Understanding how self-management education and support programmes for type 2 diabetes are expected to change behaviour: A document analysis of two programmes.

Background: Diabetes is a growing health problem worldwide. Diabetes self-management education and support (DSMES) program is a crucial component in promoting self-care in all people with diabetes. However, the practice in certain countries, including Thailand, is not yet standardized, thus the effectiveness of such program is unknown. Objective: To evaluate the effectiveness of DSMES in Thailand. The outcomes were glycemic control, lipid levels, body mass index (BMI), quality of life (QoL), and diabetes knowledge. Materials and Methods: The authors searched PubMed, Scopus, and ProQuest databases since their inception until March 2019 for randomized controlled trials conducted in Thailand that evaluated outcomes of DSMES programs. Meta-analyses were performed to pool mean differences (MD) of the outcomes. Results: Seven studies, with 1,523 participants, were included. DSMES programs were conducted in different healthcare settings by health professionals from multiple disciplines. The results revealed that participants receiving DSMES had significantly lower hemoglobin A1c, MD –0.66% (95% CI –0.90 to –0.42), and FBG levels, MD –15.88 mg/dL (95% CI –20.95 to –10.79), than those who did not. Lipid levels, BMI, QoL, and diabetes knowledge, however, did not significantly differ. Conclusion: Meta-analysis results showed that DSEMS is effective in improving glycemic control and should be promoted to combat the burden of this important health problem in Thailand. Keywords: Diabetes self-management education and support; DSMES; Glycemic control; Meta-analysis; Thailand

BackgroundPeople of Black African and Black Caribbean ethnicity experience higher rates and poorer outcomes of type 2 diabetes (T2D) than people of White European ethnicity; these inequalities are compounded by poor healthcare access. Cultural tailoring of diabetes self-management education and support (DSMES) programs has the potential to improve healthcare engagement and clinical outcomes for ethnic minority groups. Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) is a co-designed, culturally tailored group-based DSMES program for adults of Black African and Black Caribbean ethnicity.ObjectiveThis trial aims to evaluate the clinical and cost effectiveness of the HEAL-D intervention, compared to standard DSMES programs, in Black African and Black Caribbean adults living with T2D.MethodsA 24-month, multicenter, pragmatic, open-label, 2-arm, parallel-group, individually randomized group treatment trial will be conducted, with primary end point (glycated hemoglobin [HbA1c]) assessment at 12 months. Black African and Black Caribbean adults with T2D (n=300), recruited from 3 to 5 centers in the United Kingdom (including London, West Midlands, and Greater Manchester), will be randomized in a 1:1 ratio to HEAL-D (intervention) or a standard DSMES program (control). HbA1c, blood lipids, anthropometric outcomes, blood pressure, physical activity, and patient-reported outcome measures relating to psychological well-being and self-management support, lifestyle behaviors, and health economics will be collected at baseline and follow-up visits (6, 12, and 24 months). Cost-effectiveness will be assessed through a cost-utility analysis conducted from a health and social care perspective. A mixed methods process evaluation will provide a formative evaluation of delivery, intervention fidelity, and implementation of HEAL-D, and an embedded study within a project will assess the impact of multiple long-term conditions on uptake of, and engagement with HEAL-D, and the impact of HEAL-D on multiple long-term conditions. The trial received Research Authority and Research Ethics Council approval on April 22, 2024.ResultsFunding began in August 2023. Site “green light” was received on August 15, 2024, for London; November 29, 2024, for Manchester; and January 31, 2025, for the West Midlands. Recruitment commenced in August 2024 and is due to run for 11 months. As of March 26, 2025, a total of 76 participants have consented. Last patient, last visit is expected in June 2027; primary data analysis is expected to begin in July 2027. Final results are anticipated to be available in September 2027, and publication is expected by the end of 2027.ConclusionsThe HEAL-D trial will address whether a culturally tailored DSMES program, provided in-person or via videoconferencing, is clinically and cost-effective compared to standard DSMES at improving diabetes management in Black African and Black Caribbean adults. If effective, this would provide an evidence-based model of equitable DSMES services and improve the implementation of healthcare programs for ethnic minority groups.Trial RegistrationISRCTN 1434448; https://www.isrctn.com/ISRCTN14344948International Registered Report Identifier (IRRID)DERR1-10.2196/71861

