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.

Task Force Recommendations & Findings

The Task Force on Community Preventive Services 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
  • Task Force findings
• 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
  • Task Force findings

The Task Force on Community Preventive Services 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)
  • Task Force findings
• Recreational camps (based on a small number of studies that evaluated relevant outcomes, inconsistent findings and methodological limitations)
  • Task Force findings
• Worksites (only one study qualified for review)
  • Task Force findings
• School settings (only one study qualified for review)
  • Task Force findings

Results from the Systematic Reviews

• 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.

Review of Economic Findings

• 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

• Analytic frameworks
• Research gaps
• Included studies

Publications

Norris SL, Nichols PJ, Caspersen CJ, et al. Increasing diabetes self-management education in community settings: a systematic review. 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. 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.

Task Force on Community Preventive Services. Diabetes. 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.

More Community Guide publications about Diabetes Prevention and Control

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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.

Review completed: 2002