Diabetes Self-management Support Research Articles

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...

Evaluating the Impact of Year-Long, Augmented Diabetes Self-Management Support.

This was a randomized controlled study to test a scalable intervention model addressing the need for ongoing diabetes support. The study included individuals receiving care in a Federally Qualified Health Center (FQHC) with HbA1c >8. The aim of this project was to determine whether augmenting diabetes self-management education (DSME) with support for an economically vulnerable population might better meet patient needs and reduce morbidity and premature mortality. The intervention utilized pre and post comparisons and was designed to test the efficacy of a telephonic diabetes support intervention to increase patient engagement in self-care and with the health care system as a means to improve clinical outcomes. There were significant improvements in HbA1c, body mass index, low-density lipoprotein cholesterol, triglycerides, and depression screening scores in the year following DSME. However, there was no statistically significant difference between the 2 groups. This randomized controlled study demonstrated that comprehensive face-to-face care with consistent assessment and documentation over time in FQHCs produce clinically significant and predictable improvement for people with diabetes. The addition of structured provision of telephonic support overlapping in time with the comprehensive face-to-face process of care in this environment did not produce statistically significant clinical or behavioral care improvement.

Long-term follow-up of a randomized controlled trial of a text-message diabetes self-management support programme, SMS4BG.

AimsTo determine the long‐term effectiveness of an individually tailored text‐message diabetes self‐management support programme, SMS4BG, on glycaemic control at 2 years in adults with diabetes with an HbA1c concentration > 64 mmol/mol (8%).MethodsWe conducted a 2‐year follow‐up of a two‐arm, parallel, randomized controlled trial across health services in New Zealand. Participants were English‐speaking adults with type 1 or 2 diabetes and with an HbA1c >64 mmol/mol (8%). In the main trial participants randomized to the intervention group (N=183) received up to 9 months of an automated tailored text‐message programme in addition to usual care. Participants in the control group (N=183) received usual care for 9 months. In this follow‐up study, 293 (80%) of 366 randomized participants in the main trial were included. The primary outcome measure was change in glycaemic control (HbA1c) from baseline to 2 years. Mixed‐effect models were used to compare the group differences at 3, 6, 9 and 24 months, adjusted for baseline HbA1c and stratification factors (health district category, diabetes type and ethnicity).ResultsThe decrease in HbA1c at 2 years was significantly greater in the intervention group [mean (sd) –10 (18) mmol/mol or –0.9 (1.6)%] compared with the control group [mean (sd) –1 (20) mmol/mol or –0.1 (1.8)%], with an adjusted mean difference of –9 mmol/mol (95% CI –14, –5) or –0.8% (95% CI –1.2, –0.4; P<0.0001).ConclusionsImprovements in glycaemic control resulting from a text‐message diabetes self‐management support programme were sustained at 2 years after randomization. These findings support the implementation of SMS4BG in current practice.

