Who Can Provide Diabetes Self-Management Support in Primary Care?

Siminerio, Linda M.; Ruppert, Kristine; Gabbay, Robert A.

doi:10.1177/0145721713492570

Cited by 61 publications

(65 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies have shown that implementing DSME programs that directly connect with primary care and rely on technology is effective in improving clinical, psychosocial, and behavioral outcomes (16,(71)(72)(73)(74). Patients receiving care in these practice settings report more confidence in provider communication and satisfaction with direct access to an educator for information and ongoing support (16).…”

Section: Overcoming Barriers That Limit Access and Receipt Of Dsme/smentioning

confidence: 99%

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

et al. 2015

Self Cite

View full text Add to dashboard Cite

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes (1-7). Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Table 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial DSME is typically provided by a health professional, whereas ongoing support can be provided by personnel within a practice and a variety of community-based resources. DSME/S programs are designed to address the patient's health beliefs, cultural needs, current knowledge, physical limitations, emotional concerns, family support, financial status, medical history, health literacy, numeracy, and other factors that influence each person's ability to meet the challenges of self-management.It is the position of the American Diabetes Association (ADA) that all individuals with diabetes receive DSME/S at diagnosis and as needed thereafter (8). This position statement focuses on the particular needs of individuals with type 2 diabetes. The needs will be similar to those of people with other types of diabetes (type 1 diabetes, prediabetes, and gestational diabetes mellitus); however, the research and examples referred to in this article focus on type 2 diabetes. The goals of the position statement are ultimately to improve the patient experience of care and education, to improve the health of individuals and populations, and to reduce diabetes-associated per capita health care costs (9). The use of the diabetes education algorithm presented in this position statement defines when, what, and how DSME/S should be provided for adults with type 2 diabetes.

show abstract

Section: Overcoming Barriers That Limit Access and Receipt Of Dsme/smentioning

confidence: 99%

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…21,26,27,30,37 In contrast, the pooled effect size from the 7 studies with predominantly white, non-Hispanic participants showed no improvement in HbA 1c level with peer support interventions, with an SMD of -0.004 (95% CI, -0.153 to 0.144; P = .95; I 2 = 59.41%). 22,25,29,[31][32][33][34] The pooled effect in the subgroup of 3 studies with predominantly African American participants showed a similar effect size to that seen in the Hispanic subgroup but was not statistically significant, with an SMD of 0.25 (95% CI, -0.064 to 0.571; P = .11; I 2 = 58.60%). 23,24,28 The differences in effect sizes between ethnicity subgroups were statistically significant, with a between-group P value of .03.…”

Section: Subgroup Analyses Studies With Ethnic or Racial Predominancementioning

confidence: 72%

“…20 Ultimately, 14 articles with RCT designs and 3 cluster RCTs were eligible for inclusion in the meta-analysis, for a total of 4,715 participants. Of the 17 trials, 10 were done in the United States, [21][22][23][24][25][26][27][28][29][30] …”

mentioning

confidence: 99%

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

Patil

Ruppar

Koopman

et al. 2016

The Annals of Family Medicine

View full text Add to dashboard Cite

PURPOSE Peer support intervention trials have shown varying effects on glycemic control. We aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A 1c (HbA 1c ) levels in adults. METHODSWe searched multiple databases from 1960 to November 2015, including Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and Scopus. We included randomized controlled trials (RCTs) of adults with diabetes receiving peer support interventions compared with otherwise similar care. Seventeen of 205 retrieved studies were eligible for inclusion. Quality was assessed with the Cochrane risk of bias tool. We calculated the standardized mean difference (SMD) of change in HbA 1c level from baseline between groups using a random effects model. Subgroup analyses were predefined.RESULTS Seventeen studies (3 cluster RCTs, 14 RCTs) with 4,715 participants showed an improvement in pooled HbA 1c level with an SMD of 0.121 (95% CI, 0.026-0.217; P = .01; I 2 = 60.66%) in the peer support intervention group compared with the control group; this difference translated to an improvement in HbA 1c level of 0.24% (95% CI, 0.05%-0.43%). Peer support interventions showed an HbA 1c improvement of 0.48% (95% CI, 0.25%-0.70%; P <.001; I 2 = 17.12%) in the subset of studies with predominantly Hispanic participants and 0.53% (95% CI, 0.32%-0.73%; P <.001; I 2 = 9.24%) in the subset of studies with predominantly minority participants; both were clinically relevant. In sensitivity analysis excluding cluster RCTs, the overall effect size changed little. CONCLUSIONSPeer support interventions for diabetes overall achieved a statistically significant but minor improvement in HbA 1c levels. These interventions may, however, be particularly effective in improving glycemic control for people from minority groups, especially those of Hispanic ethnicity. Ann Fam Med 2016;14:540-551. doi: 10.1370/afm.1982. INTRODUCTIONT he global burden of diabetes is expected to increase from 381.8 million people affected in 2013 to an estimated 591.9 million by 2035.1 Despite increasing evidence of benefits from self-management education, only 5% of Medicare-insured and 7% of privately insured people with diabetes receive this intervention within 1 year of diagnosis. [2][3][4] Diabetes self-management education improves hemoglobin A 1c (HbA 1c ) levels, and longer duration of education further lowers levels; however, the benefits decline 1 to 3 months after education ends. 5 The World Health Organization (WHO) has stated that peer support appears to be a promising approach to improving and sustaining diabetes self-management behaviors. 6 Randomized controlled trials (RCTs) using peer support interventions delivered by people affected by diabetes have shown varying results on glycemic control, however. A 2012 narrative review examined the effect of peer support interventions on diabetes outcomes, but several additional studies with these interventions have b...

show abstract

“…Patients with T2DM typically get most of their diabetes care in short visits from family physicians that may or may not have additional multi-disciplinary support. In addition, OHIP covers services provided by DEPs, which are multi-disciplinary, non-physician led programs designed to deliver self-management education of diabetes and self-management support [18]. The three recruitment sites included 1) a DEP located in an urban area in a large city centre (>2 million people 2) a DEP located in a mid-size city in a remote area of the province (<150,000 people) and 3) a DEP located in a semi-urban area surrounding a large city centre (<600,000 people).…”

Section: Settingsmentioning

confidence: 99%

Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial (Preprint)

Agarwal¹,

Mukerji²,

Desveaux³

et al. 2018

Preprint

View full text Add to dashboard Cite

Background: A growing number of mobile apps are available to support self-management of diabetes. One such app, called BlueStar™, has been shown to significantly reduce glycemic control in small trials. While the efficacy of the app led to become the first app in the USA to receive FDA approval as a Mobile Prescription Therapy, its effectiveness across a range of usual care settings remains unclear.

show abstract

Who Can Provide Diabetes Self-Management Support in Primary Care?

Cited by 61 publications

References 15 publications

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial (Preprint)

Contact Info

Product

Resources

About