Patient Engagement in Type 2 Diabetes: A Collaborative Community Health Initiative

Abstract

Purpose

The purpose of this study was to describe the effects of an innovative rural community-based, diabetes self-management education and support (DSMES) program on patient behaviors and outcomes.

Methods

A 12-month pre-post study design with physiological data collection at program initiation, 16 weeks, and 6 and 12 months postenrollment was used for program assessment. The program consisted of an American Diabetes Association–accredited curriculum provided by the hospital and interfaced with a YMCA curriculum promoting lifestyle change. The 28-session program was delivered over a 1-year period.

Results

The sample size was 115. Participants were primarily white and female, with a mean age of 57 years. Mean body mass index (BMI) at program initiation was 37; mean A1C was 8.5 (69.4 mmol/mol). Significant reductions were obtained in weight, BMI (at 16 weeks), and A1C (at 6 months); these reductions were sustained at 12 months. Medication intake was significantly reduced, and diabetes-related emergency department visits were below national averages.

Conclusions

Results support the positive impact of a year-long, community-based, healthy behavior, DSMES program on health outcomes and overall costs of care delivery in the rural setting.

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References

Centers for Disease Control and Prevention. National Diabetes Statistics Report. Atlanta, GA: US Department of Health and Human Services; 2017.

Chrvala

Sherr

Lipman

RD.

Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-943.

Powers

Bardsley

Cypress

et al . 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 Educ. 2017;43(1):40-53.

Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html. Accessed November 30, 2015.

American Association of Diabetes Educators. Guidelines for the Practice of Diabetes Education. Chicago, IL: American Association of Diabetes Educators; 2009.

Beck

Greenwood

Blanton

et al . 2017 National standards for diabetes self-management education and support. Diabetes Educ. 2017;43(5):449-464.

Wang

et al . Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine. 2017;55(3):712-731.

Rickheim

Weaver

Flader

Kendall

DM.

Assessment of group versus individual diabetes education. Diabetes Care. 2002;25(2):269-274.

Asimakopoulou

Empowerment in the self-management of diabetes: are we ready to test assumptions?

European Diab Nurs. 2007;4(3):94-97.

10.

Isaksson

Hajdarevic

Abramsson

Stenvall

Hörnsten

Å.

Diabetes empowerment and needs for self-management support among people with type 2 diabetes in a rural inland community in northern Sweden. Scand J Caring Sci. 2015;29(3):521-527.

11.

Kuo

Lin

Tsai

FM.

Effectiveness of empowerment-based self-management interventions on patients with chronic metabolic diseases: a systematic review and meta-analysis. Worldviews Evid Based Nurs. 2014;11(5):301-315.

12.

Lewis

Williams

Fitzgerald

et al . Improving the implementation of diabetes self-management findings from the alliance to reduce disparities in diabetes. Health Promot Prac. 2014;15(2 suppl):83S-91S.

13.

Norris

Engelgau

Narayan

KV.

Effectiveness of self-management training in type 2 diabetes a systematic review of randomized controlled trials. Diabetes Care. 2001;24(3):561-587.

14.

Tang

Funnell

Brown

Kurlander

JE.

Self-management support in “real-world” settings: an empowerment-based intervention. Patient Educ Couns. 2010;79(2):178-184.

15.

Espeland

Glick

Bertoni

et al . Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care. 2014;37(9):2548-2556.

16.

Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;2013(369):145-154.

17.

Johnston

Moreno

Foreyt

JP.

Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. Curr Atheroscler Rep. 2014;16(12):457-457.

18.

Lian

McGhee

Chau

Wong

CKH

Lam

CLK

Wong

WCW

. Systematic review on the cost-effectiveness of self-management education programme for type 2 diabetes mellitus. Diabetes Res Clin Pract. 2017;127:21-34.

19.

Yuan

Lai

Chan

Chow

Law

Ying

. The effect of diabetes self-management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus. J Diabetes Res. 2014;2014:789761.

20.

Walton

Snead

Collinsworth

Schmidt

KL.

Reducing diabetes disparities through the implementation of a community health worker–led diabetes self-management education program. Fam Community Health. 2012;35(2):161-171.

21.

