Diabetes Self-Management Education: Miles to Go

Abstract

This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts.

Performance Obstacles and its relation to the Perceived Quality of patient care and Quality of Working Life among ICU Nurses: A Comparative Study

“…These findings are consistent with that of Steinsbekk et al [17] which concluded that patients may need ongoing reinforcement to achieve lasting behavioral change and glucose control to more fully realize the full impact of diabetes education and to yield sustainable improvements in nutrition, exercise, and blood sugar control. The findings of the current study were further supported by Klein et al [14] ; Powers et al [29] and Sperl-Hillen et al [31] .…”

“…Participants also indicated that the programme could reduce the stress of Diabetes in the country, a revelation which mimics a finding in a Hispanic and non-Hispanic community in another country. [15,23] Again in support of the findings of the current study regarding benefits of DSME, Klein [14] found that DSME resulted in significantly reduced A1c levels and life style changes and observe that most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. These results are all in keeping with the CHNs postulate that DSME would result in more educated and empowered clients who will be able to better manage their diabetes.…”

“…These affirmations are in keeping with nurses in other regions. In Nigeria, Nwankwo et al [10] showed in their research study where majority of the nurses indicated that they believed that DSME would [14] .…”

“…A number of studies have documented the efficacy of this strategy [2, 7, 8, 9, 10, 11, 12, and 13] . Klein, Jackson, Street, Whitacre, and Klein [14] , in their meta-analysis study, assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels.The overall results showed that the DSME interventions significantly reduced A1c levels Leyva, Zagarins, Allen, and Welch [15] in their diabetes self-management education intervention analysis to examine the relative impact of change in diabetes distress and change in depressive symptoms on change in glycemic control in Hispanic patients following DSME intervention. In Oman, it is believed to be a cheaper method and the added advantages of having patient meet and discuss with each other among others [16 and 17] .…”

Health education to prevent chronic diabetes mellitus complications in primary care

“…[21][22][23] In the context of DM and the prevention of chronic complications, considering the complexity of the disease and its treatments, actions involving health education are extremely important for people to successfully control the disease. 5,24,25 Furthermore, appropriation of knowledge is not based on the amount of information accumulated, but on the socialization of knowledge in a contextualized way. 7 In light of the shortcomings presented, guidance should be considered as an instrument of health education, essential for users to be able to take care of their condition, as recognized by DM health policies and many other complementary policies ofthe Brazilian public health system.…”