Diabetes Self-management Class Research Articles

Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices.

The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

614-P: Receiving Diabetes Self-Management Education Associated with Following Self-Care and Clinical Preventive Care Practices

Background: Diabetes self-management education and support services empower people with diabetes to follow preventive care practices that reduce disease complications. Objective: We describe self-reported receipt of diabetes education among people with diabetes, and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 Behavioral Risk Factor Surveillance System for 42,631 adults (≥18 years) with self-reported diabetes (all types) in 38 states, D.C., and Guam. Diabetes education was defined as ever taking a diabetes self-management class. We assessed four self-care practices (daily glucose testing, daily foot checks, smoking abstention, and regular physical activity), and six clinical practices (pneumococcal vaccination, biannual HbA1c test, and an annual dilated eye exam, influenza vaccination, healthcare visit for diabetes, and foot exam). We used multivariable logit regression with predicted margins to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, 52.3% reported receiving diabetes education; those who did had a higher (p<0.01) predicted probability for 3 of 4 self-care practices [daily glucose testing (70.1% vs. 51.2%, respectively), daily foot check (62.6% vs. 52.2%), and regular physical activity (65.6% vs. 56.9%)] and all 6 clinical practices [pneumonia vaccination (72.8% vs. 59.1%), biannual HbA1c test (81.5% vs. 70.4%), and an annual eye exam (74.3% vs. 65.7%), flu vaccination (60.0% vs. 54.2%), healthcare visit (92.3% vs. 86.2%), and medical foot exam (83.0% vs. 68.5%)]. Conclusions: Diabetes education was positively associated with following preventive care practices. Developing strategies to improve receipt of education can be informed by studies that elucidate barriers to education. Disclosure E.A. Lundeen: None. I. Mendez: None. M.M. Saunders: None. J.B. Saaddine: None.

Diabetes Self-Care and Clinical Care Among Adults With Low Health Literacy.

Low health literacy has been associated with unfavorable health outcomes. We examined diabetes self- and clinical care measures among adults with diabetes by 3 dimensions of health literacy. Questions about health literacy were available for optional use in the 2016 Behavioral Risk Factor Surveillance System. We analyzed 2016 Behavioral Risk Factor Surveillance System data from 4 states and the District of Columbia that had included both the Health Literacy and Diabetes optional modules. Respondents who participated in the 2016 Behavioral Risk Factor Surveillance System in Alabama, Louisiana, Mississippi, Virginia, and Washington, District of Columbia, and completed both modules (n = 4397). Health literacy was measured by level of difficulty (easy, difficult) with 3 health literacy tasks: getting health advice or information, understanding health information delivered orally by health professionals, and understanding written health information. Diabetes care measures included physical activity, self-monitoring blood glucose, self-checking feet, hemoglobin A1c testing, professional foot examination, flu vaccination, professional eye examination, dental visits, and diabetes self-management education. Among those with self-reported diabetes, 5.9% found it difficult to get health advice or information, 10.7% found it difficult to understand information health professionals told them, and 12.0% found it difficult to understand written health information. Those who found it difficult to get health advice or information had 44% to 56% lower adjusted odds of A1c testing, professional foot examinations, and dental visits; those who found it difficult to understand written health information had lower odds of self-monitoring glucose and self-checking feet. Difficulty understanding both oral and written health information was associated with never having taken a diabetes self-management class. Our results suggest that problems with health literacy may be a barrier to good disease management among adults with diabetes and that health care providers should be attentive to the needs of patients with low health literacy, especially for diabetes-specific specialty care.

Diabetes Quality of Care and Maintenance in New England: Can Cross-State Collaboration Move Us Forward?

State efforts to identify subpopulations at higher risk for inadequate diabetes maintenance are sometimes hampered by small sample size. We provide a model of a cross-state collaboration that might provide the foundation for identifying political and economic forces underlying inter- and intra-state variability in chronic disease care. We collected Behavioral Risk Factor Surveillance System data directly from 5 of 6 New England states and ran multivariate logistic regressions on 5 exposures: race/ethnicity, federal poverty level (FPL) bracket, insurance status (yes or no), insurance type (public or private), and state of residence. Our sample consisted of adults aged 35 or older diagnosed with diabetes. Outcomes included whether respondents with diabetes received complete annual diabetes care (≥2 hemoglobin A1c tests, eye examination, foot examination), had ever taken a diabetes self-management class, or reported diabetes-related retinopathy. Half (50.4%) of our sample had incomplete annual diabetes care. In multivariate logistic regressions, race/ethnicity and FPL bracket were not major drivers of outcomes, although Hispanic/Latino adults had significantly higher risk than non-Hispanic white adults of not knowing how many hemoglobin A1c tests they had had in the past year or what such a test is (adjusted odds ratio = 2.74 [95% confidence interval, 1.15-6.56]) and of diabetes-related retinopathy (adjusted odds ratio = 3.13 [95% confidence interval, 1.61-6.10]). With few exceptions, higher FPL bracket, insurance status, insurance type, and state of residence were not associated with diabetes maintenance. Inadequate annual diabetes care among adults with diagnosed diabetes was endemic even in this relatively advantaged US census division, and traditional disparities (eg, race/ethnicity, FPL bracket) only partially explained patterns in diabetes maintenance activities. Interstate analyses can create the foundation for active partnerships to identify and address the causes of lapses in care.