Background: Prevalence of and factors associated with use of diabetes self-management education and support (DSME/S) programs in newly diagnosed type 2 diabetes (T2D) patients in Louisiana (LA) have not been fully evaluated. Methods: We used EHRs from 3 hospital systems in LA (01/01/2013 to 10/31/2019). Eligible patients were 35-94 y-old with T2D based on ICD-codes, an antidiabetic drug prescription, an HbA1c ≥6.5%, an FPG ≥126, a 2-hr OGT ≥200, or random plasma glucose ≥200 mg/dL. New T2D was defined as entry of T2D diagnosis in the condition list occurring ≥1 y after first recorded office visit. DSME/S were searched by HCPCS codes G0108 and G0109. Logistic regressions compared differences between DSME/S vs. non-DSME/S group ≥180 days before the first recorded DSME/S. Results: The prevalence of DSME/S use in T2D patients was 5.6% (18,139/313,242). In newly diagnosed T2D patients, the prevalence was 6.2% (8,918/137,629). Comparing to gender-, age- and race-matched non-DSME/S group, DSME/S group had worse clinical profiles, e.g., higher mean A1c and triglycerides, lower mean HDL, and higher obesity rate. Adjusted models showed self-pay patients were 70% less likely (OR 0.3, 95% CI 0.2-0.6) to use DMSE/S than Medicare beneficiaries. Current smokers were 2.6 times more likely (2.6, 1.8-3.7), but former smokers were 40% less likely (0.6, 0.5-0.7) to use DMSE/S than never smokers. Patients with hypolipidemic or antihypertensive drugs were 50% (1.5, 1.4-1.8) or 60% (1.6, 1.4-1.8) more likely to use DSME/S than those without the medications. Patients with A1c >6.5% were 3.9 times more likely (3.9, 3.4-4.6) to use DSMES/S than those with normal A1c. Obese patients were 60% more likely (1.6, 1.4-1.9), but hypertensive patients (SBP>130/DBP>80 mmHg) were 60% less likely to use DSME/S (0.4, 0.3-0.5). Conclusion: Use of DSME/S is low in LA, and there are marked differences in using the service by insurance type, smoking status and diabetes risk control. Disclosure Y. Yoshida: None. L. Shi: None. D. Hong: None. E. Nauman: None. G. Hu: None. P.T. Katzmarzyk: None. E.G. Price-Haywood: None. A.N. Bazzano: None. Y. Shen: None. V. Fonseca: Consultant; Self; Abbott, Asahi Kasei Corporation, AstraZeneca, Bayer Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Stock/Shareholder; Self; Amgen, Bravo4health.

Self-management is critical for optimisation of diabetes care, and diabetes self-management education and support (DSMES) programmes are well recognised to improve biomedical, behavioural and psychological outcomes for people living with diabetes. The aim of this perspective piece is (1) to delineate the barriers experienced by under-represented groups with type 2 diabetes mellitus (T2DM) and (2) to evaluate the role of targeted interventions and digital health as potential solutions to address these barriers and bridge the gaps in diabetes care. Common barriers to accessing DSMES programmes include practical issues such as timing and location, as well as psychological barriers such as stigma. Available evidence shows that tailoring diabetes self-management programmes to fit with people’s culture or specific needs increases effectiveness and acceptability of DSMES programmes in seldom heard groups. Digital-based self-management programmes have the opportunity to reach a vast number of individuals and offer an alternative source to empower people with T2DM. However, technology may also widen health inequalities and increase social isolation. Therefore, further research is required to establish bespoke and effective diabetes self-management programmes for under-represented individuals with T2DM.

