferences. They then completed a video call with the DM-BOOST team to confirm patient portal access, review key functions, and set a diabetes behavior goal. This was later followed by receipt of a patient portal message with their goal, which they commit to sending to the DSMT provider they are scheduled to meet with. Methods: Adults with poorly controlled type 2 diabetes (HbA1c ≥ 8) received mailed invitations and a recruitment phone call. Participants (n=60) were randomized (1:1) to usual care or DM-BOOST. All participants received assistance obtaining a DSMT referral and scheduling a DSMT appointment. The primary outcome of interest was the DSMT appointment no-show/cancellation rate. Results: Enrolled participants (n=60) were 60.0% female with a mean age of 45.5 years (SD = 8.3). The average HbA1c at enrollment was 10.1% (SD = 1.8). All intervention participants (30/30) had a DSMT appointment scheduled compared to 86.7% of comparison participants (26/30). Intervention group participants had fewer DSMT no-shows/cancellations (3/30, 10%) compared to comparison group participants (10/26, 35%) (p = 0.01). Conclusions/Discussion: Technology-based interventions guided by behavioral economics can increase initial engagement with DSMT. Several system-level barriers, including challenges in obtaining referrals and scheduling appointments, were identified. Secondary outcomes, including patient-reported changes in diabetes self-efficacy, self-management skills, and treatment satisfaction are being evaluated. Future research efforts include cultural adaption of DM-BOOST for Spanish-speaking patients and rigorous implementation evaluation. Disclosure D.J.Amante: None. L.L.Shenette: None. G.Puerto: None. S.Lemon: None. D.M.Harlan: Advisory Panel; Novartis, Vertex Pharmaceuticals Incorporated, Diabeloop SA, Other Relationship; Stability Health, Wolters Kluwer Health. B.S.Gerber: Other Relationship; Abbott. Funding National Center for Advancing Translational Sciences (KL2TR001455); National Institute for Diabetes and Digestive and Kidney Diseases (1K01DK131318)

The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications.

The Treatment and Complications subcommittee of the National Clinical Care Commission focused on factors likely to improve the delivery of high-quality care to all people with diabetes. The gap between available resources and the needs of people living with diabetes adversely impacts both treatment and outcomes. The Commission's recommendations are designed to bridge this gap. At the patient level, the Commission recommends reducing barriers and streamlining administrative processes to improve access to diabetes self-management training, diabetes devices, virtual care, and insulin. At the practice level, we recommend enhancing programs that support team-based care and developing capacity to support technology-enabled mentoring interventions. At the health system level, we recommend that the Department of Health and Human Services routinely assess the needs of the health care workforce and ensure funding of training programs directed to meet those needs. At the health policy level, we recommend establishing a process to identify and ensure pre-deductible insurance coverage for high-value diabetes treatments and services and developing a quality measure that reduces risk of hypoglycemia and enhances patient safety. We also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health. The Commission strongly encourages Congress, the Department of Health and Human Services, and other federal departments and agencies to take swift action to implement these recommendations to improve health outcomes and quality of life among people living with diabetes.

The effect of self-efficacy and self-management training on efficacy and stress in diabetes mellitus patients

Background: Quality of life in patients with diabetes mellitus still tends to be low. This is caused by low self-efficacy and self-management and is followed by a condition that connects the two variables in the form of stress. Therefore, there is a need for efficacy and self-management training in patients with diabetes mellitus.Objective: The purpose of this study was to analyze the effect of self-efficacy and diabetes self-management training on diabetes mellitus patients.Methods: This is a quasi-experimental study with a design without a control group; as many as 34 people with diabetes were included in the study. Stress and efficacy levels were measured before and after being given diabetes self-management and efficacy training. The Wilcoxon test analyzed data..Results: Before training, the average self-efficacy score was 44.21, while after training was 58.76, p<0.0001. The average stress score before training was 44.41; after training, it decreased to 30.29, p<0.0001.Conclusion: Diabetes self-efficacy and self-management training increases efficacy and reduces stress in diabetes mellitus patients.