Participation in a Diabetes Self-Management Class Among Adults With Diabetes, New Jersey 2013-2015.

Identifying patient groups with low participation in diabetes self-management education can inform efforts to improve its use. Data from the 2013–2015 Behavioral Risk Factor Surveillance System were used to assess variation in participation in a diabetes self-management class in New Jersey. Nonparticipation varied significantly by race/ethnicity (P < .001), education (P < .001), health care coverage (P = .04), county (P < .001), years since diagnosis (P < .001), and whether a diabetes provider visit occurred in the past year (P = .002). Attention is warranted in identifying participation barriers among patients who live in certain counties, have less education, are without health care coverage, have been diagnosed with diabetes more recently, visit a provider less often, or belong to certain racial/ethnic minority groups.

Diabetes Self-Management Behaviors among American Indians in the Midwestern United States.

The purpose of this study was to understand if American Indian adults with diabetes in the Midwest are similar to American Indian adults nationally in their self-management behaviors. This cross-sectional survey was conducted from May 2009 to April 2010 at powwows, health fairs, and other community events. The convenience sample self-selected into the study and answered questions via touch screen computer about diabetes self-management. Participants were significantly below the national average for American Indians in their adherence to self-management recommendations in daily foot checks (p=0.0035) and having had a dilated eye exam in the previous year (p=0.0002), despite being significantly more likely to have taken a diabetes self-management class (p<0.0001). They were similar to the national average for daily glucose checks and having had one or more hemoglobin A1C tests in the previous year. Participants were less likely to eat 5 or more servings of fruits or vegetables per day (p=0.0001), but more likely to achieve 150 minutes or more of physical activity per week (p=0.0001). Programs addressing self-care issues should be developed to help improve the self-management habits of American Indian adults with diabetes, with particular attention to activities outside of monitoring blood glucose and hemoglobin A1C levels.

Diabetes Self-Management Education and Self-Efficacy Among African American Women Living With Type 2 Diabetes in Rural Primary Care.

African American women suffer the highest prevalence of type 2 diabetes (T2D). Self-efficacy is important for optimal diabetes self-management (DSM). Purpose: To evaluate DSM by comparing pre- and postintervention responses to a diabetes self-efficacy scale. Design: Descriptive pilot study. Sample: Participants for this study were N = 15 African American women aged 25-65 years (M = 47.4 years) and recruited from a rural health clinic in the Southeastern United States, who received a 4-hr DSM class. Method: Data were collected using the Stanford Self-Efficacy for Diabetes (SED). Results: The increase in the pre- and posttest SED scores were statistically significant, (p < .001). Implications for Nursing: Health care providers should tailor a diabetes education program for these individuals living with T2D. Through a collaborative patient-provider relationship to care, individuals may ultimately experience increased self-efficacy leading to improved DSM.

Ethnic Disparity in Diabetes Self-Management Class Utilization, Behavioral Risk Factors Surveillance System 2012

AbstractWe examined diabetes self-management class utilization in a study sample of adult BRFSS 2012 participants with diabetes (n=34,665). This study assessed demographic variables that might be associated with class utilization, specifically sex, age, income, having health insurance (yes or no), and ethnicity (Hispanic and non-Hispanic) on diabetes self-management class utilization. Participation in diabetes self-management class was 53.8% overall. Male sex, age greater than 49 years, income &lt;$25,000 per year, and lack of health insurance were each significantly associated with decreased class utilization. Hispanics (n=2,962) were 43% less likely to have taken a class compared to non-Hispanics (n=31,703) (OR 0.57, CI:0.53-0.62, p&lt;0.001) with 41.2% of Hispanics and 55% of non-Hispanics reporting that they had taken a diabetes self-management class. This disparity remained after adjusting for sex, age, income, and health insurance (OR 0.60, CI:0.55-0.65, p&lt;0.001). Efforts to enhance participation in diabetes self-management education are needed, particularly in Hispanic communities.

