Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study
Open accessAbstract
OBJECTIVE: To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress. METHODS: We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes. RESULTS: DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress. CONCLUSION: DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Many DSME participants report that the program did not fully meet their information and support needs.
“While DSME has consistently been demonstrated to improve patients’ clinical [15] and psychosocial [16] outcomes, many DSME participants report that the program did not fully meet their information and support needs [14].”
From Evaluation of the Impact of Mobile Health App Vitadio in Patients With Type 2 Diabetes: Randomized Controlled Trial (2025) · cites this paper as [14]
Diabetes management requires substantial diabetes-related knowledge and health literacy.
“In addition, it requires substantial diabetes-related knowledge and health literacy, enabling patients to make well-informed decisions about their lifestyle choices [8,14].”
From Evaluation of the Impact of Mobile Health App Vitadio in Patients With Type 2 Diabetes: Randomized Controlled Trial (2025) · cites this paper as [14]
Cites
The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000093487.78664.3c · Cited by 6,359 · see citing works
Nathan, D. M., & for the DCCT/EDIC Research Group (2014) · Diabetes Care · doi:10.2337/dc13-2112 · Cited by 1,832 · see citing works
Detecting and monitoring depression with a two-item questionnaire (PHQ-2)
Löwe, B., Kroenke, K., & Gräfe, K. (2005) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2004.09.006 · Cited by 1,473 · see citing works
Fully conditional specification in multivariate imputation
Van Buuren, S., Brand, J. P. L., Groothuis-Oudshoorn, C. G. M., & Rubin, D. B. (2006) · Journal of Statistical Computation and Simulation · doi:10.1080/10629360600810434 · Cited by 1,217 · see citing works
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2015.11.003 · Cited by 914 · see citing works
Barriers to diabetes management: patient and provider factors
Nam, S., Chesla, C., Stotts, N. A., Kroon, L., & Janson, S. L. (2011) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.02.002 · Cited by 680 · see citing works
Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M. B., & Fretheim, A. (2012) · BMC Health Services Research · doi:10.1186/1472-6963-12-213 · Cited by 660 · see citing works
Khunti, K. K., Gray, L. J., Skinner, T. C., Carey, M., Realf, K., Dallosso, H. M., Fisher, H., Campbell, M. J., Heller, S. R., & Davies, M. J. (2012) · BMJ · doi:10.1136/bmj.e2333 · Cited by 465 · see citing works
McGuire, B. E., Morrison, T. G., Hermanns, N., Skovlund, S. E., Eldrup, E., Gagliardino, J. J., Kokoszka, A., Matthews, D. R., Pibernik-Okanović, M., Rodríguez‐Saldaña, J., et al. (2009) · Diabetologia · doi:10.1007/s00125-009-1559-5 · Cited by 424 · see citing works
The CASMIN Educational Classification in International Comparative Research
Brauns, H., Scherer, S., & Steinmann, S. (2003) · Springer eBooks · doi:10.1007/978-1-4419-9186-7_11 · Cited by 402 · see citing works
Effectiveness of mHealth interventions for patients with diabetes: An overview of systematic reviews
Kitsiou, S., Paré, G., Jaana, M., & Gerber, B. S. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173160 · Cited by 390 · see citing works
Diabetes structured self-management education programmes: a narrative review and current innovations
Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30239-5 · Cited by 372 · see citing works
2017 national standards for diabetes self-management education and support
Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., Cypress, M., Faulkner, P., Fischl, A. H., Francis, T., et al. (2017) · Diabetes Care · doi:10.2337/dci17-0025 · Cited by 348 · see citing works
Update on Health Literacy and Diabetes
Bailey, S. C., Brega, A. G., Crutchfield, T. M., Elasy, T. A., Herr, H., Kaphingst, K. A., Karter, A. J., Moreland‐Russell, S., Osborn, C. Y., Pignone, M. P., et al. (2014) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721714540220 · Cited by 299 · see citing works