Gildea

Lantaff

Olenik

NL.

Identifying barriers to glycemic control in patients with type 2 diabetes after completion of an accredited education program. J Am Pharm Assoc. 2017;57(3): S211-S216.

22.

Winters

Sullivan

Chronic illness experience of isolated rural women: use of an online support group intervention. In: Winters

, ed. Rural Nursing: Concepts, Theory, and Practice. 4th ed. New York, NY: Springer; 2013:159-172.

23.

Lepard

Joseph

Agne

Cherrington

AL.

Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review. Curr Diab Rep. 2015;15(6):608.

24.

Rutledge

Masalovich

Blacher

Saunders

MM.

Diabetes self-management education programs in nonmetropolitan counties—United States, 2016. Morb Mortal Wkly Rep Surveill Summ. 2017;66(10):1-6.

25.

North Carolina Division of Public Health. The burden of diabetes in north carolina: brief 2013 report, 2013. http://www.diabetesnc.com/downloads/BurdenofDiabetesinNC2010ppt.pdf. Accessed November 30, 2015.

26.

WNC Healthy Impact. McDowell county community health assessment 2012, 2013. http://www.rpmhd.org/images/forms/1000/1120/cha/2012/2012_McDowell_CHA.pdf. Accessed November 30, 2015.

27.

Centers for Disease Control and Prevention. The social-ecological model: a framework for prevention, 2015. https://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html. Accessed February 20, 2018.

28.

Centers for Disease Control and Prevention. Colorectal Cancer Control Program (CRCCP): social ecological model, 2015. https://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html. Accessed February 20, 2018.

29.

McLeroy

Steckler

Bibeau

The social ecology of health promotion interventions. Health Educ Q. 1988;15(4):351-377. http://tamhsc.academia.edu/KennethMcLeroy/Papers/81901/An_Ecological_Perspective_on_Health_Promotion_Programs. Accessed February 20, 2018.

30.

UNICEF. Module 1: understanding the social ecological model (SEM) and communication for development (C4D). https://www.unicef.org/cbsc/files/Module_1_-_MNCHN_C4D_Guide.docx Accessed February 20, 2018.

31.

Centers for Disease Control and Prevention. Defining adult overweight and obesity, 2016. https://www.cdc.gov/obesity/adult/defining.html. Accessed October 27, 2016.

32.

National Institute of Diabetes and Digestive and Kidney Diseases. The A1C test and diabetes. https://www.niddk.nih.gov/health-information/diabetes/diagnosis-diabetes-prediabetes/a1c-test. Accessed October 27, 2016.

33.

Washington

Andrews

Mutter

RM.

Emergency department visits for adults with diabetes, 2010. HCUP Statistical Brief No. 167. 2013. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb167.jsp. Accessed January 15, 2018.

34.

Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374(9702):1677-1686.

35.

Ely

Gruss

Luman

et al . A national effort to prevent type 2 diabetes: participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes Care. 2017;40(10):1331-1341.

36.

National Diabetes Information Clearinghouse. Diabetes Prevention Program (DPP). https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Documents/DPP_508.pdf. Accessed March 8, 2018.

37.

Tuomilehto

Lindström

Eriksson

et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.

38.

Gildea

Lantaff

Olenik

NL.

Identifying barriers to glycemic control in patients with type 2 diabetes after completion of an accredited education program. J Am Pharm Assoc. 2017;57(3): S211-S216.

39.

Ing

Zhang

Dillard

et al . Social support groups in the maintenance of glycemic control after community-based intervention. J Diabetes Res. 2016;2016:7913258.

40.

McEwen

Pasvogel

Murdaugh

Hepworth

5. Effects of a family intervention to promote Mexican American family social capital for diabetes management. Nurs Outlook. 2017;65(1):132.

41.

Schwennesen

Henriksen

Willaing

Patient explanations for non-attendance at type 2 diabetes self-management education: a qualitative study. Scand J Caring Sci. 2016;30(1):187-192.

42.

US Census Bureau. QuickFacts: McDowell County, North Carolina; 2017. https://www.census.gov/quickfacts/fact/table/mcdowellcountynorthcarolina/PST045217. Accessed Januarly 22, 2018.