Learning Approaches as a Means to Understand Difficulties and Opportunities in Type 2 Diabetes Self-Management Training: A Qualitative Content Analysis of Two German Educational Curricula

ABSTRACT Background Diabetes self-management education (DSME) improves disease-specific markers (HbA1c levels and bodyweight) and prevents disease-related complications. Yet, patients do not seem to benefit equally from such education, likely because of differences in approaches to learning. Purpose We investigated which learning approaches are best addressed by diabetes curricula and suggest improvements in curriculum design. Methods Two of the most popular German type 2 DSME curricula were studied. We used qualitative content analysis to build a systematic coding frame, extracting and connecting categories of meaning from the material. Criteria for categories were drawn from research on learning preferences in adult Germans. Results Both curricula mainly address participants preferring educator-guided and application-driven learning. One of the curricula more actively involves its participants with open discussions and personal goal-setting and shows a stronger emphasis on social support strategies. Discussion Different learning approaches are not met equally in the curricula, which might create unique difficulties for participants of DSME. Translation to Health Education Practice Introducing personal goal-setting and progress monitoring in DSME should benefit participants with passive approaches to learning. Offering additional course material could diversify teaching methods and satisfy theoretically driven people. All DSME programs should emphasize social support strategies. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Current Topics in Health Care Law

Current Topics in Health Care Law

Accomplishing provider status: Getting pharmacists paid for their patient care services

Accomplishing provider status: Getting pharmacists paid for their patient care services

482-P: Comprehension of Medicare Program and Participation of Diabetes Self-Management Training among Medicare Beneficiaries with Diabetes

Poorly managed diabetes can lead to complications which account for a large portion of diabetes costs. Although diabetes self-management programs have been shown to be effective in reducing the risk of complications, low uptake of diabetes self-management training (DSMT) has been reported. Identifying factors associated with participation in DSMT among Medicare beneficiaries (MBs) with diabetes can provide information to improve uptake of these programs. DSMT is a Medicare-covered benefit. We analyzed the nationally representative 2018 Medicare Current Beneficiary Survey PUF of MBs aged ≥ 65 years with reported type 2 diabetes (n=1,056). A survey-weighted logistic model, adjusted for socio-demographics and co-morbidities, was performed to examine the relationship between participation of DSMT and two binary variables including: 1) whether providers gave instructions on how to take care of one’s health; and 2) whether the Medicare program was easy/difficult to understand. Of study MBs, 49.6% self-reported participation in DSMT (a rate higher than other studies analyzing claims data). DSMT participants had higher rates of reporting the Medicare program was easy to understand (73.3% vs. 66.1%), and that providers gave instructions on how to take care of one’s health (68.0% vs. 64.0%) than non-DSMT participants. Among the study MBs, those reporting the Medicare program was easy to understand were more likely to participate in DSMT (odds ratio (OR)=1.40, p<0.046). Surprisingly, those reporting that providers gave instructions on how to take care of one’s health were not significantly associated with the participation of DSMT (OR=1.12, p<0.506). Our finding highlights that a better comprehension of the Medicare Program has a positive impact on the participation of DSMT. Interventions to improve MBs’ understanding of the Medicare program and associated benefits may increase participation in DSMT. Disclosure B. Ng: None. S. D. Towne: None. J. B. Lamanna: None. K. Kim: None.

