Effectiveness Of Diabetes Self-management Education Research Articles

Promoting Diabetes Self-Management in a Psychiatric Hospital.

Type 2 diabetes and psychiatric illnesses have a bidirectional association, influencing each other in direct but independent ways. People with psychiatric illnesses are more likely than the general population to develop type 2 diabetes, in part because antipsychotic medications affect the metabolic system, disrupting glucose metabolism, and also because they lack diabetes self-management education and self-care skills. This study assessed the effectiveness of diabetes self-management education and support (DSMES) in patients with mental illness and diabetes using the Diabetes Self-Management Questionnaire. Analysis of paired responses to the pre- and post-DSMES survey questions showed a statistically significant increase in diabetes self-management knowledge after participation in the education sessions. These results emphasized the importance of DSMES in strengthening patients' knowledge and skills, with additional support from their psychiatrist and medical team.

Effectiveness of Diabetes Self-Management Education on Distress and HbA1C among Indian Type 2 Diabetes Mellitus Patients: A Randomized Controlled Trial.

The interrelationship of diabetes with mental illness has increased in recent years. Diabetes-related distress is the emotional burden, stress, and worries associated with diabetes, which does not reach the threshold for depressive disorder. A diabetes self-management education (DSME) is a structured educational approach to improve glycemic control and diabetes-related distress. This study aimed to assess the effectiveness of DSME in comparison with usual diabetes care in improving glycemic control and diabetes-related distress. This is a single-center, parallel randomized controlled trial. A total of 106 participants were recruited for both intervention and control groups with 53 participants each. The control group received only routine outpatient department (OPD) care. The intervention group received DSME in addition to routine OPD care. Diabetes-related distress and HbA1C were assessed after 3 months. The data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 25. Per-protocol analysis was done. Of 127 patients screened, 106 met the eligibility criteria and were randomized. At 3-month follow-up, the reduction in mean HbA1C, fasting blood sugar (FBS), postprandial blood sugar (PPBS), and diabetes distress were significant in the intervention group compared with the control group (p 0.001). The mean HbA1C reduction in the intervention group was significant (mean difference: -1.3, SD: 0.4). The mean DDS had decreased significantly in the intervention group from 2 to 1.2 (mean difference: -0.8, SD: 0.1). The DSME was effective in improving the glycemic control, diabetes-related distress, and self-care among type 2 diabetes (T2DM) mellitus patients.

Impact of diabetes self-management education in middleaged patients with type 2 diabetes mellitus: A systematic review

Introduction: Diabetes Mellitus (DM) disease, if not treated properly, will cause various complications. Entering the age of 40 years and above, patients with DM disease begin to show progress toward the occurrence of complications. Hence, DM patients need to know about the appropriate self-management of diabetes through diabetes self-management education (DSME). This systematic review aimed to identify the effectiveness of diabetes self-management education in middle-aged patients (40-64 years) with type 2 DM.

The effectiveness of Diabetes Self-Management Education (DSME) with self-acceptance and self-care for diabetes mellitus patients

Background: Diabetes mellitus is a complex group of chronic diseases associated with hyperglycemia, resultingin impaired insulin secretion and other organs. Patients with type 2 diabetes mellitus will experience changes inthemselves. Each individual responds and has a different perception of dealing with these changes. Providingeducation aims to increase knowledge and improve the patient’s ability in self-care so that health problems areresolved.Objectives: The study wants to know the effectiveness of Diabetes Self-Management Education (DSME) onself-acceptance and self-care of Type II Diabetes Mellitus patients.Patient and Methods: A quasi-experimental design was used through one group pre-test and post-test design. Thetotal population is 25 people, with a saturated sampling technique, and a sample of 25 people. Data analysis useda non-parametric statistical test, namely the Wilcoxon Signed Rank Test.Results: The majority of patients with Diabetes Mellitus had good self-acceptance, and the majority of patients’self-care was found to be good (p=0.000).Conclusions: The resulting study is the effectiveness of DSME on patient self-acceptance and self-care.Recommendations: The DSME program requires involvement in glucose monitoring by health professionals.Providing education to patients effectively provides psychological support and patient self-care.

The effectiveness of social media intervention in people with diabetes: An integrative review.

This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus. DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME. An integrative review was conducted based on Whittemore and Knafl's (2005) methodology. The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used. A total of 13studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression. Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression. This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.

