Diabetes Prevention and Control: Self-Management Education

Research Gaps

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field.

Identified Research Gaps

In Community Gathering Places

More studies are needed to examine the effectiveness of DSME interventions in community gathering places. Which settings are optimal? What is the best way to recruit people with diabetes to these interventions? Who is the ideal provider in these settings? What is the optimal intensity and duration of interventions in community gathering places? What type of maintenance-phase interventions are best? How do DSME interventions in community gathering places compare with those delivered in the clinical setting with respect to effectiveness, ease of implementation, barriers, long-term maintenance capabilities, and cost-effectiveness? Which characteristics of community gathering places affect adoption and outcomes of DSME interventions? How are these interventions best coordinated with primary care? Are there racial or ethnic groups that perceive a relatively greater need for DSME in alternative settings? Are there racial or ethnic groups that may benefit more from community interventions compared with interventions delivered in the clinic setting?

In the Home

The most effective components of DSME in the home, the optimal intensity and duration of the interventions, and the best person to deliver these interventions all need to be identified. The effectiveness of these interventions as measured by intermediate outcomes (including changes in diet and physical activity, social support, and self-efficacy), health outcomes (including weight, lipid levels, and blood pressure), and quality of life needs to be determined. Whether educating the person with diabetes in the home has health benefits for the family also needs to be examined. Additionally, the effectiveness of these interventions among adults with type 2 diabetes, particularly the elderly (65 years), should be addressed. The effectiveness of these interventions in various racial and socioeconomic groups needs to be determined, as these data are rarely reported in this literature. Perceived barriers to implementing DSME in the home also need to be identified, as does the best way to identify people who would benefit from an intervention in the home. Finally, how these interventions are best linked to primary care and to disease management strategies needs to be determined.

In Recreational Camps

Further studies are needed to determine the effectiveness of DSME in recreational camps on self-efficacy and other psychosocial mediators, behavior change, and quality of life. Studies with longer follow-up intervals are also needed. Glycemic control and other physiologic outcomes are important outcomes and should be examined, but quality of life and psychosocial outcomes are probably more important for these short-term interventions. Long-term maintenance interventions need to be examined: repetitive interventions are likely needed to maintain any gains from the initial intervention. Finally, the optimal frequency of the camp experience needs to be determined.

At the Worksite

Studies are needed to determine the perceived educational needs of workers with diabetes, their supervisors, and coworkers. Studies also are needed to determine what populations of workers might benefit, what patient and coworker outcomes should be measured, and the most effective interventions for achieving desired goals.

Education of School Personnel About Diabetes

Further research is needed on the effectiveness of educating school personnel about diabetes. Research is needed to define the most effective interventions and who should deliver them. What is the most desirable intensity, duration, and frequency of the interventions? Is group education of personnel or individual education of a teacher with reference to a specific student preferred? A broad array of outcomes that focus on both teachers and students should be examined. For teachers these outcomes include knowledge and attitudes, self-efficacy in dealing with emergencies, coping skills, and perceived barriers, and for students these outcomes include glycemic control, weight, social support, self-efficacy, complication rates, absenteeism, academic performance, and quality of life.

Evidence Review

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.