Diabetes Self-Management Education (DSME): Does More Matter?

Objective: This study examines whether increased time spent receiving DSME translates into an increased likelihood of receiving clinical services and engaging in self-management practices.

Methods: Questions about DSME were added to the 2008 Florida Behavioral Risk Factor Surveillance System (BRFSS).  The BRFSS is an on-going, cross-sectional, population-based telephone survey of non-institutionalized adults.  The 2008 Florida BRFSS had 10,874 respondents of which 1,446 (9.5%, weighted) had diabetes.  About 52% of diabetic adults received DSME.  DSME duration was categorized into four time intervals: 0 hours, >0 but <4 hours, 4-10 hours, and >10 hours.  Descriptive and logistic regression analyses were conducted using SAS 9.2 and SUDAAN 10.

Results: Overall, 1,335 (92%) reported their DSME time.  About 50% did not receive DSME (0 hours), 22% had >0 but <4 hours, 15% had 4-10 hours, and 12% had >10 hours.  Longer DSME duration was positively associated with receiving clinical services and engaging in self-management practices.  The adjusted odds ratios varied by outcome, but, overall, those with 4 or more hours of DSME had higher odds of self-monitoring blood glucose (OR=2.5), receiving annual foot exams (OR=2.0) and flu shots (OR=1.8), receiving two A1C tests in the past year (OR=2.7), and receiving a pneumococcal vaccination (OR=2.0) compared to those who did not receive DSME.

Conclusion: These data show that receiving four or more hours of DSME increases the odds of receiving clinical services and engaging in self-management practices.  These results support other studies showing that duration of DSME is associated with diabetes self- and clinical-management.