Background: Diabetes self-management education and support (DSMES) services are an integral part of quality diabetes care. However, despite strong evidence regarding its effectiveness and clear guidelines from the ADA recommending its use, <10% of eligible patients have received DSMES. In this study, we examine rates of referral to DSMES across specific subgroups at an academic medical center in Kentucky.

Methods: We analyzed patterns of DSMES referrals at University of Kentucky HealthCare from 1/1/2016-12/31/20among adult patients (aged ≥ 18) with diabetes (ICD-9: 249, 250; ICD-10: E08-E13) . We restricted our sample to patients receiving primary care at UKHC with at least 365 days of follow-up and examined referral rates across the following subgroups: sex, race/ethnicity, age group, insurance type.

Results: In our sample of 3,854 patients with diabetes (mean (SD) age=56.8 (13.9) ; 50% female) , 9.3% of eligible patients were referred for DSMES. Referral rates were higher in non-Hispanic Black patients (14.5%) compared to non-Hispanic Whites (9.4%) and Hispanics (9.4%; p<0.001) . Females were more likely to be referred for DSMES than males (12.3% vs. 8.7%; p<0.001) and younger patients were more likely to be referred than older patients (27.5% of patients age 18-24 vs. 5.0% of patients aged 65+; p<0.0001) . Referral rates were lower in patients with Medicare coverage (7.6%) compared to those with Medicaid (13.0%) or commercial insurance (11.6%; p<0.0001) .

Conclusions: Results from our study highlight low referral rates for DSMES services in the primary care setting for patients with diabetes. Our findings also underscore disparities in key subgroups that can be targeted to improve DSMES referrals. Of particular significance are differences in DSMES referral rates across age categories. Older patients face diabetes-related challenges they may change as they age. The importance of continuing DSMES services across the lifespan should be highlighted.


G.C.Bryant: None. J.Keck: None. M.E.Lacy: None.


National Institutes of Health (UL1TR000117, UL1TR001998, KL2TR001996)

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