HEALTH CARE PROVISION FOR CHILDREN WITH DIABETES IN UKRAINE

Diabetes mellitus is one of the most common human diseases that lead to disability and death. According to the reports of Ministry of Health, in Ukraine at the end of 2018 there were about 1,300,000 diabetic patients and 9,000 of them were children under 18 years of age. The sooner a child is diagnosed with diabetes, the more likely he/she is to save from the complications that cause disability and premature death. Solving issues on diabetes is one of the top priorities of national health systems. Purpose. The paper is aimed at the study of current health care provision for children with diabetes. Methods and Material. The steps in organization of health care provision for children with diabetes in Ukraine have been studied. The following methods have been used: bibliosemantic: for the analysis of scientific literature; content-analysis: to study the regulatory framework; system analysis: to analyze the organizational provision of health care for children with diabetes. Results. Type 1 diabetes is characterized by the destruction of beta cells, which leads to absolute insulin deficiency. About 75% of all type 1 diabetes cases are diagnosed in people under 18 years of age. Children and adolescents are assigned to a special category of patients who need more attention from physicians. Children find it difficult to understand what negative manifestations and the development of specific complications, leading to early disability, can be caused by a persistent and long-term decompensation of the disease. Based on the Adapted Clinical Guidelines for Type 1 Diabetes, the Working Group has developed Unified Clinical Protocols for Type 1 Diabetes in Young People and Adults and Type 1 Diabetes in Children, using evidence-based provisions for the effectiveness of medical interventions, which also served as the basis for identifying quality indicators for the health care provision for patients with type 1 diabetes. The main directions of the developed therapeutic and rehabilitation approach to medical assistance for patients with type 1 diabetes are the provision of medical, psychological and social assistance by multidisciplinary teams, involving an endocrinologist, specialists (therapist, neurologist, ophthalmologist, nephrologist, pediatrician), a social worker, a guidance counselor at the Diabetes School, a nurse. First of all, it is necessary to raise the awareness of physicians, especially at the primary level. The improvement of outpatient and in-patient care for children with diabetes, involving children themselves and their parents is also relevant. It is important to organize and provide an effective school for diabetes awareness and self-control. It is indisputably necessary to constantly and continuously monitor the state of clinical and metabolic compensation of diabetes. Attention should be paid to the need for more active use of the advanced technologies, such as pump insulin therapy. The main components of treatment are diet and insulin therapy, which the child must keep to throughout the whole life to compensate his/her health state. The role of the international diabetes movement in overcoming the diabetes epidemic in Ukraine and worldwide is noteworthy, since it called on all nations to adopt National Diabetes Prevention and Treatment Programs. Consequently, the Ministry of Health of Ukraine, together with international and national experts, has developed a number of fundamental legal acts that initiate structural changes in the health care system. Conclusion. Ukraine is one of the countries with the highest incidence of diabetes. Currently, there is a very significant increase in the incidence of diabetes among children of preschool and school age. Therefore, solving issues on diabetes is one of the top priorities of national health systems. Consequently, the life of a sick child depends on the level of organization of medical and social assistance. It is crucial that awareness and support for diabetes self-management, drug therapy and psychosocial assistance be provided from the time of diagnosis and regularly thereafter. Living a long life with diabetes is possible in proper disease control and prevention. In recent years, diabetes treatment has improved, though it has not solved all the problems. The novel modes of treatment are being actively implemented, namely, insulin analogues and insulin pumps.

Emerging practices supporting diabetes self-management among food insecure adults and families: A scoping review.

Food insecurity undermines a patient's ability to follow diabetes self-management recommendations. Care providers need strategies to direct their support of diabetes management among food insecure patients and families. To identify what emerging practices health care providers can relay to patients or operationalize to best support diabetes self-management among food insecure adults and families. Food insecure populations with diabetes (type 1, type 2, prediabetes, gestational diabetes) and provided diabetes management practices specifically for food insecure populations. Only studies in English were considered. In total, 21 articles were reviewed. Seven databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Medline, ProQuest Nursing & Allied Health Database, PsychInfo, Scopus, and Web of Science. Emerging practices identified through this review include screening for food insecurity as a first step, followed by tailoring nutrition counseling, preventing hypoglycemia through managing medications, referring patients to professional and community resources, building supportive care provider-patient relationships, developing constructive coping strategies, and decreasing tobacco smoking. Emerging practices identified in our review include screening for food insecurity, nutrition counselling, tailoring management plans through medication adjustments, referring to local resources, improving care provider-patient relationship, promoting healthy coping strategies, and decreasing tobacco use. These strategies can help care providers better support food insecure populations with diabetes. However, some strategies require further evaluation to enhance understanding of their benefits, particularly in food insecure individuals with gestational and prediabetes, as no studies were identified in these populations. A major limitation of this review is the lack of global representation considering no studies outside of North America satisfied our inclusion criteria, due in part to the English language restriction.

