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Diabetes Prevention and Control: Self-Management Education

Diabetes self-management education (DSME) is the process of teaching people to manage their diabetes. The goals of DSME are to control the rate of metabolism (which affects diabetes-related health), to prevent short- and long-term health conditions that result from diabetes, and to achieve for clients the best possible quality of life, while keeping costs at an acceptable level.

DSME can be provided in a variety of community settings, including community gathering places, the home, recreational camps, worksites, and schools.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends that diabetes self-management education (DSME) interventions be implemented in:
  • Community gathering places on the basis of sufficient evidence of effectiveness in improving glycemic control for adults with Type 2 diabetes
  • Homes of children and adolescents who have Type 1 diabetes on the basis of sufficient evidence of effectiveness in improving glycemic control among adolescents with Type 1 diabetes
The Community Preventive Services Task Force found insufficient evidence to determine the effectiveness of DSME interventions implemented in:
  • Homes of people with Type 2 diabetes (based on too few studies qualifying for review)
  • Recreational camps (based on a small number of studies that evaluated relevant outcomes, inconsistent findings and methodological limitations)
  • Worksites (only one study qualified for review)
  • School settings (only one study qualified for review)

Results from the Systematic Review

  • DSME in community gathering places (Recommended for adults with Type 2 diabetes):
    • Glycated hemoglobin (GHb) levels: mean decrease of 1.9 percentage points (95% CI:-2.4, -1.4) (4 studies)
    • Fasting blood glucose (mmol/L): median decrease of 2.0(range: 1.3 to -4.0) (4 studies)
    • Weight (lbs): median decrease of 5.2 lbs (range: -9.0 to -1.6) (6 studies)
    • Blood pressure (mmHg): decreases in favor of the intervention (2 studies)
    • Cholesterol (mg/dL): inconsistent findings (3 studies)
    • All of the included studies involved adults with Type 2 diabetes.
  • DSME in the home (Recommended for adolescents with Type 1 diabetes):
    • Glycated hemoglobin (GHb) levels: mean decrease of 1.1 percentage points among adolescents with Type 1 diabetes (95% CI: -1.6, -0.6) (4 studies).
    • Evidence was insufficient to determine whether or not home-based DSME works for people with Type 2 diabetes because too few studies were available.
  • DSME in recreational camps, DSME at the worksite, and education of school personnel about diabetes:
    • For these interventions, evidence was insufficient to determine effectiveness because too few studies were available.

Economic Evidence

  • No studies were found for diabetes self-management education (DSME) when implemented in community gathering places (for adults with Type 2 diabetes).
  • One study was found for diabetes self-management education (DSME) in the home (for adolescents with Type 1 diabetes).
    • The average program costs for the home intervention (adjusted to the Community Guide reference case) were $50 per child more than for traditional-care patients (a nonsignificant difference between groups).
    • Mean GHb levels were 10% lower for the home-care patients at 24 and 36 months after the intervention.

These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to diabetes prevention and control.

Supporting Materials

Publications

Norris SL, Nichols PJ, Caspersen CJ, et al. Increasing diabetes self-management education in community settings: a systematic review.. Adobe PDF File [PDF - 1.14 MB] Am J Prev Med 2002;22(4S):39-66.

Task Force on Community Preventive Services. Recommendations for healthcare system and self-management education interventions to reduce morbidity and mortality from diabetes. Adobe PDF File [PDF - 67 kB] Am J Prev Med 2002;22(4S):10-4.

Task Force on Community Preventive Services. Strategies for reducing morbidity and mortality from diabetes through health-care system interventions and diabetes self-management education in community settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2001 ;50(RR16):1-15. External Web Site Icon

Task Force on Community Preventive Services. Diabetes. Adobe PDF File [PDF - 331 kB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:188-222.

Read other Community Guide publications about Diabetes Prevention and Control in our library.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Diabetes prevention and control: self-management education interventions.www.thecommunityguide.org/diabetes/selfmgmteducation.html. Last updated: MM/DD/YYYY.

Reviews completed: September 2000, March 2001