Participation in structured diabetes mellitus self-management education program and association with self-management behavior - results from a population-based study

Solveig Carmienke, Marcus Heise, Jens Baumert, Lars Gabrys, Alexander Bauer, Yong Du, Thomas Frese, Christin Heidemann, Astrid Fink

Keywords: diabetes mellitus self-management education;elf-management; diabetes mellitus; population-based study


Participation in structured diabetes self-management education programs (DSME) for patients with diabetes mellitus is associated with an improved self-management behavior (SMB) in randomized-controlled studies. However, little is known of the effects of DSME on SMB in population-based studies after a broadly dissemination of DSME in German routine health care.

Research questions:

Is participation in an DSME associated with an increased SMB in routine health care setting for diabetic patients?


We included 1,495 persons with diabetes (934 ever- and 561 never-DSME participants) from the population-based survey German Health Update 2014/2015. SMB was defined by keeping a diet plan, keeping a diabetes diary, holding a diabetes pass, blood sugar self-measurement, foot self-examination, eye examination, haemoglobin A1c (HbA1c) measurement. We conducted multivariable weighted logistic regression analyses for SMB differences comparing ever- and never-DSME participants and a latent class analysis. Age, sex, socioeconomic status, living together, limitation due to chronic illness for six months, self-efficacy, health attention and time since diagnosis were included as confounders in the all analyses.


DSME participation increased the chance for SMB regarding (all OR [95% CI]) keeping to a diet plan (2.10 [1.33-3.32]), keeping a diabetes journal (4.0 [2.92-5.49]), keeping a diabetes pass (6.21 [4.51-8.55]), blood sugar self-measurement (3.86 [2.95-5.05]), foot self-examination (2.94 [2.04-4.24]), eye examination (3.85 [2.84-5.22]), HbA1c measurement (2.95 [2.19-3.96]). Furthermore, we could identify three SMB-profiles: 1) poor performance in all variables, 2) good performance in HbA1c measurement, foot self-examination and eye examination, but poor performance in the other SMB-variables, 3) very good performance in all variables. Participation in DSME increases the average probability for high SMB for diabetic patients from 5% to 59%.


DSME participation is associated with a significantly improved SMB even in routine health care. General practitioner should refer patients to a DSME to improve their SMB.

Points for discussion:

-Should future research investigating SMB in diabetic patients take DSME as a confounder into account?

-What could population-based studies in routine health care add to knowledge of DSME interventions based on data randomized-controlled trials ?

- SMB and confounding variables we analysed in this study