%0 Journal Article
%T Diabetes Self-Management Education: Miles to Go
%A Helen Altman Klein
%A Sarah M. Jackson
%A Kenley Street
%A James C. Whitacre
%A Gary Klein
%J Nursing Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/581012
%X This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts. 1. Introduction Diabetes afflicts approximately 25.8 million people in the United States, or 8.3% of the population. Type 2 diabetes, or non-insulin dependent diabetes mellitus (NIDDM), accounts for 90 to 95% of all diagnosed cases of diabetes in adults [1]. The problem is growing, particularly among young people. Over their lifetime, patients experience increased risks of complications including blindness, kidney damage and failure, cardiovascular disease, nerve damage, and lower-limb amputation. A NIH study from 2011 estimated that costs related to the treatment of diabetes accounts for about $174 billion of the national health care annually [1]. Type 2 diabetes complications stem from the inability of the body to use insulin properly, resulting in heightened blood glucose levels [2]. This is measured with the HbA1c test, the percent of glycated hemoglobin in the blood. It is commonly called the A1c. The NIH criterion for diagnosing diabetes is an A1c of 6.5 or higher although this varies somewhat with the individual. Pre-diabetes is between 5.7 and 6.4. A reading below 5.7 is normal [3]. The U.K. Prospective Diabetes Study
%U http://www.hindawi.com/journals/nrp/2013/581012/