A Diabetes Self-Management Program: 12-Month Outcome Sustainability From a Nonreinforced Pragmatic Trial

Abstract

BackgroundDiabetes self-management education has been shown to be effective in controlled trials. The 6-week Better Choices, Better Health-Diabetes (BCBH-D) self-management program was also associated with an improvement in health outcomes in a 6-month translation study.ObjectiveThe objective of this study was to determine whether a national translation of the BCBH-D self-management program, offered both Web-based and face-to-face, was associated with improvements in health outcomes (including HbA1c) and health behaviors (including recommended medical tests) 1 year after interventionMethodsWeb-based programs were administered nationally, whereas face-to-face workshops took place in Atlanta, Indianapolis, and St Louis. Self-report questionnaires were either Web-based or administered by mail, at baseline and 1 year, and collected health and health-behavior measures. HbA1c blood samples were collected via mailed kits. A previous 6-month study found statistically significant improvements in 13 of 14 outcome measures, including HbA1c. For this study, paired t test compared baseline with 1-year outcomes. Subgroup analyses determined whether participants with specific conditions improved (high HbA1c, depression, hypoglycemia, nonadherence to medication, no aerobic exercise). The percentage of participants with improvements in effect size of at least 0.4 in at least 1 of the 5 measures was calculated.ResultsA total of 857 participants with 1-year data (69.7% of baseline participants) demonstrated statistically significant 1-year improvements in 13 of 15 outcome measures; 79.9% (685/857) of participants showed improvements in effect size of 0.4 or greater in at least 1 of the 5 criterial measures.ConclusionsParticipants had small but significant benefits in multiple measures. Improvements previously noted at 6 months were maintained or amplified at 1 year.

2017 National Standards for Diabetes Self-Management Education and Support

“…Evidence-based communication strategies such as collaborative goal setting, action planning, motivational interviewing, shared decision making, cognitive behavioral therapy, problem solving, selfefficacy enhancement, teach-back, and relapse-prevention strategies are also effective (120,(136)(137)(138)(139). It is crucial to develop action-oriented behavior change goals and objectives (130,140). Creative, person-centered, experience-based delivery methods beyond the mere acquisition of knowledge are effective for supporting informed decision making and meaningful behavior change and addressing psychosocial concerns (122,141).…”

Evaluation of a Diabetes Self-Management Program: Claims Analysis on Comorbid Illnesses, Health Care Utilization, and Cost (Preprint)

“…While there is potential for some biases between the full Lorig, et al, (2016) study sample and the claims sample based on sex, age, and format of treatment, on the whole, the claims identified cohort represents the original study population. [16] Impact of Diabetes Self-Management on Healthcare Costs 8 Baseline demographics and healthcare utilization data for post-match patients are presented in …”

“…Two related studies evaluating the small group and internet based BCBH-D program, led by a consortium of the Stanford Patient Education Research Center, National Council on Aging (NCOA), and Anthem Health Plans reported modest benefits among the program participants based on 6 and 12-month follow-up periods. [15,16] The 6-month follow-up study reported statistically significant improvements in 13 of 14 outcome measures, including HbA1c and health behaviors (e.g. communication with physicians, stretching/strengthening exercise, medication adherence, frequency of eye, foot, cholesterol and kidney exams).…”

“…The researchers noted that that the improvements at 6 months were maintained and augmented during the 12-month period. [16] However, to date, there has been no research that has evaluated the impact of the self-management program on healthcare utilization and costs.…”

“…[15,16] The study took place in a real world setting and the objective was to evaluate 1) the program's impact on comorbid illness related to DM, 2) healthcare utilization, and total medical cost at 1-year baseline. [17] The index date was defined for controls as a randomly selected date during the same period as program recruitment period (October 2013 to October 2014).…”