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.
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