Learning to manage: An analysis of the receipt of diabetes self-management education in US adults

Background: Increasingly, individuals with diabetes have access to diabetes self-management education (DSME) in primary care settings, group classes, and over the internet and telephone.  However, racial/ethnic and income related disparities exist persist, potentially due to differential access to DSME.  Therefore, the objective of this study is describe access to diabetes self-management education in adults with type 2 diabetes. 

Methods: Using data from the Medical Expenditure Panel Survey, I identified adults with type 2 diabetes from years 2008-2011 (n = 4773; weighted n = 48, 962, 241).  I performed descriptive analysis to produce national estimates of receipt of any DSME in the previous year and receiving DSME via (1) doctor (2) other healthcare provider (3) internet (4) telephone call with health care provider (5) group class.  Subsequently, I used multivariable logistic regression to model the adjusted odds of receipt of DSME by race/ethnicity and income adjusting for sociodemographic, health care access, and health status.

Results: 20.1% of adults with diabetes reported that they had not received DSME in the prior year.  Of those who received DSME, reported mediums include primary care provider (71.8%), internet (22.4%), group class (15.3%), other provider (14.1%), and telephone (9.6%).  African-Americans (OR 1.53; 95% CI 1.18-2.00) and Hispanics (OR 1.96; 95% CI 1.43-2.67) were more likely to report receiving DSME compared to Whites.  Differences in the medium of DSME were seen by race/ethnicity, income, and education.

Conclusion: Receipt of DSME appears to differ largely based on medium of delivery which may explain racial/ethnic disparities in diabetes management.