Peyrot, M. F., Burns, K. K., Davies, M. J., Forbes, A., Hermanns, N., Holt, R. I. G., Kalra, S., Nicolucci, A., Pouwer, F., Wens, J., et al. (2012) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2012.11.016 · Cited by 252 · see citing works
Health Information Seeking, Receipt, and Use in Diabetes Self-Management
Longo, D. R., Schubert, S., Wright, B. A., LeMaster, J., Williams, C. D., & Clore, J. N. (2010) · The Annals of Family Medicine · doi:10.1370/afm.1115 · Cited by 220 · see citing works
Illness perceptions and glycaemic control in diabetes: a systematic review with meta‐analysis
McSharry, J., Moss-Morris, R. E., & Kendrick, T. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03298.x · Cited by 173 · see citing works
Advances in Cross-National Comparison
Hoffmeyer-Zlotnik, J. H. P., & Wolf, C. (2003) · Springer eBooks · doi:10.1007/978-1-4419-9186-7 · Cited by 166 · see citing works
van der Heide, I., Uiters, E., Rademakers, J. J. D. J. M., Struijs, J. N., Schuit, A. J., & Baan, C. A. (2014) · Journal of Health Communication · doi:10.1080/10810730.2014.936989 · Cited by 146 · see citing works
Kugbey, N., Asante, K. O., & Adulai, K. (2017) · BMC Research Notes · doi:10.1186/s13104-017-2707-5 · Cited by 140 · see citing works
Nunes, J. A. W., Wallston, K. A., Eden, S., Shintani, A., Ikizler, T. A., & Cavanaugh, K. L. (2011) · Kidney International · doi:10.1038/ki.2011.240 · Cited by 138 · see citing works
Lee, A. A., Piette, J. D., Heisler, M., & Rosland, A.-M. M. (2018) · Diabetes Care · doi:10.2337/dc17-2396 · Cited by 117 · see citing works
Patient-Driven Diabetes Care of the Future in the Technology Era
Ashrafzadeh, S., & Hamdy, O. (2019) · Cell Metabolism · doi:10.1016/j.cmet.2018.09.005 · Cited by 111 · see citing works
Mikhael, E. M., Hassali, M. A., & Hussain, S. A. (2020) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s232958 · Cited by 111 · see citing works
Chao, J., Nau, D. P., Aikens, J. E., & Taylor, S. D. (2005) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2005.09.002 · Cited by 105 · see citing works
Hailu, F. B., Moen, A., & Hjortdahl, P. (2019) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s223123 · Cited by 105 · see citing works
Reddy, J., Wilhelm, K. A., & Campbell, L. V. (2013) · Psychosomatics · doi:10.1016/j.psym.2012.08.004 · Cited by 89 · see citing works
Diabetes-related information-seeking behaviour: a systematic review
Kuske, S., Schiereck, T., Grobosch, S., Paduch, A., Droste, S., Halbach, S. M., & Icks, A. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0602-8 · Cited by 76 · see citing works
Nicolucci, A., Burns, K. K., Holt, R. I. G., Lucisano, G., Skovlund, S. E., Kokoszka, A., Benedetti, M. M., & Peyrot, M. F. (2016) · Diabetic Medicine · doi:10.1111/dme.13178 · Cited by 66 · see citing works
Kalantzi, S., Κωσταγιόλας, Π., Kechagias, G., Niakas, D. A., & Makrilakis, K. (2015) · BMC Research Notes · doi:10.1186/s13104-015-1005-3 · Cited by 53 · see citing works
Heidemann, C., Paprott, R., Stühmann, L. M., Baumert, J. J., Mühlenbruch, K., Hansen, S., Schiborn, C., Zahn, D., Gellert, P. R., & Scheidt‐Nave, C. (2019) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2019-000680 · Cited by 52 · see citing works
Self-citationAbubakari, A., Jones, M. C., Lauder, W., Kirk, A. F., Anderson, J. V., & Devendra, D. (2011) · Journal of Nursing and Healthcare of Chronic Illness · doi:10.1111/j.1752-9824.2011.01098.x · Cited by 49 · see citing works
Liu, Y., Han, Y., Shi, J., Li, R., Li, S., Jin, N., Gu, Y., & Guo, H. (2014) · Journal of Diabetes Investigation · doi:10.1111/jdi.12311 · Cited by 47 · see citing works
Persian Diabetes Self-Management Education (PDSME) program: evaluation of effectiveness in Iran
Shakibazadeh, E., Bartholomew, L. K., Rashidian, A., & Larijani, B. A. (2015) · Health Promotion International · doi:10.1093/heapro/dav006 · Cited by 37 · see citing works
Information and decision support needs in patients with type 2 diabetes
Weymann, N., Härter, M. C., & Dirmaier, J. (2014) · Health Informatics Journal · doi:10.1177/1460458214534090 · Cited by 35 · see citing works