454-P: Pharmacist-Led Diabetes Self-Management Education and Reduction of Readmission Rates at a County Hospital

Pharmacist-led Diabetes Self-Management Education and Reduction of Readmission Rates at a County Hospital With 10.5% of the US population or 34.2 million people affected by diabetes, education is greatly needed. The American Diabetes Association (ADA) and the Association for Diabetes Care and Education Specialists (ADCES) state that Diabetes Self-Management Education or Training (DSME/T) improves diabetes management, which can avoid hospital admissions and readmissions. Although DSME/T has traditionally been provided by nurses and dieticians, pharmacists can play a part, given their expertise in medication management, non-pharmacological therapies, and monitoring. The ADA and ADCES recommend that people with diabetes receive DSME/T at diagnosis, annually, when factors influence self-management, and at transitions of care. Therefore, a pharmacist-led transitions of care program was developed to reduce readmissions for patients with diabetes at Zuckerberg San Francisco General Hospital and Trauma Center. This hospital serves a diverse, low-income, and unhoused patient population, increasing the challenges of diabetes management. Pharmacists and pharmacy trainees were given a refresher course on DSME/T. Low-health literacy handouts in several languages, as well as demonstration kits, glucometers, insulin and insulin supplies, were all utilized for patient education. The objective of the study was to determine whether using pharmacists as educators, could reduce hospital readmissions. In 2017, provision of DSME/T at this institution was less than 5% and increased to 74% by December 2019, with the implementation of this program. The rate of readmission for patients with diabetes who received DSME/T was 11.7% compared to 19.2% for those who did not; an absolute risk reduction in readmission of 7.5%. Pharmacists and pharmacy trainees should use DMSE/T to help reduce readmissions, improve outcomes, and increase the national levels of patients with diabetes receiving DSME/T. Disclosure L. Mulala: None. T. Lenhoff: None.

Adventures in getting paid

Adventures in getting paid

Self-management Education in Type 2 Diabetes in Primary Care.

Diabetes self-management education (DSME) is defined as a systematic intervention involving active participation of the individual in self-monitoring of health parameters and/or decision making using knowledge and skills. The goal of DSME is to create opportunities for people with diabetes to be informed and motivated to continuously participate in effective methods and methods of self-monitoring of diabetes. To evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach's reliability coefficient for each domain/subscale was ≥ 0.7. The data were analysed using an independent selective t-test and one-way ANOVA. More than half of the doctors provided "inadequate quality" of diabetes self-management in all areas. Doctors had the highest average score in the domain of "drug intake" (4.46±0.61). Average scores in the "problem-solving domain" (3.52±0.63) and "being active domain" (3.46±0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. The quality of doctors' communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behaviour associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.

Some reasons to stay energized during uncertain times

Over the last few weeks, there have been some sensational developments for pharmacists and our patients. I hope you’re as excited about them as I am. At the end of July, President Trump signed an executive order resurrecting a rule that could force PBMs to pass on to Medicare Part D beneficiaries any discounts from manufacturer rebates and other price concessions at point of sale. It was a rare L for PBMs, and it’s a positive sign that the executive branch recognizes that PBMs do not make drugs more affordable to patients—yet it’s not quite a W for us. Now, our job is to work with the U.S. Department of Health and Human Services (HHS) and our pharmacy partners to ensure the agencies implementing the rebate rule also end PBMs’ gaming of Medicare regulation loopholes that allows them to inflate patients’ prescription-drug costs and put pharmacies on life support by extracting vampiric direct and indirect remuneration (DIR) fees—not just retroactively, but once and for all. A few weeks later, CMS issued updated guidance granting new flexibility for accredited and recognized diabetes self-management training (DSMT) programs already billing Medicare Part B for DSMT services. These programs, CMS said, may furnish and bill for DSMT services provided via telehealth during the COVID-19 public health emergency. This is a huge triumph for diabetes care and education specialists and the Medicare beneficiaries with diabetes whom they serve. Then HHS announced it would authorize licensed pharmacists to provide all vaccines recommended by CDC’s Advisory Committee on Immunization Practices and approved or licensed by FDA to all children ages 3 to 18 during the COVID-19 pandemic, regardless of state laws and regulations to the contrary. This is great news. APhA has long advocated that pharmacists are uniquely positioned to address this public health emergency, and we worked with HHS to develop this strategy to engage all pharmacists. As Admiral Brett Giroir, the HHS assistant secretary for health, said in the announcement, pharmacists have always been a trusted voice in the community, and they’re readily accessible. We couldn’t agree more. We’ve still got some milestones to reach. Congress must include coverage for pharmacists’ COVID-19 and flu testing and immunizing services under Medicare Part B in the next coronavirus stimulus package. Keep writing and calling Capitol Hill to tell your patients’ stories and how much more pharmacists could be doing to help them stay safe and healthy, during the public health crisis and beyond. We aren’t done, but I’m thrilled with the progress we’re making and more optimistic than ever about pharmacy’s future. Let’s get there together!