<p dir="ltr">Objective: Previous studies have identified limited access to diabetes self-management education and support (DSMES) programs in many US communities. This retrospective cohort study examines rural-urban differences in DSMES utilization among individuals newly diagnosed with type 2 diabetes using the Arkansas All-Payer Claims Database from 2015 to 2019. Research Design and Methods: A cohort of 42,875 individuals covered by commercial or Medicare/Medicare Advantage insurance was identified. Generalized estimating equations, based on a multivariable logistic regression, were used to assess the association between rural residence and DSMES utilization accounting for clustering at the county level. The model adjusted for demographic characteristics, insurance type, diabetes complication severity score, and county-level factors including primary care shortages, median household income, and the density of DSMES-recognized programs per 10,000 individuals with diabetes. Results: DSMES utilization was lower in rural areas compared to urban areas (3.4% versus 6.2%, p<0.01). However, after adjusting for county level factors, rural-urban differences were not statistically significant (OR=0.83, CI:0.47-1.47, p=0.52). Individuals in the lowest quartile of household income had lower odds of DSMES utilization (OR=0.65, CI:0.46-0.91, p=0.01). Those in counties with higher density of DSMES programs had higher odds of DSMES utilization (quartile 2: OR=1.75, CI:1.22-2.50, p<0.01; quartile 3: OR=1.53, CI:1.10-2.12, p=0.01; quartile 4: OR=1.40, CI=1.04-1.90, p=0.03). Conclusions: Findings suggest that structural factors, including income and program availability, explain much of the rural–urban differences in DSMES utilization. Geographic context should be considered in efforts to improve access to diabetes education. Article Highlights · Why did we undertake this study? We conducted this study to examine rural and urban differences in the utilization of Diabetes Self-Management Education and Support services among individuals newly diagnosed with type 2 diabetes in Arkansas. · What specific question(s) did we want to answer? We hypothesized that county-level geographic factors, including median household income and the availability of DSMES programs, may explain differences in DSMES utilization between rural and urban areas. · What did we find? We found that geographic context accounted for much of the observed rural–urban difference in DSMES utilization. · What are the implications of our findings? Improving DSMES availability and access in rural communities may help reduce gaps in diabetes self-management support.</p>

BACKGROUND: Diabetes self-management education and support (DSMES) programs are patient-centered, holistic solution that enables it one of the best approaches for improving medication adherence enhanced coping, empowerment and self-efficacy, quality of life (QoL), and lower rates of depression, in people with type 2 diabetes mellitus (T2DM). In isolation, DSME strategies have not shown significant improvements to self-care and/or reduction of diabetic foot ulcer (DFU). AIM: This study sought to determine the effect of modified DSMES on self-care, DFU severity, and QoL in rural Indonesian patients with DFUs. METHODS: A quasi-experimental design with pre-test and post-test control group design, in Singkawang, West Kalimantan, Indonesia, with a total sample of 60 patients consisting of 30 patients in the intervention group and 30 patients in the control group. The DSMES has been adapted to cover 2 h of content for a period of 8 weeks and the eight-core components of DSMES. The curriculum was culturally adapted revised to incorporate culturally appropriate nature similarities, such as a prominent change to represent changes in glucose counts; to incorporate photos; to incorporate culturally relevant eating habits, such as fish and fruit; to communicate in detail the significance of medication adherence, with an emphasis on metformin’s organic, plant-based characteristics; and to emphasize engagement. Intention-to-treat analyses were conducted to determine the effect of modified DSMES on self-care, DFU severity, and QoL. RESULTS: The DSMES program improved outcomes in three of the three outcome indicators when compared to the control group at T1: In this study, (1) the DFU degree increased by 3.3% points (95% confidence interval [CI]: 0.018–0.194), (2) the diabetes foot self-care behavior score increased by a modest 8.8% points (95% CI: 0.021–0.203), and (3) the QoL increased by 32.7% points (95% CI: 00.075–0.689). The degree of DFU (difference-in-difference [DID] coef. 0.350, 95% CI 0.084–0.572), diabetes foot self-care behavior (DID coef. 0.085, 95% CI 0.065–0.405), and QoL (DID coef. 0.343, 95% CI 0.078–0.436) are all still significantly improved compared to the control at T2. CONCLUSION: The primary outcome analyses indicate that the adapted DSMES was more effective than standard care at improving self-care and QoL and decreasing DFU degree in this sample of Indonesians with DFU, both immediately after and 3 months after the intervention. As nurse educators, it is our responsibility to ensure that we evaluate all of the support options accessible to the patients in our care.