IDF21-0099 Development of self-management program with carbohydrate counting for Type 1 Diabetes delivered during Covid-19 pandemic

Background: There is a lack of data on effectiveness of diabetes self-management education and support (DSMES) programs for South Asian adults with type 1 diabetes mellitus (T1DM). Aim: This formative research was conducted to explore existing practices on the said subject and gather information for planning an enhanced usual care (EUC) intervention program. The suggestions were incorporated for the intervention to be delivered especially during Covid-19. Method: We conducted in-depth semi-structured interviews with endocrinologists, dieticians, diabetes educators and adults with T1DM for this qualitative formative research. The participants were selected from a mix of public and private health facilities. Thematic analysis using inductive and deductive approach was undertaken. Results: In total, 28 in-depth interviews were conducted, 18 with health care professionals and 10 with adult individuals with T1DM. The results demonstrated deficiencies in the implementation of a structured self-management program for diabetes owing to several patient and healthcare system-related factors in usual practice. A detailed nutritional counselling was provided at all sites by a qualified dietitian, however, carbohydrate counting was not routinely practiced. The content of this formative research revolved around two broad domains hence explored: (a) evaluation of the existing usual care and gaps in implementation of a structured DSMES program, and (b) development of approaches that will help in formulation of an intervention package and its effective delivery to the participants. Principles of FUSED and COM-B models were also reported to be significant components for the success and refinement of such interventions. During the pandemic, the challenges reported in diabetes management were in maintaining monitoring chart of blood glucose levels due to lack of monitoring strips, procurement of insulin, procurement of diabetes supplies and management of disease condition during acute complications with lack of hospital facilities. Blood sampling was reported to be halted due to complete lockdown and restricted red zones. For effective delivery of such EUC interventions, it was suggested to conduct the sessions via video conferencing apps. Similarly, the follow-ups and reinforcement during this period were suggested to continue via telephonic calls, audio clips, video calls, video clips and SMS modes. As a part, it was suggested to relax blood glucose monitoring, the insulin of same type but different brands were suggested to be prescribed among choices available in local area and other mentioned challenges were suggested to be continuously looked after and provide timely advice for the same emphasizing sick day rules. Further, it was suggested to get the blood tests performed from reliable (accredited) labs at the recommended intervals. Discussion: This research study comprehensively investigated the existing practices among diabetes-health care professionals caring for persons living with T1DM, deficiencies in carbohydrate counting meal-planning technique and rendered insights towards development of a scientific DSMES program.

Reach and Effectiveness of Diabetes Self-Management Education and Support in a Network of Federally Qualified Health Centers.

Diabetes self-management education and support (DSMES) is an evidence-based intervention to improve diabetes-related outcomes. Access to DSMES is limited for diverse and low-income groups, despite greater need for services to address health disparities. Providing DSMES in federally qualified health centers (FQHCs) may increase reach for priority populations, and further study is needed to evaluate this delivery model. This report examines program effectiveness, including outcomes by race/ethnicity and Medicaid status, among 1,247 enrollees in FQHC-based DSMES. There was substantial glycated hemoglobin (A1c) improvement overall (-0.98%) among a diverse, majority-Medicaid population. However, Medicaid beneficiaries were approximately half as likely to attend as other enrollees (p<.001), while Latinx and non-Latinx Black participants attended fewer sessions (p=.008 and p=.040, respectively). Additionally, Medicaid beneficiaries experienced less A1c improvement than others (p=.040). Findings are promising that FQHC-based delivery can increase access to high-quality DSMES, although further effort appears needed to ensure optimal outcomes for all.

Diabetes Self-management Education Effect on Family Knowledge of Hypoglycemia Episodes Detection on Type 2 Diabetes Mellitus

BACKGROUND: Diabetes self-management education (DSME) is a health education process for individuals or families in managing diabetes. AIM: This research was aimed to evaluate DSME effect on family knowledge of hypoglycemia episodes detection on Type 2 diabetes mellitus (T2DM). METHODS: Quasi-experimental design with simple random sampling was used in this study. A total of 62 family members of T2DM patients were collected from the Public Health Center, Jambi Province, Indonesia. They were divided into the intervention group (n = 31) and control group (n = 31). The intervention group received 2-month intervention, including DSME of diabetes mellitus with following stages of activity: Socialization, implementation, monitoring, and evaluation. The control group received standard education. Data were collected from pre- and post-test questionnaire followed by statistical analysis using paired t-test. RESULTS: There were different mean values in the family knowledge pretest-posttest between experimental groups (10.71–12.39) and control groups (9.45–12.26) to detect hypoglycemic episodes before and after DSME mentoring. There was effectiveness of DSME on family knowledge to hypoglycemia episodes detection among T2DM (p = 0.0001), including in the control group (p = 0.002) CONCLUSIONS: This study found out the significant improvements in the intervention with DSME participants hypoglycemia episodes detection knowledge. This demonstrates that our DSME may be clinical importance.