Pilot randomized controlled trial of a complex intervention for diabetes self-management supported by volunteers, technology, and interprofessional primary health care teams

BackgroundMost health care for people with diabetes occurs in family practice, yet balancing the time and resources to help these patients can be difficult. An intervention empowering patients, leveraging community resources, and assisting self-management could benefit patients and providers. Thus, the feasibility and potential for effectiveness of “Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management” (Health TAPESTRY-HC-DM) as an approach supporting diabetes self-management was explored to inform development of a future large-scale trial.MethodsFour-month pilot randomized controlled trial (RCT), sequential explanatory qualitative component. Participants—patients of an interprofessional primary care team—were over age 18 years, diagnosed with diabetes and hypertension, and had Internet access and one of the following: uncontrolled HbA1c, recent diabetes diagnosis, end-stage/secondary organ damage, or provider referral. The Health TAPESTRY-HC-DM intervention focused on patient health goals/needs, integrating community volunteers, eHealth technologies, interprofessional primary care teams, and system navigation. Pilot outcomes included process measures (recruitment, retention, program participation), perceived program feasibility, benefits and areas for improvement, and risks or safety issues. The primary trial outcome was self-efficacy for managing diabetes. There were a number of secondary trial outcomes.ResultsOf 425 eligible patients invited, 50 signed consent (11.8%) and 35 completed the program (15 intervention, 20 control). Volunteers (n = 20) met 28 clients in 234 client encounters (home visits, phone calls, electronic messages); 27 reports were sent to the interprofessional team. At 4 months, controlling for baseline, most outcomes were better in the intervention compared to control group; physical activity notably better. The most common goal domains set were physical activity, diet/nutrition, and social connection. Clients felt the biggest impact was motivation toward goal achievement. They struggled with some of the technologies. Several participants perceived that the program was not a good fit, mostly those that felt they were already well-managing their diabetes.ConclusionsHealth TAPESTRY-HC-DM was feasible; a large-scale randomized controlled trial seems possible. However, further attention needs to be paid to improving recruitment and retention. The intervention was well received, though was a better fit for some participants than others.Trial registrationClinicalTrials.gov, NCT02715791. Registered 22 March 2016—retrospectively registered.

Changes in diabetes distress among people with type 2 diabetes during a risk screening programme for diabetic kidney disease – Longitudinal observations of the PRIORITY study

AimsTo investigate levels and changes in diabetes distress over the course of the PRIORITY (Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In people with TYpe 2 diabetes and normoalbuminuria) randomised controlled trial of screening for diabetic kidney disease (DKD) risk among people with type 2 diabetes (T2D) at a specialist diabetes clinic in Denmark. MethodsOf 436 trial participants with T2D, 216 were invited to complete the 17-item diabetes distress scale at the time of screening (T1, n = 180), immediately after receiving the screening results at 6–8 weeks (T2, n = 169), and at 12 months follow up (T3, n = 107). Linear mixed models were used to explore changes in diabetes distress. ResultsNo significant changes in diabetes distress were observed between the time of screening, receiving results, and at 12 months. Changes in diabetes distress were not influenced by diabetes empowerment, sense of coherence, or perceived support for diabetes self-management. ConclusionsIn contrast to previous studies demonstrating that screening programmes can have negative psychological consequences, our findings indicate that participating in this screening programme for DKD does not influence emotional burden or physician-related distress among people with T2D.

Inpatient Diabetes Education in the Real World: an Overview of Guidelines and Delivery Models.

Diabetes self-management education and support improves diabetes-related outcomes, yet less than 50% of persons with diabetes in the USA receive this service. Hospital admissions present a critical opportunity for providing diabetes education. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. As diabetes rates continue to soar and adults with diabetes continue to have high hospitalization and readmission rates, hospitals face challenges in assessing and meeting diabetes patients' educational needs. The consensus recommendation for inpatient diabetes teaching is to provide survival skills education to enable safe self-management following discharge until more comprehensive outpatient education can be provided. Established and emerging models for delivery of diabetes survival skills education in the hospital may be broadly grouped as diabetes-specialty care models, diabetes non-specialty care models, and technology-supported diabetes education. These models are often shaped by the availability of diabetes specialists, including endocrinologists and diabetes educators-or lack thereof, and staffing resources for provision of services. Recent studies suggest that all three approaches can be deployed successfully if well planned. This article presents an overview of the current state of inpatient diabetes education. It incorporates a summary of existing guidance relative to content followed by an overarching discussion of existing inpatient diabetes education models and their reported outcomes, when available. The authors seek to make the reader aware of the heterogeneous approaches that are being implemented nationwide for inpatient diabetes education delivery. Meeting inpatient diabetes educational needs will require a sustained effort, diverse strategies based on resources available, and additional research to explore the impact of these strategies on outcomes.

