Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure

Abstract

Kimberly D Brunisholz,1,2,* Pascal Briot,1,2,* Sharon Hamilton,1 Elizabeth A Joy,3 Michael Lomax,2 Nathan Barton,2 Ruthann Cunningham,3 Lucy A Savitz,2 Wayne Cannon1 1Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA; 2Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA; 3Office of Research, Intermountain Healthcare, Salt Lake City, UT, USA*Joint first authors Purpose: The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM). Methods: A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011–2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2–6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%–14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure <140/90 mmHg, LDL <100 mg/dL, HbA1c <8.0%. Results: DSME patients had a significant difference in achievement of the five element IH diabetes bundle and in HbA1c % compared to those without DSME. After adjusting for possible confounders in a multivariate logistic regression model, DSME patients had a 1.5 fold difference in improvement in their diabetes bundle and almost a 3 fold decline in HbA1c compared to the control group. Conclusion: Standardized DSME taught within an IH American Diabetes Association center is strongly associated with a substantial improvement in patients meeting all five elements of a diabetes bundle and a decline in HbA1c beyond usual care. Given the low operating cost of the DSME program, these results strongly support the value adding benefit of this program in treating T2DM patients. Keywords: diabetes, type 2 diabetes, HbA1c, bundle, diabetes education, DSME