Advocating for Expanded Access to Diabetes Self-Management Training in Medicare

Advocating for Expanded Access to Diabetes Self-Management Training in Medicare

Advancing Diabetes-Related Equity Through Diabetes Self-Management Education and Training: Existing Coverage Requirements and Considerations for Increased Participation.

America is in the grips of a diabetes epidemic. Underserved communities disproportionately bear the burden of diabetes and associated harms. Diabetes self-management education and training (DSME/T) may help address the epidemic. By empowering patients to manage their diabetes, DSME/T improves health outcomes and reduces medical expenditures. However, participation in DSME/T remains low. Insurance coverage offers 1 approach for increasing participation in DSME/T. The impact of DSME/T insurance coverage on advancing diabetes-related health equity depends on which types of insurers must cover DSME/T and the characteristics of such coverage. We conducted a legal survey of DSME/T coverage requirements for private insurers, Medicaid programs, and Medicare, finding that substantial differences exist. Although 43 states require that private insurers cover DSME/T, only 30 states require such coverage for most or all Medicaid beneficiaries. Public health professionals and decision makers may find this analysis helpful in understanding and evaluating patterns and gaps in DSME/T coverage.

EVALUATION OF DIABETES SELF-MANAGEMENT EDUCATION IN PATIENTS WITH CONCOMITANT CHRONIC KIDNEY DISEASE

The aim: Was to evaluate the quality of DSME provided by primary care physicians to people with diabetes mellitus. Materials and methods: A descriptive cross-sectional study was conducted among 120 primary care physicians. The quality of diabetes self-management training provided by physicians was assessed on a personal scale of 39 Likert questions obtained from the American Association of Diabetes Educators in seven areas of diabetes self-monitoring. The Cronbach's reliability coefficient for each domain / subscale was ≥ 0.7. The data were analyzed using an independent selective t-test and one-way ANOVA. Results: More than half of the doctors provided "inadequate quality" of diabetes self-management in all areas. Doctors had the highest average score in the domain of "drug intake" (4.46 ± 0.61). Average scores in the "problem-solving domain" (3.52 ± 0.63) and " being active domain" (3.46 ± 0.75) were low. The quality of DSME provided by physicians was not related to any of the characteristics of the physician. Conclusions: The quality of doctors' communication on DSME in this study was suboptimal. Most adequately informed cases of diabetic behavior associated with self-management have been associated with reduced risk factors and an orientation towards disease. Thus, training of primary care physicians in diabetic self-management is recommended because of the key role that these doctors play in managing diabetes.

157 Diabetes Self-Management Training with a Mobile APP among Older Adults in Taiwan: Comparative and Longitudinal Program Effectiveness