Formative research to develop diabetes self-management education and support (DSMES) program for adults with Type 1 Diabetes

Background and aimThere is a lack of data on effectiveness of diabetes self-management education and support (DSMES) programs for South Asian adults with type 1 diabetes mellitus (T1DM). This formative research was conducted to explore existing practices on the said subject and gather information for planning an intervention program. Methods and materialsWe conducted in-depth semi-structured interviews with endocrinologists, dieticians, diabetes educators and adults with T1DM. The participants were selected from a mix of public and private health facilities. Thematic analysis using inductive and deductive approach was undertaken. The intervention was developed and refined using the principles of FUSED and COM-B models. ResultsIn total, 28 in-depth interviews were conducted, 18 with health care professionals and 10 with adult individuals with T1DM. The results demonstrated deficiencies in the implementation of a structured self-management program for diabetes owing to several patient and healthcare system-related factors. A detailed nutritional counseling was provided at all sites by a qualified dietitian, however, carbohydrate counting was not routinely practiced. The interviews of this formative research revolved around: (a) evaluation of the existing usual care and gaps in implementation of a structured DSMES program, and (b) development of themes that will help in formulation of an intervention package and its effective delivery to the participants. ConclusionThis research study comprehensively investigated the existing practices among diabetes-health care professionals caring for persons living with T1DM and rendered insights towards development of a scientific DSMES program.

Effectiveness of Diabetes Self-management Education Against Diet Behavior in Patients Type 2 Diabetes Mellitus: A Literature Review

BACKGROUND: Diabetes mellitus (DM) is a disease that describes a problem with insulin deficiency and the inability of the pancreas to produce enough insulin. The World Health Organization predicts that the number of people with DM type II in Indonesia will increase to 12 million by 2030. AIM: This study looks at Journals on diabetes selfmanagement education (DSME) on DM patients in improving dietary behavior. METHODS: This study uses an online journal database that provides free articles and journals in PDF such as: ProQuest, EBCSO, PubMed, Elsevier, Scinapse, MDPI, and Google Scholar. Literature was collected from the past 10 years, namely, 2010–2020 using the following set of keywords: “DSME,” “DSME Program Evaluation,” and “Diabetes Self-Care Education.” RESULTS: DSME intervention can improve the condition of DM patients if it is routinely carried out. In addition, the DSME intervention was able to control hemoglobin A1c levels and control blood sugar. This intervention still needs to be developed, considering that various forms of education in DM patients have been carried out such as using text messages, leaflets, illustrated pictures or leaflets, by telephone, video, handbooks, or direct education. These investigations can be developed into empirical research. CONCLUSIONS: The application of DSME interventions can help improve the conditions experienced by DM type II sufferers if it is routinely carried out.

Diabetes Self-Management Education Support Healthy Teaching Kitchen Cooking Classes Delivered Using a Telehealth Technology.

The purpose of the study was to evaluate the effectiveness of diabetes self-management education and support (DSMES) among veterans with diabetes using the Healthy Teaching Kitchen (HTK) by means of telehealth communication. A retrospective chart review collected data from veterans with type 2 diabetes (T2DM) that participated in the DSMES-HTK program at 2 Veterans Affairs Northeast Ohio Healthcare System facilities between February 2013 and December 2018. A factorial design was used to compare A1C data and use of clinical video telehealth from main hub to satellite site. Statistical analyses were performed using SPSS (Version 25). Repeated measures analysis of variance (RMANOVA) were performed to compare mean A1C in veterans that attended HTK at the main site versus a telehealth site. RMANOVA was also used to compare mean A1C in veterans that attended at least 1 hands-on class versus those that attended at least 1 demonstration class. A1C values of all groups improved over time and were sustained regardless of DSMES-HTK delivery method or location. Sustained improvement in A1C was observed in patients that participated in both DSMES-HTK in person and via clinical video telehealth classes conducted by hub site facilitator with RDN, CDCES credential. The use of a clinical video telehealth strategy for DSMES-HTK capitalizes on limited, highly skilled, credentialed instructional team members.

To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education.

Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.

Restrictors of the effectiveness of diabetes self-management education: A qualitative content analysis.

