Diabetes Self-Management Training: Essential-- And Often Ignored

December 29, 2014

Diabetes self-management training can improve glycemic control and reduce the risk for complications, hospitalizations, and health care costs. But training is substantially underused, shows a new study.

Diabetes self-management training (DSMT) is recommended by the ADA for those newly diagnosed with diabetes. Yet little has been known about how many people actually participate.

Now a recent study by researchers at the CDC may fill in this gap. The study was published during National Diabetes Month in the Morbidity and Mortality Weekly Report. It suggests that only 6.8% of people with private insurance participate in DSMT in the first year after receiving a diagnosis of diabetes.

“Diabetes self-management and training is essential in diabetes care, but substantially underused among persons with newly diagnosed diabetes even in a privately insured population,” commented first author Rui Li, PhD, from the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion at the CDC. 

“Health care providers are encouraged to refer patients with newly diagnosed diabetes into DSMT programs.” He continued, “Patients are encouraged to talk to their doctor or healthcare provider about learning to manage, control, and take charge of their diabetes.”

DSMT can improve glycemic control and reduce the risk for diabetes complications, hospitalizations, and health care costs, according to Dr Li. The DSMT curriculum usually includes material on diabetes disease process and treatment, healthy lifestyle, blood glucose monitoring, personalized strategies for decision making, as well as prevention, detection, and treatment of diabetes complications.

Studies have suggested that the optimal time for teaching DSMT is soon after diagnosis, when a window of opportunity exists during which patients may be most receptive to DSMT.

In the CDC study, researchers used data from the Marketscan Commercial Claims and Encounters database (Truven Health Analytics), which covers private insurance claims data on millions of employees, spouses, and dependents. The researchers looked at DSMT claims within 12 months after diagnosis among adults newly diagnosed with diabetes between 2009-2012. They used multivariate logistic regression to look at DSMT participation by age, sex, oral diabetes medication prescription, insulin prescription, insurance type, metropolitan area, and region.

The researchers identified 95,555 people with newly diagnosed diabetes between 2011-2012. They found that adjusted rates for DSMT participation ranged between 5.1% and 14.2%, depending on the subgroup.

Higher DSMT rates occurred among:

  • Older (45-64 years) compared to younger adults (18-44 years)  (7.2% vs 5.9%, p<0.001)
  • Those taking insulin vs oral agents (14.2% vs 6.7%, p<0.001), or not taking any agent (14.2% vs 5.1%, p<0.001)
  • Those in fee-for-service health plans, compared to capitated health plans (7.0% vs 6.0%, p<0.001)
  • Those in metropolitan areas compared to those not in metropolitan areas (7.1% vs 5.5%, p<0.001)
  • Those in North Central regions, compared to other regions (9.2% vs 5.7%-6.9%, p<0.001 for each)

Several barriers to participation in DSMT may exist, according to Dr Li. One problem is that many private insurance plans require copayment or do not cover the cost of DSMT, even though 40 states mandate that private insurance cover it. Medicare and Medicaid, on the other hand, do cover DSMT, he added. Moreover, physician referral is often required for DSMT, potentially limiting access. Patient behaviors could also play a role, such as perceptions about diabetes, avoidance, and lack of knowledge about the existence of DSMT.

“Health system level interventions such as improving reimbursement and access to DSMT, along with personal level interventions such as behavioral change strategies, might be considered to increase the rate of DSMT participation among persons with newly diagnosed diabetes,” Dr Li emphasized.

For more information about DSMT, click here.

References:

Li R, Shrestha SS, Lipman R, et al. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes-United States, 2011-2012. MMWR 63(46):1045-1049.