Abstract Diabetes is a prevalent chronic disease and a major medical disability worldwide. It affects 1 in 5 older people in Taiwan. Use of mobile computing technology has become increasingly prevalent among older adults but its potential to improve diabetes self-management and social integration is only begun to be realized. This presentation will introduce the Intergenerational Mobile Technology Opportunities Program (IMTOP) designed to motivate and train older adults with diabetes to use mobile technology for diabetes self-management. The IMTOP curriculum taught participants about diabetes self-management combined with tablet and Internet skill training. Patients were taught a diabetes self-management app to activate self-monitoring and behavior change. College students participated as volunteer tutors to provide intergenerational and technological support. The program was delivered in 8 weekly sessions of 2-hour long small group classes. To understand the program effects, a wait-list control trial with 350 age 55+ adults with diabetes was conducted in 2 Taiwanese hospital outpatient settings. Patients were assessed at baseline and every 4 months for up to 12 months post intervention. After participating in the intervention, the pre-post changes for the intervention group were significantly better than the waitlist group at 4-month in terms of physical health status, diabetes self-care, use of mobile technology, and overall quality of life. In addition, the intervention group was less depressed compared to its counterpart. The longitudinal effects were evaluated using linear mixed-effects models including contrasts compared mean estimates at each follow-up to the baseline. The results indicate a stable overtime improvement in overall diabetes self-care (p<.0001). Specifically, patients reported more blood-glucose testing, foot-care, and risk reduction (all with p<.0001), specific diet (p=.04), and reduced frequency of smoking (p=.03). Both the WHO-QOL physical health (p=.03) and self-rated general health (p=.001) were enhanced. The findings support the effectiveness of IMTOP intervention for older adults with diabetes.

National survey of diabetes self-management program coordinators views about pharmacists’ roles in diabetes education

ObjectivesTo examine the viewpoints of diabetes self-management training (DSMT) program coordinators about the roles and engagement of pharmacists who participate in DSMT programs, and the engagement between community pharmacies and DSMT programs by developing and administering a nationwide survey. DesignA mixed-methods exploratory sequential design; initial qualitative phase followed by a quantitative phase. Six in-depth interviews of DSMT program coordinators and intensive literature review informed the development of a 20-item survey instrument. Survey responses were descriptively analyzed, and themes were generated from context analysis of open-ended questions to generate the overall findings. Setting and participantsThe survey was distributed in 2017 to 742 active American Association of Diabetes Educators DSMT program coordinators in the United States. Outcome measuresProportion of DSMT programs engaging pharmacists and description of pharmacist’s roles. Content areas pharmacists teach in DSMT programs. Challenges faced by pharmacists in completing 1000 direct patient hours as a prerequisite for attaining Certified Diabetes Educator certification and strategies used to overcome them. Perceived benefits of pharmacist involvement by coordinators and patients. ResultsOne-third of DSMT programs have pharmacists involved with most using pharmacists as educators. Coordinators believe that pharmacist care is highly beneficial to patients and recognize that community pharmacist’s care is an added benefit to patients. However, collaborative practices are not well established between community pharmacists and DSMT programs. Program coordinators identified challenges they face when trying to involve community pharmacists in program delivery. ConclusionCoordinators of DSMT programs and their patients see pharmacists’ care as highly beneficial within DSMT programs. Increasing participation and scope of community pharmacists’ involvement is desired by both DSMT coordinators and the patients they serve. There is substantial growth potential for both greater involvement of pharmacists in DSMT programs and enhancing links to community pharmacists’ care.

Creating a Legion of Diabetes Patient Advocates: DPAC Policy Training Meeting and Hill Day.

The Diabetes Patient Advocacy Coalition (DPAC) held a Policy Training Meeting and Hill Day September 29-October 1, 2018, in Washington, DC. Attendees were members of DPAC's Board of Directors and Staff, Patient Advisory Board, and individuals identified through a competitive call for applicants on DPAC's website and social media. We were joined by advocates from the Association of Black Cardiologists and the Endocrine Society. The Policy Training Meeting focused on teaching citizen advocates how to share their stories with legislators while integrating facts and statistics to reinforce their experiences. After two days of training, we met with our legislators on Capitol Hill to discuss two closely related issues: access to affordable insulin and diabetes self-management training. The partnership of patient advocates and health care providers was a powerful tool to get our message across. Meetings like this encourage open discussion and networking as well as education regarding individual advocacy. They are an effective way to bring people together as allies for the diabetes community. DPAC plans to hold additional Policy Training Meetings to develop leaders in each state who represent the voice of people living with diabetes.