The Healthy Diabetes Plate: An Evolving Diabetes Meal Planning Program

Copyright: © 2015 Raidl M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The three components of diabetes self-management are diet, physical activity, and medication (if necessary) [1]. Data collected by the Centers for Disease Control and Prevention (CDC) National Diabetes Surveillance System shows that approximately 57.4% of adults with diabetes in the United States attend at least one diabetes selfmanagement class [2]. Unfortunately, among adults age 40 and over with diagnosed diabetes, only 52% managed to keep their blood sugars under control by achieving a HbA1c of less than 7% [3].

South Carolina Guidelines for Diabetes Care 2013

BackgroundThere is a huge economic burden of diabetes in South Carolina. MethodsThe South Carolina Guidelines for Diabetes Care were based on the 2013 Standards of Medical Care from the American Diabetes Association. ResultsFrom a review of the Diabetes Quality Indicators in South Carolina 2007, Medicare claims data show: 65% of South Carolinians with diabetes insured by Medicare received 2 A1C test per year, 54% received an eye examination and 78% received a lipid panel. Only 42% of these individuals with diabetes had all 3 tests in the same year. In addition, only 50% of individuals with diabetes in South Carolina attended a diabetes self-management class. To improve the statistics and outcomes, the Diabetes Advisory Council provided the evidence-based South Carolina Guidelines for Diabetes Care. They are based on the 2013 Standards of Medical Care from the American Diabetes Association. These guidelines have been promoted at the continuing education programs sponsored by the Diabetes Initiative of South Carolina and the South Carolina Division of Diabetes Prevention and Control and distributed in the community sites by the Racial and Ethnic Approaches to Community Health coalition. ConclusionsThe South Carolina Guidelines for Diabetes will provide evidence-based therapy and monitoring to minimize complications from diabetes and promote a higher quality of life for those with diabetes.

Influence of Patient Characteristics on Assessment of Diabetes Self-Management Support

Factors contributing to patient-reported experiences of diabetes self-management support are not understood well, particularly over time. The aim of the study was to identify the contribution of patient characteristics to patient-reported quality of SMS. Using secondary data from a prospective clinical trial (n = 339) comparing three approaches of providing diabetes self-management support (Group Medical Visits, Automated Telephone Support, and Usual Care) in a diverse, underserved population, the influence of patient characteristics (e.g., age, gender, income, and health status) was examined on Patient Assessment of Chronic Illness Care ratings. At baseline, older age (p = .014), being female (p = .038), and having lower income (p = .001) were associated with lower ratings. Income and interactions involving income combined explained 12% of the variance in baseline ratings. Compared with White patients, African American and Asian patients tended to have higher baseline ratings (p = .076 and p = .045, respectively). Race or ethnicity influenced perceptions throughout the trial, explaining 5% of the variance at baseline and 2% of the variance in 1-year changes in Patient Assessment of Chronic Illness Care ratings. As expected, over 1 year, ratings increased more for patients in both intervention groups compared with the control group (p < .001). Ratings of healthcare quality are influenced by patient characteristics independent of the nature of the care provided. Understanding more precisely how these differences are associated with differences in clinical processes will be particularly important for efforts aiming to integrate patient-reported measures into assessments of healthcare quality during routine clinical care and clinical trials.

The Evolving Role of the Diabetes Educator—Changing Patient Behavior in Diabetes Self-management Education

In this day and age of evidence-based practice, we seek to provide interventions that we know will make a significant difference in the lives of our patients. For those of us who specialize in the care of people with diabetes, e.g. endocrinologists and diabetes educators, diabetes self-management education/training (DSME/T) has long been considered an essential intervention, a cornerstone of diabetes care. The government’s Healthy People 2010 objective that 60% of persons with diabetes should receive formal diabetes education supports this logic.1However, for many healthcare professionals outside of the specialty, this belief in the efficacy of DSME/T appears to be less solid, as evidenced by the poor referral rates for education. This disconnect is illustrated by the following findings. Although Medicare covers DSME/T as a benefit for patients with diabetes, only 1% of Medicare beneficiaries received this service in 2004 and 2005.2The Centers for Disease Control and Prevention (CDC) d ta indicate that only 54.3% of people who responded to a survey had ever attended some type of diabetes self-management class.3A 2007 Roper US Diabetes Patient Market Study found that only 26% of nearly 17 million diagnosed diabetes patients in the US had visited a diabetes educator within the past year.4Anecdotal reports from diabetes educators support the notion that with the current type 2 diabetes epidemic facing the US, education programs should be over-run with referrals for DSME/T. This, however, is far from the case for most programs. Most diabetes educators are sorely underutilized, and the rate of recognized diabetes education program closures is staggering, at three per week in the US.5