A gap exists between diabetes self-management education (DSME), DSMS practices, and the infrastructure needed to foster sustainability of improved outcomes, particularly in low-resource communities. We determined the relative effectiveness of 3 parallel DSMS approaches in improving A1c and diabetes distress (DD). Moderate DD was 2.0-2.9 and high DD was ≥ 3.0. 370 individuals [mean age: 64.6 years, 74% female, 100% African American (AA), mean A1c: 7.7%±1.9, 22.8% with moderate DD] from 21 AA churches in southeast Michigan and northwestern Ohio, took part in a cluster randomized trial from 2016-2020. Data were collected at baseline, 6, 9, 21, and 33 months. Churches were randomized to one of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS (n=123), PL DSMS (n=127), or PN DSMS (n=109)]. Twenty-one PNs and 28 PLs were trained to facilitate DSMS at each church. Sustained reduction in A1c was observed in all groups (PNPL: -0.2%, p=0.68; PN: -0.2%, p=0.13). PL had borderline statistically significant reductions (-0.3%, p=0.08). The proportion of participants with A1c < 7% also improved over time in each group (PNPL: 57.3 vs. 60.7%, p=0.21; PL: 57.3 vs. 62.7%, p=0.44; PN: 40.9 vs. 44.1%, p=0.66), but not significantly. Of those who achieved A1c < 7% following DSME (9-month follow-up), 81.3% of participants, across all groups, sustained the goal at 33 months. PN had the most participants with sustained glycemic control (PNPL: 81.6%, PL: 76.7%, PN: 86.9%). Significant improvements in mean DD scores were observed from baseline to 33 months in all groups (PNPL: 2.1 vs. 1.8, p=0.05; PL: 2.0 vs. 1.7, p=0.004). Moreover, there was a 50% reduction in the proportion of participants with moderate DD in PL (31.7% vs. 12.2%) and PN (27.5% vs. 15%) and severe DD in PN (10% vs. 5%). Varied approaches to DSMS within the context of existing community infrastructures (AA churches) fostered the sustainability of improvements in diabetes-related outcomes.
G. Piatt: None. A. M. Provenzano: None. R. Nwankwo: None. D. Hall: None. K. A. Kloss: None. J. M. Hawkins: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association.
National Institutes of Health (R01DK103733)