December 3, 2015
Do DSME Programs Do Enough?
My answer to this question is “NO.” There are some decent parts of Diabetes Self Management Education programs, but in many areas, there is a deficiency. Behavioral programs for patients with diabetes (both for type 1 and type 2) provides minor benefit for glycemic control.
The authors suggest that without added support, most DSME programs provide minimal benefit. This is important when less than 10 hours of contact are provided. Patients with poor glycemic control benefit better from DSME than patients with decent control.
The weakness of the study is the fact that it was a meta-analysis and the studies used may not have had the proper controls in place.
Investigators applied published data between 1993 and January 2015 for the study on T2DM, and data from 1993 to June 2015 for T1DM. Databases used include Ovid MEDLINE, EMBASE, PubMed and others. For the study on T1DM, data was analyzed from 35 prospective controlled studies.
In the study for T2DM, researchers analyzed 132 randomized studies. Researchers found at least a 0.4% reduction in HbA1c through lifestyle and diabetes management education (DSME) in addition to support programs that provided a minimum of 11 contact hours to these individuals.
The research is important because it was conducted in Canada and not in the United States, as most insurance companies only pay for 4 hours of support and a few pay for only 2 hours. Plus, in the United States, CDEs often use mandates and not good diabetes education. They have too many strings attached to the organization that dictate many of their actions.