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Self Care Outcomes for Patients in a Diabetes Self-Management Education Program. Frank West, M.D., Morgan Arvidson, M.D. Leah Jacobson, M.D. Trident/MUSC Family Medicine Residency Program . Background. Epidemiology Diabetes is everywhere. Guidelines

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self care outcomes for patients in a diabetes self management education program
Self Care Outcomes for Patients in a Diabetes Self-Management Education Program

Frank West, M.D., Morgan Arvidson, M.D.

Leah Jacobson, M.D.

Trident/MUSC Family Medicine Residency

Program

background
Background
  • Epidemiology
    • Diabetes is everywhere.
  • Guidelines
    • ADA has guidelines for both medical and behavioral health components of diabetes.
  • Problem
    • We’re missing treatment opportunities
purpose
Purpose
  • To evaluate the effect of a Diabetes Self Management Education (DSME) program on self-care, behavioral health, and mental health of patients with diabetes.
methods
Methods
  • Identified patients with diabetes through the University Family Medicine electronic health record.
  • Patients voluntarily enrolled in a comprehensive DSME program
  • Educational material was drawn from an American Diabetes Association certified curriculum
    • Material presented by a multi-disciplinary team in a group visit setting
  • This project was approved as exempt research by the MUSC IRB
program structure
Program Structure

INDIVIDUAL

ASSESSMENT & COUNSELING

(RN, PharmD, RD)

4-HOUR GROUP

VISIT

(RN, RD)

SHARED

MEDICAL VISIT

(MD, Residents,

students)

6-8 Weeks

SUPPORT

GROUP

(RN, patients)

1-2 Weeks

6-8 Weeks

Monthly

methods6
Methods
    • Prior to starting the educational curriculum, participants completed validated surveys on:
    • self-care and behavioral changes
      • Behavior Assessment 7-day Scale
    • mental health issues
      • Diabetes Psychosocial Distress Scale
      • Patient Health Questionnaire (PHQ-9) Depression Screen
  • Surveys were repeated four to eight weeks after completion of the DSME program
outcome measures
Outcome Measures
  • Survey scores (pre vs. post) for three assessment tools:
    • Behavior Assessment 7-day Scale
    • Diabetes Psychosocial Distress Scale
    • PHQ-9 Depression Scale
demographics
Demographics
  • -115 Adults with type 2 DM completed the program
    • -Mean age: 50.9+12.4 years
    • -51% AA, 49% Caucasians
    • -60% female, 40% male
    • -Baseline HbA1c 8.6%, LDL 114 mg/dL, blood pressure 139/81 mmHg
behavior outcomes depression assessment
Behavior OutcomesDepression Assessment

PHQ-9 Depression Scale:

Improvements were not noted

24% of patients found to be moderately or severely depressed and referred to Psychologist or PCP for further evaluation

discussion
Discussion

Patients who completed the DMSE program showed statistically significant improvement in the following areas of diabetes self care:

Diet

Exercise

Foot care

No improvements were shown in medication compliance, glucose monitoring or smoking

Implications?

conclusion
Conclusion
  • Care for patients with diabetes provides a multi-faceted challenge for primary care physicians.
  • Behavioral health is an important component of diabetes care
  • A significant impact can be made in the behaviors of patients with diabetes through a DMSE system.
special thanks to
Special thanks to:
  • Michael Aho, MS3
  • Maria Gibson, M.D.
  • Lori Dickerson, Pharm.D.