Text messaging to engage friends/family in diabetes self-management support: acceptability and potential to address disparities.

Explore acceptability of engaging family/friends in patients' type 2 diabetes (T2D) self-management using text messaging. Participants (N = 123) recruited from primary care clinics for a larger trial evaluating mobile phone support for T2D completed self-report measures and a hemoglobin A1c test and then had the option to invite an adult support person to receive text messages. We examined characteristics and reasons of participants who did/did not invite a support person, responses to the invitation, and feedback from patients and support persons. Participants were 55.9 ± 10.1 years old, 55% female, 53% minority, and 54% disadvantaged (low income, less than high school degree/GED, uninsured, and/or homeless). Participants who invited a support person (48%) were slightly younger, more likely to be partnered, and reported more depressive symptoms and more emergency department visits in the year prior to study enrollment as compared to participants who did not (all p <.05). Participants' reasons for inviting a support person included needing help and seeing benefits of engaging others, while reasons for not inviting a support person included concerns about being a "burden" and support person's ability or desire to text. Support persons reported the texts increased awareness, created dialogue, and improved their own health behaviors. Patients inviting a support person had higher need and thus may stand to benefit most. Most support persons were open to engagement via text messages. Across race and socioeconomic status, text messaging may engage support persons to increase health-related support-particularly for patients with higher levels of need. Clinicaltrials.gov NCT02409329.

Examining implementation and effects of a comprehensive community intervention addressing type 2 diabetes among high-risk minority patients in Durham County, NC

Type-2 diabetes affects millions of people. Racial minorities are at higher risk for developing diabetes and suffering complications. Duke University and its partners built a team to improve population-level health outcomes and reduce health disparities in Durham County, NC. An empirical case study design was used to examine the Durham Diabetes Program (DDP) and its effects on emergency department (ED) visits and hospital admissions (HAs). High-risk program participants (N = 200) were enrolled into the DDP using a risk algorithm. Culturally competent teams delivered various intervention components that were anchored in behavior change strategies (e.g. diabetes self-management education and support, enhancing clinical care, community mobilization, and health system/community transformation). More than a hundred community/system changes were implemented as part of the DDP. Further, the DDP was associated with decreased ED visits (by 34%) and HAs (by 40.5%). This research can inform the way diabetes is assessed and interventions are delivered.

Medication management support in diabetes: a systematic assessment of diabetes self-management apps

BackgroundSmartphone apps are becoming increasingly popular for supporting diabetes self-management. A key aspect of diabetes self-management is appropriate medication-taking. This study aims to systematically assess and characterise the medication management features in diabetes self-management apps and their congruence with best-practice evidence-based criteria.MethodsThe Google Play and Apple app stores were searched in June 2018 using diabetes-related terms in the English language. Apps with both medication and blood glucose management features were downloaded and evaluated against assessment criteria derived from international medication management and diabetes guidelines.ResultsOur search yielded 3369 Android and 1799 iOS potentially relevant apps; of which, 143 apps (81 Android, 62 iOS) met inclusion criteria and were downloaded and assessed. Over half 58.0% (83/143) of the apps had a medication reminder feature; 16.8% (24/143) had a feature to review medication adherence; 39.9% (57/143) allowed entry of medication-taking instructions; 5.6% (8/143) provided information about medication; and 4.2% (6/143) displayed motivational messages to encourage medication-taking. Only two apps prompted users on the use of complementary medicine. Issues such as limited medication logging capacity, faulty reminder features, unclear medication adherence assessment, and visually distracting excessive advertising were observed during app assessments.ConclusionsA large proportion of diabetes self-management apps lacked features for enhancing medication adherence and safety. More emphasis should be given to the design of medication management features in diabetes apps to improve their alignment to evidence-based best practice.

