Ongoing diabetes self-management support study

A participant-driven reinforcement program for diabetes self-management education (DSME) can have a positive effect on self-care behaviors as well as metabolic and cardiovascular health, according to a study published recently in Preventing Chronic Disease.

Results of a 2-year ongoing diabetes self-management support (DSMS) intervention known as Lifelong Diabetes Self-Management Intervention (LMI) and a 1-year follow-up period demonstrated significant improvements in self-care for following a health diet (P=.03), spacing carbohydrates evenly throughout the day (P=.005), and insulin use (P=.047). In addition, diabetes-specific quality of life improved significantly (P=.02). There were also significant improvement at 1-year follow-up for HbA_1c (P<.001), serum cholesterol (P<.001), and LDL cholesterol (P=.001).

Participants were recruited from the greater Ypsilanti, Michigan, area, targeting African-American adults who were 40 and older with type 2 diabetes for at least 1 year and having received DSME in the past. They also had to be under the care of a healthcare provider.

Seventy-seven participants were recruited and 52 were retained at the 36-month end point. The attrition rate was 33%, below the expected rate of 48% over the 3-year study, the authors noted.

Mean age was 63 years, more than 70% were female, and 46% were married. One-third had a high school diploma or less, three-quarters were not employed, and 52% were Medicare beneficiaries.

“The [DSMS] intervention consisted of 88 weekly sessions, each lasting 75 minutes, conducted over 24 months [by a nurse-certified diabetes educator and a clinical psychologist],” said Tricia S. Tang, PhD, and colleagues in the published online report. “We offered sessions at a local community center and at different times (10 am and 3 pm) to accommodate participants’ schedules.”

During the sessions, participants were encouraged to share challenges with self-management, their emotions dealing with these challenges, possible problem-solving, goals for self-management, and action plans to meet those goals. Assessments at baseline, 24 months, and 36 months included HbA_1c and lipid panel, weight and height measurement, blood pressure reading, and self-report survey. Participants were compensated for their time and effort at each assessment with a $50 stipend.

“Participants had complete control over the frequency and extent of support that they sought. Essentially, participants functioned as active agents of their self-management and lifestyle change, and the weekly DSMS sessions served as a resource they could use in their self-management efforts,” Dr. Tang and colleagues wrote. “Clearly, a goal of DSMS interventions is to foster this type of self-sufficiency and self-efficacy.”

The study was supported by a K23 patient-oriented career development award from the National Institutes of Health and by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. At the time of the study, Dr. Tang was a faculty member at the University of Michigan Medical School. She is now with the University of British Columbia School of Medicine, Department of Medicine, Vancouver.