Impact of Diabetes Self-Management Education on Diabetes Process Measures: An Analysis of Behavioral Risk Factor Surveillance System Data

Research Objective: Individuals with type 2 diabetes are not receiving preventive care that could decrease or delay the onset of diabetes-related complications. Diabetes self-management education (DSME) is known to empower persons with diabetes to self-manage the disease. This study examined the impact of DSME attendance on adherence to: daily foot self-examination, clinical foot examination, ≥2 annual hemoglobin A1C tests, and an annual dilated eye examination among individuals with type 2 diabetes in the United States (US).

Study Design: A cross-sectional, secondary data analysis of the 2009 Behavioral Health Risk Factor and Surveillance System (BRFSS) core and diabetes optional modules. Individuals were classified with type 2 diabetes if their age at diagnosis was ≥ 30 or if their age at diagnosis was < 30 and the individual was not insulin dependent. Logistic regression was employed to examine the association between DSME status with the use of preventive care and risk behaviors while controlling for confounders. Statistical analysis was performed using SUDAAN to account for the BRFSS complex sampling design and to calculate adjusted prevalence estimates and 95% confidence intervals (CI).

Population Studied: The 2009 BRFSS dataset contained 432,607 respondents. Women who responded “yes” to having diabetes only during pregnancy (n = 3,163), individuals who responded “no” to having diabetes (n = 369,824), individuals who responded “no” to having pre-diabetes or borderline diabetes (n = 6,809), individuals who did not know if they had diabetes (n = 277), and individuals who refused to respond (n = 148) were excluded. This yielded 52,386 respondents; 33,615 were classified with type 2 diabetes, of which 33,433 had a valid (yes or no) response for DSME attendance.

Principal Findings: Approximately 55.63% (95% CI [(.55, .57), P= 0.0849] of individuals with type 2 diabetes attended a DSME course. Individuals who attended DSME were 83%, more likely to perform daily foot self-examination (OR 1.83, 95% CI 1.54, 2.16), twice as likely to receive a clinical foot examination within the previous 12 months (OR 2.23, 95% CI 1.93, 2.57), nearly three times as likely to receive ≥2 hemoglobin A1c test within the previous 12 months (OR 2.80, 95% CI 2.10, 3.74), and 52% more likely to receive a dilated eye examination within the previous 12 months (OR 1.52, 95% CI 1.33, 1.73).

Conclusions: DSME attendance increases adherence to daily foot self-examination, clinical foot examination, ≥2 annual hemoglobin A1C tests, and an annual dilated eye examination among individuals with type 2 diabetes in the US.