How important is support for patients who self-manage their diabetes?
Diabetes Self-Management Education and Support (DSMES) is the ongoing process of facilitating the knowledge, skills, and ability necessary for diabetes self-management, as well as activities that assist a person in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis, beyond or outside of formal self-management training.
A variety of models have been proposed to provide the support required to achieve the desired improvement in diabetes knowledge and self-management skills. Community health workers, peer support, and online programs can help address issues having to do with socioeconomic conditions, as well as aid in health care system navigation.
A study by Chrvala et al aimed to assess the effect of diabetes self-management education and support methods, providers, duration, and contact time on glycemic control in adults with type 2 diabetes. It included 118 interventions, with 61.9% reporting significant changes in A1C. Overall mean reduction in A1C was 0.74 and 0.17 for intervention and control groups; an average absolute reduction in A1C of 0.57. A combination of group and individual engagement results in the largest decreases in A1C (0.88). Contact hours ≥10 were associated with a greater proportion of interventions with significant reduction in A1C (70.3%). In patients with persistently elevated glycemic values (A1C > 9), a greater proportion of studies reported statistically significant reduction in A1C (83.9%).
The study concluded that engagement in diabetes self-management education results in a statistically significant decrease in A1C levels. The data suggest mode of delivery, hours of engagement, and baseline A1C can affect the likelihood of achieving statistically significant and clinically meaningful improvement in A1C.
Another recent study was conducted to answer the question of whether augmented diabetes self-management support with an economically vulnerable population addresses unmet needs and reduces morbidity and premature mortality.
The randomized clinical trial was conducted at 4 sites. A total of 446 individuals were enrolled. The intervention utilized pre-and post-comparisons. The study was designed to test the efficacy of a telephonic diabetes support intervention to increase patient engagement in self-care utilizing the health care system to improve clinical outcomes.
To be eligible, individuals needed to be either English- or Spanish-speaking adults, ages 21–85 years, and have a diagnosis of type 2 diabetes mellitus. It was required that study participants had not participated in a diabetes self-management education program in the last year and had A1c >8 at the time of enrollment. Subjects excluded from the study included individuals who were currently pregnant or undergoing cancer treatment, had a diagnosis of end-stage renal disease or serious mental illness, or were receiving systemic treatment with prednisone or immunosuppressant therapy following organ transplant.
Individuals in both the usual care control and telephonic support intervention group showed statistically significant and clinically meaningful improvement in A1c after participation in this study. There were significant improvements in A1c, BMI, LDL, triglycerides, and depression screening scores in the year following Diabetes Self-Management Education and Support. However, there were no statistically significant difference-in-differences between the groups for A1c, BMI, HDL, LDL, triglycerides, and blood pressure. There was no significant change in either systolic blood pressure or diastolic blood pressure observed following Diabetes Self-Management Education and Support for either group.
The study concluded that comprehensive face-to-face care with consistent assessment and documentation over time produced significant improvement for people with diabetes. The addition of structured telephonic support overlapping in time with the comprehensive face-to-face provision of care in this environment did not produce statistically significant clinical or behavioral care improvement. Professionals who work with people with diabetes found value in the added connection.
- Diabetes Self-Management Education and Support has the potential to achieve clinically meaningful reductions in A1C, with resultant complication risk reduction.
- Mode of delivery, hours of engagement, and baseline A1C can affect the likelihood of achieving statistically significant and clinically meaningful improvement in A1C.
- Further research and exploration of means to enhance Diabetes Self-Management Education and Support are needed to advance the understanding of approaches that will advance care.
Bluml BM, Kolb LE, Lipman R. Evaluating the Impact of Year-Long, Augmented Diabetes Self-Management Support. Popul Health Manag. 2019 Jan 22.
Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016 Jun;99(6):926-43.
Dahlia Elimairi, Pharm D Student, Skaggs School of Pharmacy, UC Denver