Intensive Diabetes Education Programs Improve Blood-Sugar Control

DIABETICS need information in order to manage their disease; but their knowledge about the facts is still not enough for behavioral change. What is needed is to find a way to be able to give people the skills to solve their problems in all areas of their lives so that they can be able to start caring for themselves.

One of the most important aspects of diabetes management is educating the patient to manage their condition themselves. This is known as Diabetes Self-Management Education, better known by its acronym DSME. It has been demonstrated by many studies that education works.

A team of researchers at Johns Hopkins University School of Medicine have developed a diabetes education program that significantly improves long-term blood-sugar control among patients by educating low income, poorly educated diabetes patients to be able to manage their disease. Their findings have been published online in the March issue Journal of General Internal Medicine.

The researcher’s premise was that lower socioeconomic status is associated with excess disease burden from diabetes and that diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change.

Dividing about 56 participants into two groups, the researchers provided an intensive problem solving course in the first group that lasted more than nine sessions and covered standard diabetes self-management and care. They also include the way in managing financial, social, resource and interpersonal issues that relate to the disease.

The second group received only a solid two-session version of the program.

At the end of the program after three months, those who were in the intensive group showed a fall in hemoglobin levels by an average of 0.7 as compared to the levels they had before the program started. Below 5.7 is considered normal while the target of people with diabetes is below 7. The participants in the two-session group did not see any improvement.

The researchers conclude that literacy-adapted, intensive, problem-solving-based diabetes self-management training is effective for key clinical and behavioral outcomes in lower income patients.

“We know that people need information to manage their disease, but having knowledge of the facts is not enough for behavioral change,” said Felicia Hill-Briggs, an associate professor in the general internal medicine division at the Johns Hopkins University School of Medicine and the study’s lead author.

“With this novel approach, we have found a way to give people the skills to solve problems in all areas of their lives so that they can take diabetes off the back burner and start caring for their health.”

Another DSME advocate Linda Siminerio, RN, PhD, CDE, director of the University of Pittsburgh Diabetes Institute, and associate professor at the University of Pittsburgh School of Medicine and the School of Nursing points out, “Diabetes self-management education (DSME) should always be considered as part of the treatment plan, even if a patient is reported to have excellent metabolic control.

“Attention to self-care behaviors and psychosocial needs are equally as important as metabolic outcomes when managing a burdensome, chronic disease like diabetes. Active listening, providing accurate information and building a patient’s confidence are all important tools used in diabetes education.

“It is (therefore) essential that physicians and everyone on the diabetes care team work together to support patient self-management by developing patient-centered goals that will be more likely to be achieved.”

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