Purpose: Diabetes Self-Management Education (DSME) is a crucial aspect of treating type 2 diabetes mellitus (T2DM). Daily individual decisions affect patient health, well-being, and long term outcomes. This pilot study evaluated what best educates and motivates patients to improve glucose control.
Method: 17 participants with T2DM were recruited from Penn Rodebaugh Diabetes Center to attend 3 monthly diabetes support group meetings, and receive American Association of Diabetes Educators education. Weight and hemoglobin A1C (A1C) were measured at baseline and completion. Fitbit Activity Trackers were provided, as well as bi-weekly communication to reinforce behavior change. Pre and post-study surveys assessed nutrition, activity, monitoring blood glucose, and taking medication. Two sided paired t-test was performed to compare change in A1C and weight. A type I error rate of 0.was used for statistical significance.
Results: 15 participants completed the study. DSME interventions resulted in a statistically significant decrease in mean A1C from 8.5% to 7.7% with a mean A1C reduction of 0.8% in 3 months (p-value=0.01). Mean weight decreased 4.80 lb (p-value=0.0001). 11 remained on same medications, and 1 required reduced insulin. 3 added a glucagon-like peptide receptor agonist (GLP-1RA), with 1 adding a sodium-glucose cotransporter-2 inhibitor. 7 increased daily steps wearing Fitbit, while 8 reported no motivation. 10 increased weekly exercise, and 11 increased daily activity. All benefited from bi-weekly reinforcement, and reported improved nutrition. Food replica models aided visual reinforcement.
Conclusion: DSME in a group setting can motivate self-care and reduce both A1C and weight, however, the study met challenges. Time per patient spent coordinating was substantial. Food models and phone communication to reinforce lifestyle modification were useful. Research is needed to determine what provides long-term sustainability in a busy clinical practice.
L. McLeer Maloney: None. J. Flood: None. N. Alamuddin: Consultant; Self; Novo Nordisk Inc.. M. Al Mukaddam: None.