Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review

Abstract

Background. Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient’s care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals. Methods. Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity. Results. The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed. Conclusion. Our findings suggest that the effects of DSME on patients’ health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.

Characteristics of self-management education and support programmes for people with chronic diseases delivered by primary care teams: a rapid review

“…As SMES programmes are recommended by the main learned societies of chronic disease, we considered that our main objective was to identify models of SMES in primary care [ 4 ]. Therefore, we focused on the model of care because according to Kumah et al, it may influence the effects of the SMES programme [ 11 ].…”

“…However, to better meet the needs of people living with chronic diseases, the different dimensions of SMES interventions in primary care need to be reconsidered [ 11 ]. First, the healthcare organisation (HCO) is a major category to consider when developing a model of SMES delivery.…”

“…Third, although the educative content of SMES programmes seems well established, the educational theory developed by the team to accompany patients in their skill and competence development is rarely described [ 15 ]. These three dimensions (organisational, social/behavioural, and educational), which can be combined or not by authors, must all be taken into account because the model of care can influence the results of SMES programmes [ 11 ].…”

Nurse-Led Programs Focusing on Social Support for People with Type 2 Diabetes Mellitus: A Scoping Review

“…In addition, strategies for patients' attendance and commitment to the treatment of chronic diseases are related to family engagement and effective professional intervention, which highlights the importance of social support in achieving these goals. Such support is an essential tool for promoting improvements in health and interpersonal relationships, which leads to improved cognitive performance, and negative emotional reactions management -e.g., anxiety, and offers behavioral analysis (21,22). The literature highlights the key role played by nursing professionals in primary care in health education activities and self-management through evidence-based practices (23).…”

Significance of Educational Literature and Diabetes Log Sheet on Hemoglobin A1c

“…Studies have also stressed the importance of a multidisciplinary approach for providing care to diabetic patients. However, until recently, there was no clear consensus on whether DSME outcomes differ with a general practitioner, nurse, specialist, or any combination of healthcare professionals [ 47 ].…”