BACKGROUND:A key step for improving the effectiveness of diabetes self-management education (DSME) is to identify its restrictors.OBJECTIVES:The aim of this study was to explore the restrictors of the effectiveness of DSME.METHODS:This descriptive qualitative study was conducted in March 2016–2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) – 25 in total. Semi-structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman.RESULTS:The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients' limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health-related attitudes and behaviors, mere information delivery during education, adults' physical and perceptual limitations, and diabetes educators' limited competence in adult education).CONCLUSION:The findings of the present study provide an in-depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME.

Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: results of a randomized controlled trial (TRIGGER study)

ObjectiveTo investigate the effect of diabetes self-management education and support via a smartphone app in individuals with type 2 diabetes on insulin therapy.Research design and methodsOpen two-arm multicenter parallel randomized...

A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus

This study was aimed to assess the effectiveness of diabetes self-management education (DSME) in the improvement of glycemic control among patients with type 2 Diabetes Mellitus (T2DM) in Batticaloa District, Sri Lanka. The study was a prospective interventional study and conducted as a preliminary study at medical clinic, Base hospital, Kaluwanchikudy, Batticaloa. Thirty patients with T2DM were included based on inclusion and exclusion criteria. A structured individual diabetes self-management education for 10 hours (one hour per week) was delivered to diabetic patients by the trained Nurse Health Educator. Glycosylate hemoglobin (HbA1c) was assessed as a main outcome measure and Fasting Blood Sugar (FBS), Body Mass Index (BMI) of each patient were also measured and recorded before and after the intervention. The respondent rate was 96.7% (n = 29). Majority of them were females (n = 25, 86.2%). A Wilcoxon signed rank test showed that DSME had a statistically significant reduction in HbA1c [8.60 (IQR 2.60) vs. 7.40 (IQR 2.10), p = .000] and FBS level [159.00 (IQR 77.50) vs. 134.00 (IQR 40.50), p = .002] at 3 months of intervention. The mean BMI at baseline was higher compared to 3 months of intervention [24.88 (SD ± 3.06) vs. 24.19 (SD ± 2.79)] which was statistically significant (p = .000). Majority of participants (n = 22, 75.9%) had improved their HbA1c level by ≥ 0.5% in 3 months. The diabetes self-management education is an effective measure in improving glycemic control and other clinical parameters among patients with T2DM. Thus, DSME needs to be implemented among clinic patients with T2DM for the better outcome and the preventions of complications.

Culturally Tailored Self-Management Interventions for South Asians With Type 2 Diabetes: A Systematic Review.

Diabetes mellitus is one of the most common chronic diseases worldwide and a leading cause of morbidity and mortality. A high prevalence of type 2 diabetes mellitus has been noted among the South Asian population, in general, and migrant South Asians. Self-management is considered a proponent to the management of diabetes. Although empirical evidence supports such interventions, little is known regarding the cultural congruency of such interventions for diverse cultural and ethnic groups, particularly South Asians. Our purpose was to determine the effectiveness of diabetes self-management education (DSME) and diabetes self-management support (DSMS), interventions on migrant South Asian's glycated hemoglobin (A1C) levels and whether DSME and DSMS interventions are culturally tailored to the migrant South Asian population. In this study, a systematic review, with narrative synthesis, was conducted. Data were extracted on the study, participant, and intervention characteristics and the cultural congruity using Leininger's sunrise model. Four studies meeting the inclusion criteria were included. Overall, most (75%) of the DSME and DSMS interventions were not effective in reducing A1C levels. Specific to cultural congruity of the interventions, all studies delivered the intervention based on the participant's preferred language and incorporated culturally sensitive dietary information primarily by persons of the same cultural and ethnic background. However, little information was presented on the provision and integration of culturally congruent care. Findings highlight the importance of rethinking the way in which South Asians are labelled as a homogenous group and accounting for such differences when adapting and designing culturally tailored DSME and or DSMS interventions in clinical practice.

Effectiveness of Diabetes Self-Management Education in Community Health.

Diabetes self-management education (DSME) programs utilize a multidisciplinary, skills-based approach allowing participants to make self-management choices and follow a comprehensive plan of care, improving their glycemic control. The purpose of this quality improvement project was to evaluate the effectiveness of DSME on the reduction of hemoglobin A1c (HgbA1c) and body mass index (BMI) in overweight/obese community health center patients. The free program met 2 hours weekly for 6 consecutive weeks. A retrospective chart review was conducted to compare baseline to post-session HgbA1c and BMI 12 weeks after completion of the program. Pre- and post-session surveys were also conducted to assess improved diabetes knowledge and confidence. Mean HgbA1c decreased by 1.6% (p = .003) 12 weeks after completion of the program; however, BMI remained unchanged (p = .582). Diabetes knowledge and confidence also improved significantly following DSME (p = .000 and p = .001, respectively). The study demonstrated that a reduction in HgbA1c levels and an increase in diabetes knowledge and confidence can occur in low income, community health center patients following participation in DSME. Community health center patients who have access to free DSME can improve their health, self-efficacy, and diabetes self-management practices.