Group-based storytelling in disease self-management among people with diabetes.

ObjectiveWe explored the underlying mechanisms by which storytelling can promote disease self-management among people with type 2 diabetes.MethodsTwo, eight-session storytelling interventions were delivered to a total of eight adults with type 2 diabetes at a community health center in Toronto, Ontario. Each week, participants shared stories about diabetes self-management topics of their choice. Using a qualitative descriptive approach, transcripts from each session and focus groups conducted during and following the intervention were coded and analyzed using NVivo software. Through content analysis, we identified categories that describe processes and benefits of the intervention that may contribute to and support diabetes self-management.ResultsOur analysis suggests that storytelling facilitates knowledge exchange, collaborative learning, reflection, and making meaning of one’s disease. These processes, in turn, could potentially build a sense of community that facilitates peer support, empowerment, and active engagement in disease self-management.ConclusionVenues that offer patients opportunities to speak of their illness management experiences are currently limited in our healthcare systems. In conjunction with traditional diabetes self-management education, storytelling can support several core aspects of diabetes self-management. Our findings could guide the design and/or evaluation of future story-based interventions.

Perceived impact of caregiver’s participation in diabetes education classes on implementation of self-care behaviors

ObjectiveThe objective of this study was to describe the experiences of participants in a community pharmacist–delivered diabetes self-management education and support (DSMES) program. Specifically, we explored (1) self-efficacy and barriers to implementing self-care behaviors and (2) the participants’ perception of the impact that caregiver participation in DSMES classes has on achievement of 6-month personal health goals. MethodsTen semistructured interviews were conducted in person or by telephone with participants who completed DSMES between July 2014 and December 2017. The Health Belief Model of health behaviors was used to frame the interview tool with questions exploring the concepts of perceived benefits, perceived barriers, and self-efficacy. Interviews were audio recorded and transcribed by a medical transcription service for analysis in qualitative data software. Coding was completed after data collection. ResultsMeal planning and movement were the most commonly identified barriers to implementation of self-care behaviors, and the emotional aspect of diabetes emerged as a challenge of self-efficacy for most participants. Negative effects of a caregiver’s participation were not reported. The most common goals chosen by participants included reaching target hemoglobin A1c and losing 5%-10% of body weight. All participants reported positive progress toward or success of at least some of their goals, and most attributed that to healthier eating and increasing exercise. All participants believed that caregiver participation in the education program had a positive impact on their ability to implement behavior changes. Participants identified having caregiver support to implement changes in eating habits and meal planning was the most important of all self-care behaviors. ConclusionParticipants concluded having a caregiver attend DSMES with them had a positive impact on their ability to succeed with implementation of self-care behaviors. These findings support the incorporation of caregivers into the DSMES model.

Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support.

The purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs. The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors. Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened. Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.

Diabetes self-care in primary health facilities in India - challenges and the way forward.

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes self-management education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

696-P: The CDC Web-Based Diabetes Self-Management Education and Support Toolkit

Diabetes self-management education and support (DSMES) provides an evidence-based approach to empower people with diabetes to navigate self-management decisions and activities, and has been shown to improve health outcomes. Despite the evidence that DSMES services are cost-effective and have a positive impact on diabetes-related outcomes, they are underutilized. To address this problem, the Centers for Disease Control and Prevention (CDC) developed a DSMES toolkit to increase access to and participation in DSMES services among people with diabetes and to promote health care provider referrals. The toolkit explains the process for securing recognition or accreditation of DSMES services. It offers resources to assist in maximizing reimbursement, eliminating barriers to participation, and linking DSMES to quality measures. The toolkit suggests improving access to DSMES through shared medical appointments, pharmacies, and telehealth. It describes the four critical times to refer persons to DSMES and provides tools to assist with making referrals. National experts from the American Diabetes Association and the American Association of Diabetes Educators, certified diabetes educators (CDE), and public health professionals informed the content of the toolkit. Participants from six state health departments; three DSMES services (pharmacy, federally qualified health center, local health department); and experts from the CDC (pharmacist CDE, nurse diabetes educator, project officer, endocrinologist) tested the toolkit and found it easy to use with relevant information that will be helpful in addressing barriers and challenges to improving access to and participation in DSMES. Expanded use of and referrals to DSMES can help ensure that people with diabetes receive the support they need to successfully manage their diabetes and prevent or delay serious and costly complications. The DSMES toolkit can assist diabetes and public health professionals in working together to address underuse of DSMES. Disclosure J. Houston: None. L.E. Edwards: None.