The purpose of the study was to describe the development and feasibility of implementing the DM-BOOST program in support of an established diabetes self-management education and support (DSMES) program. A patient panel of 4 adults with type 2 diabetes (T2DM) codesigned DM-BOOST. DM-BOOST is a patient-focused program that includes peer-written text messages about diabetes self-management behaviors and digital health training to improve patient portal use and initiate goal setting prior to a scheduled DSMES appointment. Adults with T2DM and A1C ≥8.0% participated in a 6-month feasibility pilot. Participants were randomly assigned (1:1) to receive either DM-BOOST or usual care. Outcomes included DSMES engagement (scheduled and attended DSMES appointments) and changes in diabetes self-efficacy and treatment satisfaction. Pilot participants (n = 60) were 60.0% female with mean age 45.5 years (SD 8.3) and A1C 10.1% (SD 1.8%). All DM-BOOST participants (30/30, 100%) had DSMES appointments scheduled compared to 86.7% of usual care (26/30). DM-BOOST participants had fewer DSMES appointment no-shows/cancellations (3/30, 10%) compared to usual care (10/26, 35%). There was greater improvement in diabetes self-efficacy in the DM-BOOST group compared to usual care and no difference in treatment satisfaction. DM-BOOST, leveraging peer-written text messaging and digital health training, increased DSMES engagement. Implementation of DM-BOOST was determined to be feasible, with several system-level barriers identified, including obtaining provider referrals and scheduling appointments. An effectiveness trial of DM-BOOST is needed to evaluate the impact on clinical outcomes.

This Evidenced-Based Project (EBP) aimed to decrease the incidence of patients diagnosed with prediabetes converting to Type 2 diabetes. By utilizing the Diabetes Self-Management Education and Support (DSMES) program, the project will enhance patient knowledge of diabetes and self-care practices. Education in patients diagnosed with prediabetes in a small community clinic in Tijuana, Mexico. Background: The American Diabetes Association (ADA) recommends that patients diagnosed with prediabetes attend Diabetes Self-Management Education and Support (DSMES) classes. DSMES focuses on the lifestyle management of diabetes, and it facilitates knowledge, skills, and abilities necessary for optimal self-care. The focus is on supporting patient empowerment by providing them with tools to make informed decisions on their diabetes management ("Prevention or delay of type 2 diabetes and associated comorbidities: Standards of medical care in diabetes-2022", p. S39-S43). Evidence-Based interventions: The evidence recommends a weight loss of 7% from baseline and a minimum of One hundred fifty minutes of exercise per week. Participants between the ages of 18 to 75 with an A1c of 5.7% to 6.4% and referred to their primary care provider or community clinic healthcare provider if they did not have a primary care provider. Patients attend diabetic education classes, which include content on diet and exercise. Results: Of 57 participants, 53 were between the ages of 20 to 81 and had Hgb A1c completed. Nine had Hgb A1c between 5.7% to 6.4%, and three had a history of hypertension. Four participants had Hgb A1c greater than 6.5%, and they all had a known history of Type 2 diabetes. Of the four, three of them had a history of hypertension also. The other 40 participants had Hgb A1c within normal limits of less than 5.6%. Conclusion: Early detection and education of prediabetes can reduce the incidence of Type 2 diabetes and the complications associated with diabetes. This, in turn, will improve patients' quality of life, and it will also reduce healthcare costs for patients and healthcare facilities. Keywords: Prediabetes, Diabetes Self Management, and Hemoglobin A1c

Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.

Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2). &lt;p&gt;The prevalence of diagnosed diabetes is projected to increase in the U.S from 22.3 million (9.1% of total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of improvement in reaching clinical target goals since 2005 despite advancements in medication and technology treatment modalities. Indeed, between 2010 and 2016 improved outcomes stalled or reversed (6).&lt;/p&gt; &lt;p&gt;The goals of the consensus report are to improve clinical care and education services, to improve the health of individuals and populations, and to reduce diabetes-associated per capita health care costs (1,7). This paper is specifically directed towards health care providers (physicians, nurse practitioners, PAs), referred to herein as providers, as it outlines the benefits of DSMES; defines 4 critical times to provide and modify DSMES (see Figure 1); proposes how to locate DSMES related resources; and discusses potential solutions to access and utilization barriers. This report provides guidance to others as well: health systems and organizations can use this report to anticipate and address the needs of persons with diabetes and create access to DSMES services; persons with diabetes can increase their awareness of DSMES services as part of quality care and can advocate for self-management education and support; and payers and policy makers can work to design reimbursement processes that support participation in DSMES. The consensus report’s recommendations are listed in Table 1.&lt;/p&gt;

The world of diabetes is changing rapidly. Health care professionals, educators, and people with diabetes are advocating for more and better management options. Educators and providers must grow with the technology and tools available to better serve participants and patients. The 2017 National Standards for Diabetes Self-Management Education and Support (DSMES) (1), issued jointly this summer by the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE), help educators and providers do just that, by outlining requirements of DSMES service providers and offering best practices for those in the field. The DSMES standards are updated periodically—currently, every 5 years—by a Standards Revision Task Force convened by ADA and AADE to review and incorporate the latest research. Following are some of the major updates and highlights from the 2017 DSMES standards, including key takeaways and tools for providers of DSMES services. Previous DSMES standards referred separately to “diabetes self-management education” and “diabetes self-management support.” In the 2017 standards, the two have been combined and are now referred to jointly as “diabetes self-management education and support.” Education is not sustainable for people with diabetes if they do not have the support to continue to make choices and changes to manage their condition. Likewise, support from a diabetes care team needs to include a teaching element, so people with diabetes are up to date about tools and actions they can use for their management. Also, both education and support need to be ongoing, because diabetes is a lifelong condition; there is no “one …

Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020. In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt. Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not. Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.

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

The surge in diabetes cases affecting 3.6 million individuals in Nigeria demands a proactive response. Despite the high prevalence, the current Nigerian model is reactive leading to delayed treatment, heightened complications, elevated healthcare expenses, and diminished quality of life. This document proposes the solution of integrating culturally adapted Diabetes Self-Management Education and Support (DSMES) programs into Nigerian health policy as standard practice. Additionally, it recommends establishing diabetes educator training programs and a nationwide accreditation process. The development of such a program, in collaboration with the University of Port Harcourt Teaching Hospital, is outlined, highlighting both successes and failures during its initial implementation. These insights emphasize the importance of enhanced collaboration, sustainable funding, and a comprehensive monitoring and evaluation framework. These observations are currently driving ongoing program development.

The purpose of this qualitative descriptive study was to examine the National Standards for Diabetes Self-Management Education and Support (DSMES) defined diabetes self-care behaviors (healthy eating, being active, taking medication, monitoring, problem solving, reducing risk, and healthy coping) in the context of older community-dwelling American Indians (AIs). Secondary theme analysis of transcribed semistructured qualitative interview data from 28 participants in the Native Elder Care Study aged >60 years identified factors that influence the DSMES self-care behaviors in the context of community-dwelling AIs. Four themes that characterized barriers, facilitators, and opportunities for DSMES to support self-care behaviors included community food security, care partners in self-care, community opportunities for diabetes support, and blending of both health worlds. Tribal communities have contemporary strengths and cultural traditions that can be activated to enhance diabetes self-management education and support. Diabetes educators can work in tandem with community health representatives to strengthen the social and community support within which individual AIs with type 2 diabetes mellitus live. Community-based participatory research with AI caregivers, dyads, families, youth, and Indian Health Service clinicians may help to improve tribal food policy and school health initiatives, as well as develop intergenerational interventions for modeling effective diabetes self-management.