A systematic review of 118 studies of diabetes self-management education, or DSME, found that it leads to a statistically significant decrease in A1C levels. But the review doesn’t support the recommendation of the American Diabetes Association that the best time for this education is right after diagnosis.
The Worse Your Level Is the More This Helps
The review shows that this diabetes education typically improves blood glucose control by about 0.6 percent more than the usual care that we get. While this may not sound like a lot, it is. For example, if your A1C is 9.0 you can expect that it will drop to 8.4 after you get educated in this way.
A1C is the key measure of how well you have managed your blood glucose level during the past two to three months. For every 1 percent you reduce your A1C, you cut the risk of developing eye, kidney, and nerve damage by 40 percent, according to the landmark UK Prospective Diabetes Study. It also cuts your risk of a heart attack by 14 percent.
Actually, if you have a high A1C level, this diabetes education will help you even more. For example, about two-thirds of the studies showed that people who had A1C levels between 8.3 and 9.0 had a significant improvement compared with people in the control groups. For people with A1C levels above 9.0 the difference was even more.
More Diabetes Education Is Better
Besides the A1C that people had when they began their diabetes education, how many hours of education they got also made some difference. Not surprisingly, more is better. The mode of delivery – individual, group, or possibly remote – made a difference too, but it was smaller. Whether people got the diabetes education for one person or a team made almost no difference.
The systematic review is “Diabetes self-management education for adults with type 2 diabetes mellitus” by Carole A. Chrvala, Ph.D. and two officers of the American Association of Diabetes Educators, Dawn Sherr, a Certified Diabetes Educator, and Ruth Lipman, Ph.D. While it is scheduled for publication in the journal Patient Education and Counseling, it is currently an “article in press” that a representative of the authors made available to me.
Start When Motivated
The big difference that the authors have with the American Diabetes Association is when diabetes education works best. The ADA recommends that it start “when their diabetes is diagnosed.” But the authors of this systematic review found that “the best time to engage individuals in DSME is when they are ready to engage, i.e., when they are receptive or motivated to engage in diabetes self-management strategies.”
It’s likely that almost all diabetes self-management education comes in the first year after diagnosis. It’s certain that few people with diabetes get it even them. While most health insurance plans cover it, less than 7 percent of people who have private insurance get it then, according to the Centers for Disease Control and Prevention.
In 1997 Congress authorized Medicare to cover up to 10 hours of outpatient diabetes self-management education in the first year we get this education. But only about 5 percent of people on Medicare with newly diagnosed diabetes get this benefit, according to a study this August in Health Education and Behavior by Medicare officials.
I can vouch from my own experience that this diabetes education is worth your time. The VA Clinic where I lived in 1994 provided me with individual and group education and support that gave me the initial motivation I needed to begin to manage my diabetes. I know that it can work for you too.
See more of my articles about how to manage diabetes:
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.