53-LB: Availability of Diabetes Self-Management Education and Support Programs in United States Counties

Authors developed an interactive map visualizing county level availability of Diabetes Self-Management Education and Support (DSMES) site or program locations. Location data were overlaid with diabetes prevalence data and socio-economic status data. Over 4200 locations were geocoded including 3471 sites (American Diabetes Association recognized) and 802 program locations (American Association of Diabetes Educators accredited). Counties were characterized as having or not having DSMES class locations. Counties were additionally characterized based on tertiles of diabetes prevalence and socio-economic disadvantage (using the Area Deprivation Index (ADI) score). This analysis showed that 48 percent of U.S. counties (1515/3142 counties and county equivalents) had a DSMES program with at least one site or program location. Approximately 39% of counties in the highest diabetes prevalence tertile (greatest diabetes burden) had DSMES programs compared to 53% in the middle tertile of diabetes prevalence and 54% in the lowest tertile of diabetes prevalence. Approximately 26% of counties in the tertile with highest ADI scores (representing greatest socio-economic disadvantage) had DSMES programs compared to 48% in the middle tertile and 69% percent in the tertile with the lowest ADI scores (least socio-economic disadvantage). This interactive map is a tool that can be used at a national level and by state and local health departments and others to prioritize establishment and expansion of programs in underserved counties with higher rates of diabetes prevalence and greater socio-economic disadvantage. Disclosure B. Jayapaul-Philip: None. S. Dai: None. E. Woghiren: None. G.E. Rutledge: None.

690-P: Building a Healthy Temple: A Faith-Based Diabetes Self-Management Support Program

Background and Objective: Type 2 diabetes disproportionally affects Hispanics. Diabetes self-management is key to preventing its life threating complications. Most Hispanics affiliate with churches, presenting a promising venue for delivering diabetes self-management support (DSMS) program. “Faith-placed” (FP) programing refers to health intervention implemented in church setting; while "faith-based" (FB) signifies integrating spirituality with health interventions. Building a Healthy Temple DSMS Program integrates spirituality with DSMS to improve diabetic outcomes. Setting and Subjects: Predominantly Hispanic churches in Texas; Diabetic churchgoers. Methods: This 13-week cluster-RCT assigned 18 churches to: 1) FB Group receiving a Health Sermon, 6-session DSMS, and 6-session Healthy Bible Study delivered by trained church lay leaders; or 2) FP Group receiving 6-session DSMS accompanied by a 7-session partial attention control curriculum delivered by outside professionals. Key outcome measures included HbA1c, BMI, waist circumference (WC), DSM Self-efficacy and diabetes quality of life (DQL) using the Problem Areas in Diabetes Scale (PAID). Data are collected at baseline, 6, 9, and 12 months. Intervention effects were determined using Linear mixed-effect models, controlled for age, gender and baseline corresponding outcome measures. Preliminary Results: To date, 3 FP (n=48) and 3 FB churches (n=49) have delivered interventions and collected 9 month data. Post intervention, the FB Group appears to have a lower HbA1c than the FP Group (6.56 vs. 6.79; p=0.095). Single-group sub-analyses showed that only the FB Group sustained a 4% HbA1c reduction at 9 months (p&amp;lt;0.05), and a 16% increase in DSM Self-efficacy scores at 6 and 9 months (p&amp;lt;0.05). Compared to baseline, both groups significantly reduced WC and PAID scores (i.e., improved DQL) at 6 and 9 months. Conclusions: Integrating spirituality with DSMS could lead to improved diabetes outcomes among Hispanic diabetic churchgoers. Disclosure S.R. Wilmoth: None. L. Carrillo: None. M. Pan: None. D. Chavarria: None. B. Wilhite: None. D. Parra-Medina: None. M. He: None. Funding American Diabetes Association (1-17-ICTS-029 to M.H.)

