Vol 12, No 2 (2023)
Editorial
Published online: 2023-04-28

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Commentary on the Article “Effects of Blended Self-Management Training on Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: A Randomized Clinical Trial”

Diana Isaacs1
Clin Diabetol 2023;12(2):78-79.

Abstract

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EDITORIAL

ISSN 2450–7458
e-ISSN 2450–8187

Commentary on the Article “Effects of Blended Self-Management Training on Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: A Randomized Clinical Trial”

Diana Isaacs
Cleveland Clinic Endocrinology and Metabolism Institute, Cleveland, Ohio, USA

Address for correspondence:

Dr. Diana Isaacs

10685 Carnegie Ave. X20

Cleveland Clinic Diabetes Center

Cleveland, OH 44106, USA

Clinical Diabetology 2023, 12; 2: 78–79

DOI: 10.5603/DK.a2023.0011

Received: 24.04.2023 Accepted: 24.04.2023

Diabetes self-management education and support (DSMES) has many benefits including reduction in A1C [1], decreased weight [2], improvement in diabetes knowledge and self-care behaviors, improved quality of life, and positive coping behaviors [3–5]. It is therefore recommended that all people with diabetes participate in DSMES [6]. Despite the benefits, DSMES is underutilized and within the United States, only 5–7% of individuals eligible for DSMES actually receive it [7].

There are several barriers, some of which include logistics issues (accessibility, timing, costs) and lack of perceived benefit [7]. Technology can help overcome some barriers. Mobile apps, simulation tools, digital coaching and digital self-management interventions offer more versatile ways to deliver DSMES [8]. Greater A1C reductions are observed with more patient engagement [6] so identifying strategies to increase patient engagement is essential.

In the study conducted by Shahrzad Ghiyasvandian and colleagues, 100 people with diabetes between the ages of 20–65 were randomized to receive a blended education intervention (n = 50) or control through routine education (n = 50). The education interventions occurred over 2.5 months. The blended education intervention included two three-hour diabetes self-management workshops which incorporated problem-based learning and peer support through group interaction. Then participants were referred to a website with weekly education plans that incorporated multiple modalities including texts, photos, videos and questions. There were also weekly phone calls to encourage engagement and field questions. The control group only received educational pamphlets.

The intervention group showed statistically significant improvements in diet, physical activity, glucose monitoring, foot care, drug use and diabetes knowledge compared to the control group which only showed improvements in diet, foot care and diabetes knowledge, and to a much smaller magnitude compared to the intervention.

Strengths of this study include the randomized, controlled design, similar baseline characteristics between groups, and the use of validated tools to assess diabetes knowledge and diabetes self-management behaviors. Limitations include short intervention and follow-up. The study occurred in one center at the Tehran University, so the generalizability of results is unknown. Additionally, clinical outcomes like A1C and weight were not evaluated. Weekly phone calls were provided by researchers in the blended education intervention and it is unknown how people might adhere to this intervention in a real-world setting.

Despite some limitations, overall, this study supports the guidance to individualize diabetes education [6]. Compared to educational pamphlets, this intervention of workshops, website with multiple modalities and weekly phone calls, improved knowledge of diabetes and self-management behaviors. This confirms the strengths of DSMES and efforts are needed to address existing barriers to DSMES. Healthcare professionals should be encouraged to find creative ways to deliver this education such as incorporating technology, peer support and individual preferences as done in this study.

References

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  2. Steinsbekk A, Rygg LØ, Lisulo M, et al. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012; 12: 213, doi: 10.1186/1472-6963-12-213, indexed in Pubmed: 22824531.
  3. Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ. 2008; 34(5): 815–823, doi: 10.1177/0145721708323640, indexed in Pubmed: 18832286.
  4. Davidson P, LaManna J, Davis J, et al. The Effects of Diabetes Self-Management Education on Quality of Life for Persons With Type 1 Diabetes: A Systematic Review of Randomized Controlled Trials. Sci Diabetes Self Manag Care. 2022; 48(2): 111–135, doi: 10.1177/26350106211070266, indexed in Pubmed: 35030970.
  5. ElSayed NA, Aleppo G, Aroda VR, et al. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care. 2023; 46(Suppl. 1): S68–S96, doi: 10.2337/dc23-S005, indexed in Pubmed: 36507648.
  6. Powers MA, Bardsley JK, Cypress M, et al. Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care. 2020; 43(7): 1636–1649, doi: 10.2337/dci20-0023, indexed in Pubmed: 32513817.
  7. Horigan G, Davies M, Findlay-White F, et al. Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med. 2017; 34(1): 14–26, doi: 10.1111/dme.13120, indexed in Pubmed: 26996982.
  8. Gershkowitz BD, Hillert CJ, Crotty BH. Digital Coaching Strate- gies to Facilitate Behavioral Change in Type 2 Diabetes: A Systematic Review. J Clin Endocrinol Metab. 2021; 106(4): e1513–e1520, doi: 10.1210/clinem/dgaa850, indexed in Pubmed: 33206975.