One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes

Strawbridge, Larisa M; Lloyd, Jennifer; Meadow, Ann; Riley, Gerald F.; Howell, Benjamin L.

doi:10.1097/mlr.0000000000000653

Cited by 82 publications

(65 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(2014), several of our participants developed diabetes management mental models primarily through their personal experience and observation of others’ self‐care efforts. This is concerning for two reasons: (a) other's self‐care activities may not reflect appropriate treatment or may not be appropriate for others with diabetes; and (b) formal diabetes mellitus self‐management training reduces the risk of hospitalisation and emergency department visits (Strawbridge, Lloyd, Meadow, Riley, & Howell, 2017). Our findings suggest that “refresher” diabetes education would be helpful to some individuals who had received diabetes self‐management education including one participant who reported biannual education would be helpful.…”

Section: Discussionmentioning

confidence: 99%

Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

Despins

Wakefield

2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To describe individuals' with type 2 diabetes mellitus sense‐making of blood glucose data and other influences impacting self‐management behaviour. Background Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self‐management regimens is an ongoing healthcare challenge. Examining individuals’ sense‐making processes can advance staff knowledge of and improve diabetes self‐management behaviour. Design A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self‐management decisions. Methods Sixteen one‐on‐one interviews with adults diagnosed with type 2 diabetes mellitus using a semi‐structured interview guide were conducted from March–May 2018. An inductive–deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self‐Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. Results Three main themes described participants’ type 2 diabetes mellitus sense‐making and influences on self‐management decisions: classifying blood glucose data, building mental models and making self‐management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. Conclusion Individuals use self‐monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self‐management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. Relevance to clinical practice Nurses must assess sense‐making processes in self‐management decisions. Periodic “refresher” diabetes education may be needed for individuals with type 2 diabetes mellitus.

show abstract

Section: Discussionmentioning

confidence: 99%

Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

Despins

Wakefield

2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…Studies have found that DSMES is associated with improved diabetes knowledge and self-care behaviors (8), lower A1C (7,(9)(10)(11), lower self-reported weight (12,13), improved quality of life (10,14), reduced all-cause mortality risk (15), healthy coping (16,17), and reduced health care costs (18)(19)(20). Better outcomes were reported for DSMES interventions that were over 10 h in total duration (11), included ongoing support (5,21), were culturally (22,23) and age appropriate (24,25), were tailored to individual needs and preferences, and addressed psychosocial issues and incorporated behavioral strategies (6,16,26,27).…”

Section: Evidence For the Benefitsmentioning

confidence: 99%

5. Lifestyle Management:Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

551

279

View full text Add to dashboard Cite

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidencegrading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. Lifestyle management is a fundamental aspect of diabetes care and includes diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), physical activity, smoking cessation counseling, and psychosocial care. Patients and care providers should focus together on how to optimize lifestyle from the time of the initial comprehensive medical evaluation, throughout all subsequent evaluations and follow-up, and during the assessment of complications and management of comorbid conditions in order to enhance diabetes care. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT Recommendations 5.1 In accordance with the national standards for diabetes self-management education and support, all people with diabetes should participate in diabetes self-management education to facilitate the knowledge, skills, and ability necessary for diabetes self-care. Diabetes self-management support is additionally recommended to assist with implementing and sustaining skills and behaviors needed for ongoing self-management. B 5.2 There are four critical times to evaluate the need for diabetes selfmanagement education and support: at diagnosis, annually, when complicating factors arise, and when transitions in care occur. E 5.3 Clinical outcomes, health status, and quality of life are key goals of diabetes self-management education and support that should be measured as part of routine care. C 5.4 Diabetes self-management education and support should be patient centered, may be given in group or individual settings or using technology, and should be communicated with the entire diabetes care team. A 5.5 Because diabetes self-management education and support can improve outcomes and reduce costs B, adequate reimbursement by third-party payers is recommended. E

show abstract

“…Studies have found that DSMES is associated with improved diabetes knowledge and self-care behaviors (14,15), lower A1C (14,(16)(17)(18), lower self-reported weight (19,20), improved quality of life (17,21), reduced all-cause mortality risk (22), healthy coping (5,23), and reduced health care costs (24)(25)(26). Better outcomes were reported for DSMES interventions that were over 10 h in total duration (18), included ongoing support (12,27), were culturally (28,29) and age appropriate (30,31), were tailored to individual needs and preferences, and addressed psychosocial issues and incorporated behavioral strategies (13,23,32,33).…”

Section: Evidence For the Benefitsmentioning

confidence: 99%

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2020

2019

Diabetes Care

273

133

View full text Add to dashboard Cite

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10 .2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes .org/SOC. Effective behavior management and psychological well-being are foundational to achieving treatment goals for people with diabetes (1,2). Essential to achieving these goals are diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), routine physical activity, smoking cessation counseling when needed, and psychosocial care. Following an initial comprehensive medical evaluation (see Section 4, "Comprehensive Medical Evaluation and Assessment of Comorbidities," https://doi.org/10.2337/dc20-S004), patients and providers are encouraged to engage in person-centered collaborative care (3-6), which is guided by shared decision-making in treatment regimen selection, facilitation of obtaining needed medical and psychosocial resources, and shared monitoring of agreed-upon regimen and lifestyle (7). Re-evaluation during routine care should include not only assessment of medical health but also behavioral and mental health outcomes, especially during times of deterioration in health and well-being. DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT Recommendations 5.1 In accordance with the national standards for diabetes self-management education and support, all people with diabetes should participate in diabetes self-management education and receive the support needed to facilitate the knowledge, decision-making, and skills mastery necessary for diabetes selfcare. A 5.2 There are four critical times to evaluate the need for diabetes selfmanagement education to promote skills acquisition in support of regimen Suggested citation: American Diabetes Association. 5. Facilitating behavior change and wellbeing to improve health outcomes:

show abstract

One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes

Abstract: Findings demonstrate benefits from DSMT use, including lower health service utilization and costs. The low cost of DSMT relative to the reduction in Medicare expenditures highlights an opportunity to reduce the burden of diabetes on both individuals and the health care system.

Cited by 82 publications

References 33 publications

Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

5. Lifestyle Management:Standards of Medical Care in Diabetes—2019

5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2020

Contact Info

Product

Resources

About