Self Care Outcomes for Patients in a Diabetes Self-Management Education Program

1. Self Care Outcomes for Patients in a Diabetes Self-Management Education Program Frank West, M.D., Morgan Arvidson, M.D. Leah Jacobson, M.D. Trident/MUSC Family Medicine Residency Program

2. Background • Epidemiology • Diabetes is everywhere. • Guidelines • ADA has guidelines for both medical and behavioral health components of diabetes. • Problem • We’re missing treatment opportunities

3. Purpose • To evaluate the effect of a Diabetes Self Management Education (DSME) program on self-care, behavioral health, and mental health of patients with diabetes.

4. Methods • Identified patients with diabetes through the University Family Medicine electronic health record. • Patients voluntarily enrolled in a comprehensive DSME program • Educational material was drawn from an American Diabetes Association certified curriculum • Material presented by a multi-disciplinary team in a group visit setting • This project was approved as exempt research by the MUSC IRB

5. Program Structure INDIVIDUAL ASSESSMENT & COUNSELING (RN, PharmD, RD) 4-HOUR GROUP VISIT (RN, RD) SHARED MEDICAL VISIT (MD, Residents, students) 6-8 Weeks SUPPORT GROUP (RN, patients) 1-2 Weeks 6-8 Weeks Monthly

6. Methods • Prior to starting the educational curriculum, participants completed validated surveys on: • self-care and behavioral changes • Behavior Assessment 7-day Scale • mental health issues • Diabetes Psychosocial Distress Scale • Patient Health Questionnaire (PHQ-9) Depression Screen • Surveys were repeated four to eight weeks after completion of the DSME program

7. Outcome Measures • Survey scores (pre vs. post) for three assessment tools: • Behavior Assessment 7-day Scale • Diabetes Psychosocial Distress Scale • PHQ-9 Depression Scale

8. Demographics • -115 Adults with type 2 DM completed the program • -Mean age: 50.9+12.4 years • -51% AA, 49% Caucasians • -60% female, 40% male • -Baseline HbA1c 8.6%, LDL 114 mg/dL, blood pressure 139/81 mmHg

9. Behavior Outcomes7 Day Behavior Assessment Scale * Student t-test, p<0.05

10. Behavior OutcomesDiabetes Psychosocial Distress Scale

11. Behavior OutcomesDiabetes Psychosocial Distress Scale

12. Behavior OutcomesDepression Assessment PHQ-9 Depression Scale: Improvements were not noted 24% of patients found to be moderately or severely depressed and referred to Psychologist or PCP for further evaluation

13. Discussion Patients who completed the DMSE program showed statistically significant improvement in the following areas of diabetes self care: Diet Exercise Foot care No improvements were shown in medication compliance, glucose monitoring or smoking Implications?

14. Conclusion • Care for patients with diabetes provides a multi-faceted challenge for primary care physicians. • Behavioral health is an important component of diabetes care • A significant impact can be made in the behaviors of patients with diabetes through a DMSE system.

15. Special thanks to: • Michael Aho, MS3 • Maria Gibson, M.D. • Lori Dickerson, Pharm.D.