Diabetes Self-Management Education and Support: Referral and Attendance at a Patient-Centered Medical Home

Abstract

Background Although evidence shows that diabetes self-management education and support (DSMES) is an effective tool to help individuals with type 2 diabetes (T2DM) improve their health outcomes, there remains a large number of individuals not attending DSMES. Understanding how frequently patients receive referrals to DSMES and the number of DSMES hours they receive is important to determine, as well as patients’ health outcomes of utilizing DSMES. This will help us understand patterns of utilization and the outcomes that occur when such a valuable resource is utilized. Methods Secondary data analysis was conducted of patient electronic medical records at a primary healthcare federally qualified clinic and 2 area hospitals. We identified 105 adult patients with a new T2DM diagnosis with at least 2 A1c lab results 3 to 12 months apart during the study period. Results Only 53.5% were referred to DSMES. Out of those who were referred, 66% received no DSMES, 17% received 1-hour assessment, 4% received partial DSMES, and 13% received 8 or more hours. Linear regression of percent change in A1c and number of DSMES hours received, revealed that receiving 1 ( P = .001) or 8 or more hours of DSMES ( P = .022) had a significant negative relationship with the percent difference in A1c compared to the group who received no DSMES. Patients who had an hour of assessment had a similar percent reduction in A1c to those who had partial DSMES. Conclusion Referral rates and enrollment in DSMES remain low. Those who enrolled often dropped out after the one-hour assessment session. Results suggest making the one-hour assessment session more educationally comprehensive or longer to retain patients. Improving the DSMES referral process and further investing physicians’ decisions on whether to refer or not refer patients to DSMES are key for future studies.

Diabetes Self-management Education and Support Completion Before and During the COVID-19 Pandemic: Results From Local Health Departments in North Carolina

“…The 2017 American Association of Diabetes Educators practice survey of diabetes educators reported that only 23% of DSMES participants completed 75% or more of the program 6. More recently, a 2020 analysis of data from a network of federally qualified health centers (FQHCs) found a low DSMES completion rate of 13%10; a 2021 analysis of data from a health system found a completion rate of 13.2% 11. Taken together, existing studies show that more than 80% of patients who start DSMES do not complete the DSMES curriculum.…”

“…Numerous studies have demonstrated benefits of participating in DSMES on glycemic control, diabetes-related knowledge, and self-care behaviors 2–6. Despite this, the reported DSMES completion rate appears to be low 2,7–11. Empirical data on DSMES completion have been limited.…”

“…[2][3][4][5][6] Despite this, the reported DSMES completion rate appears to be low. 2,[7][8][9][10][11] Empirical data on DSMES completion have been limited. The COVID-19 pandemic has impacted health care tremendously, including DSMES.…”

Diabetes Self-Management and Health-Related Quality of Life among Primary Care Patients with Diabetes in Qatar: A Cross-Sectional Study

“…Other studies from the region have confirmed low levels of knowledge related to diabetes [ 27 , 28 ]. Despite the extensive evidence that diabetes self-management education (DSME) is an effective and available resource in improving knowledge related to diabetes, DSM activities, and quality of life, in addition to other diabetes-related clinical outcomes [ 11 , 12 ], attendance remains poor, and, therefore, DSME remains an underutilized resource [ 29 , 30 ].…”

Living with Chronic Kidney Disease and Type 2 Diabetes Mellitus: The Patient and Clinician Perspective

“…Therefore, it would be beneficial to include diabetes educators and patient partners to increase appropriately timed referrals at diagnosis of T2D and to incorporate CKD awareness, early detection, and prevention strategies in their patient education materials. The evidence suggests that referrals to diabetes education and support are woefully underused [ 31 , 32 ]. These strategies could help clinicians to intervene early and care for the expanding population of patients with advanced CKD.…”