659-P: Family Caregivers' Roles in Supporting Adults' Self-Management of Diabetes

Background: Increased social support positively influences self-management of diabetes, but limited data exist documenting the specific roles that family caregivers assume in supporting adults with diabetes. Moreover, explanations for why caregivers take on certain roles has received little attention. Understanding what roles caregivers fill and why is critical to informing and targeting services aimed at improving caregiver competency in promoting diabetes self-management for their loved ones. Methods: To characterize caregivers’ roles in supporting adults’ self-management of diabetes, as well as reasons for assuming those roles, 31 one-on-one, in-depth, semi-structured telephone interviews were conducted with adults with type 2 diabetes (n=19) and their family caregivers (n=12). Two coders independently reviewed transcripts from interview audio recordings in NVivo 12 Pro using interpretive phenomenological data analysis. Findings: Adults and their caregivers described three central roles of caregivers in diabetes self-management: care organizer, health motivator, and medication tracker. Caregivers also recognized another prominent role, knowledge seeker. Two explanations for assuming specified roles emerged: changes in health and healthcare expertise. Caregivers reported taking on care roles because their loved one experienced a health problem that required medical or surgical attention. Some adults described turning to caregivers for diabetes management support because their family member had a healthcare background, such as a nurse or paramedic. Conclusion: These adult and caregiver perspectives shed light on what roles families assume in supporting diabetes self-management and why. Information gleaned from this study may help healthcare providers target support for family roles to enhance caregivers’ ability to help adults with diabetes management. Disclosure B. Fields: None. K.L. Rodriguez: None. L.K. Makaroun: None. C.H. Robinson: None. J. Forman: None. A. Rosland: None. Funding Ann Arbor VA Center for Clinical Management Research; Michigan Center for Diabetes Translational Research (5P60-DK09292)

51-LB: The Impact of Digital Health Coaching on the Diabetes Distress Scale (DDS)

The ADA’s recent release of the Standards of Medical Care in Diabetes recommends including technology-based methods for the delivery of effective diabetes self-management education and support. Self-management of diabetes involves meal planning, taking medications, blood glucose monitoring, physical activity, coordinating care, and others. The program developed by Pack Health addresses all of the tasks above and more through a structured 12-week program, evidence-based tools, and a non-prescriptive Health Advisor. The program has over 60 proactive outbound touchpoints that originate from the Health Advisor (via text messages, emails, and/or phone calls). The Pack Health program collects and utilizes patient-reported outcomes (PROs) along with clinical measures, self-reported by patients. All data is used for coaching sessions and evaluation purposes. This study examines the impact of Digital Health Coaching on a national diabetes population (n=198) and an African American sub-population (n=57) enrolled in the South (AL, GA, FL, MS) upon completion of the initial 12-weeks of engagement. The DDS is a 17-item scale that captures four critical dimensions of distress: emotional burden, regimen distress, interpersonal distress and physical distress. DDS score benchmarks are established at little to no diabetes distress (&amp;lt;2.0), moderate diabetes distress (2.0-2.9), high diabetes distress (≥3.0). Health coaching demonstrates the following impact: National Diabetes Population: Baseline: 3.0; Post: 2.2; Improvement: 0.8 African Americans in the South: Baseline: 3.0; Post: 2.1; Improvement: 0.9 The data above emphasizes that digital coaching program can have a significant impact on Diabetes Distress for a general population and African American population in the South. Disclosure M. Allison: None. U. Srivastava: None. S.B. Burton: None. M. Rasulnia: None. D. Patel: None.