Diabetes Self-Management Education (DSME) can improve patient knowledge about diabetes as well as glycemic control and cholesterol levels in Black patients with type 2 diabetes, researchers said in a poster presentation at the inaugural conference of DNPs of Color, held virtually October 23, 2021.1

“Given the inequitable health outcomes among African Americans with type II diabetes, mitigating contributing factors has been a focus of interest. The study’s unique African American population subset emphasized the significance of behavioral practice influenced by cultural norms and interpretation of health,” said study author, Dr Nkeiruka Muonagolu DNP, APRN, FNP-BC. “Through the vehicle of DSME, we were able to empower patients with education and behavioral strategies to improve their management skills and, ultimately, key outcome biomarkers. It is the hope that tools that enhance patient understanding, such as DSME and perhaps, continuous blood sugar monitoring devices, which also impact patient behavioral practices, will be widely covered by insurance and supported by health care policies.”

Type 2 diabetes is prevalent among Black adults. According to a study by Rodriquez, Black individuals had the highest prevalence of type 2 diabetes (13.2%) compared with patients of Hispanic (12.8%), Asian (9.0%), and non-Hispanic White (7.6%) descent.2 Historical challenges in effective diabetes management have led to poorer health outcomes among Black patients compared with White patients with the disease. This trend has reduced the quality of life for Black patients with diabetes and led to a high risk for mortality, reported the study authors.


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“DSME has demonstrated success in improved patient management and its capacity to mitigate risk for complications,” the authors noted. To examine the role DSME can play in improving outcomes, the researchers enrolled 34 Black adults aged 18 to 70 years from a single primary care practice in Maryland in the study.  

Results

The study included 5 objectives (Table). A 16.9% increase in self-management confidence as measured by the SKILLD survey was found after DSME (P<0.001). In addition, the following findings were reported:

  • 22study participants achieved HbA1c levels below 8 after DSME intervention compared with 16 patients preintervention
  • 10 preintervention vs 18 postintervention achieved LDL levels <100; results failed to meet the goal of 20 (60%) with controlled LDL but did show a statistically significant increase (P=0.048)
  • Participants showed no significant reductions in BMI
  • No significant reductions were observed in systolic and diastolic blood pressure
Outcomes Objectives at 3-months PostinterventionPre-InterventionPost-InterventionP-values
Improve self-management confidence62.6% Mean 6.26 (2.12)79.2% Mean 7.9 (2.12)P<0.001
Achieve HbA1c <8 in 10% of participantsn=16 (47%)n=22 (64.7%)P=0.142
Achieve an SBP <140 and DBP <90 in 80% of participantsSBP:   n=18 (52.9%) DBP:   n=26 (76%)SBP:   n=26 (76%) DBP:   n=29 (85%)  P=0.052   P=0.35
Achieve LDL levels <100 in 60% of participantsn=10 (29%)n=18 (53%)P=0.048
Achieve ≥1 BMI reduction among participantsBMI=35.6 (9.1)BMI=35.4 (8.9)P=0.273
BMI, body mass index; DBP, diastolic blood pressure; LDL, low density lipoprotein; SBP, systolic blood pressure

The study authors concluded that though DSME is beneficial for patients, it may not help in improving blood pressure or weight loss. The authors called for future research on the long-term efficacy of DSME interventions in a larger sample size.

References

1. Muonagolu N, Knestrick J, Kesten K. The effects of diabetes self management education among African Americans. Poster presented at: DNPs of Color Virtual Conference; October 23, 2021.

2. Rodríguez JE, Campbell KM. Racial and ethnic disparities in prevalence and care of patients with type 2 diabetes. Clin Diabetes. 2017;35(1):66-70. doi:10.2337/cd15-0048