Effectiveness of diabetes self-management education via a smartphone application in insulin treated type 2 diabetes patients \u2013 design of a randomised controlled trial (\u2018TRIGGER study\u2019)

BackgroundHealth care providers aim to stimulate self-management in type 2 diabetes (T2DM) patients. However, they have a limited number of patient contacts to do this. With the growing number of T2DM patients, innovative and cost-effective interventions to promote self-management are needed. We aim to evaluate the effectiveness of diabetes self-management education via a smartphone app in T2DM patients on insulin therapy.MethodsNon-blinded two-arm multi-centre randomised controlled superiority trial with parallel-groups and equal randomisation (‘TRIGGER study’). Eligible patients are 40–70 years, on insulin therapy since at least 3 months, with HbA1c > 53 mmol/mol (> 7%). In total 228 patients will be recruited. The intervention group (n = 114) will receive diabetes self-management education via a smartphone app to trigger diabetes self-management: unidirectional text messages, free of charge, evidence and psychological theory based, with regard to dietary habits, physical activity, hypoglycaemia and glucose variability. Patients choose their preferred frequency (two to six times per week), topics (two or three additionally to hypoglycaemia, which is an obligatory topic), and duration (6 or 9 months). The control group (n = 114) will receive care-as-usual. The primary study endpoint is the HbA1c level after a follow-up of 6 months. The percentage of patients who achieve an HbA1c level ≤ 53 mmol/mol (≤7%) without hypoglycaemia (plasma glucose < 3.5 mmol/L (< 63 mg/dL)) is a co-primary outcome. Secondary outcomes are body mass index, waist circumference, insulin dose, lipid profile, blood pressure, number of hypoglycaemic events, glycaemic variability, self-management (SDSCA), food habits (FFQ), physical activity (IPAQ), health status (EQ-5D-5 L, SF36), diabetes-dependent quality of life (ADDQoL), diabetes treatment satisfaction (DTSQ), satisfaction with the app, the cost-effectiveness of the intervention after 3 months, and sustainability of the intervention effect (3 months extra follow-up in intervention group to compare prolonged to discontinued use of the app). We will use the intention-to-treat principle to analyse data.DiscussionInnovative solutions are needed to improve the (cost-) effectiveness of self-management for the increasing number of T2DM patients. This trial will provide evidence on the effectiveness of a newly developed smartphone app, designed to trigger diabetes self-management.Trial registrationDutch Trial Register NTR5515, registration date: 18 November 2015 (prospectively registered).

DIABETES SELF MANAGEMENT EDUCATION AGAINST TYPE 2 DM PATIENTS INDEPENDENCE IN MANAGING DIET

Introduction. Diabetes mellitus has been the cause of 4.6 million deaths. In addition, health expenditure for diabetes mellitus has reached 465 billion USD. Complications experienced by patients with type 2 diabetes mellitus that causes the sufferer to experience dependence in regulating dietary patterns. Patients depend in managing the diet due to a lack of knowledge and lack of motivation in self-care. The purpose of this study was to identify the effectiveness of Diabetes Self-Management Education to independence yipe 2 diabetic patients in managing the diet. Method. This research was aPre-experimental study. Research design was one group pre-post-test design. The sampling technique used simple random sampling with 30 samples. Data was analyze by using Wilcoxon Signed Rank Test with a significance value of α = 0.05. Result. Pre-test results showed that almost all respondents (80%) or 24 samples in the category of partial care. The post-test results showed that the majority (56.7%) or 17 respondents in the category of minimal care. Statistical analysis showed Wilcoxon p = 0.000. Discussion. The conclusion of this research showed that the effects of Diabetes Self-Management Education on patient autonomy in managing diet in type 2 diabetes patient. Keywords: Diabetes Self-Management Education, Diet, Independence

Effectiveness of a community-based diabetes self-management education (DSME) program in a rural agricultural setting.

In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months. DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination. DSME in this rural agricultural town improved glycemic control and promoted foot examination.