Studies analysing the need for health-related information in Germany - a systematic review
Pieper, D., Jülich, F., Antoine, S., Bächle, C., Chernyak, N., Genz, J., Eikermann, M., & Icks, A. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1076-9 · Cited by 34 · see citing works
Gomes, M. B., Santos, D. C., Pizarro, M., Barros, B. S. V., Melo, L. G. N., & Negrato, C. A. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s146268 · Cited by 30 · see citing works
Health literacy and quality of care of patients with diabetes: A cross-sectional analysis
Zuercher, E., Diatta, I. D., Burnand, B., & Peytremann‐Bridevaux, I. (2017) · Primary care diabetes · doi:10.1016/j.pcd.2017.02.003 · Cited by 29 · see citing works
The Effects of Intensive Nutrition Education on Late Middle-Aged Adults with Type 2 Diabetes
Li, Y., Xu, M., Fan, R., Ma, X., Gu, J., Cai, X., Liu, R., Chen, Q., Ren, J., Mao, R., et al. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13090897 · Cited by 27 · see citing works
mHealth Apps Empower Individuals
Wiederhold, B. K. (2015) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2015.29006.bkw · Cited by 26 · see citing works
Peña-Purcell, N. C., Han, G., Smith, M. L., Peterson, R., & Ory, M. G. (2019) · Diabetes Spectrum · doi:10.2337/ds18-0081 · Cited by 23 · see citing works
Hassan, D. A., Curtis, A. B., Kerver, J. M., & Vangsnes, E. H. (2020) · Journal of Primary Care & Community Health · doi:10.1177/2150132720967232 · Cited by 22 · see citing works
Becker, J., Emmert-Fees, K. M. F., Greiner, G. G., Rathmann, W., Thorand, B., Peters, A., Karl, F. M., Laxy, M., & Schwettmann, L. (2020) · Primary care diabetes · doi:10.1016/j.pcd.2020.01.004 · Cited by 21 · see citing works
Barriers of Obtaining Health Information Among Diabetes Patients
Milewski, J., & Chen, Y. (2010) · Studies in health technology and informatics · doi:10.3233/978-1-60750-588-4-18 · Cited by 20 · see citing works
Carmienke, S., Fink, A. M., Baumert, J. J., Heidemann, C., Du, Y., Frese, T., & Heise, M. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.07.017 · Cited by 19 · see citing works
Self-citationAssessment of information needs in diabetes: Development and evaluation of a questionnaire
Chernyak, N., Stephan, A., Bächle, C., Genz, J., Jülich, F., & Icks, A. (2016) · Primary care diabetes · doi:10.1016/j.pcd.2015.11.007 · Cited by 17 · see citing works
Stühmann, L. M., Paprott, R., Heidemann, C., Ziese, T., Hansen, S., Zahn, D., Scheidt‐Nave, C., & Gellert, P. R. (2020) · BMC Public Health · doi:10.1186/s12889-020-8296-6 · Cited by 16 · see citing works
Self-citationFirst results from the study ‘Disease knowledge and information needs – Diabetes mellitus (2017)’
Koch-Institut, R. (2018) · PubMed Central · doi:10.17886/rki-gbe-2018-064 · Cited by 16 · see citing works
Patient need and provider referrals to diabetes self-management education
Brown-Podgorski, B. L. (2021) · The American Journal of Managed Care · doi:10.37765/ajmc.2021.88669 · Cited by 8 · see citing works
Effectiveness of Diabetes Self-Management Education in Community Health
Brown, K., Lee, L. T., & Selleck, C. S. (2019) · Journal of Doctoral Nursing Practice · doi:10.1891/2380-9418.12.1.96 · Cited by 6 · see citing works
Flagged first, then by citations
1 of the 51 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Bretschneider, M. P., Kolasińska, A. B., Šomvárska, L., Klásek, J., Mareš, J., & Schwarz, P. E. (2025) · Journal of Medical Internet Research · doi:10.2196/68648 · Cited by 15 · see citing works
“In addition, it requires substantial diabetes-related knowledge and health literacy, enabling patients to make well-informed decisions about their lifestyle choices [8,14].”
Anjali, M., Khapre, M. P., Kant, R., Kumar, S., & Pandey, P. (2023) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_843_22 · Cited by 12 · see citing works
Rias, Y. A., Thato, R., Teli, M., & Efendi, F. (2025) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2025.06.001 · Cited by 6 · see citing works
Akçay, B., Çolak, T. K., İĞREK, S., Özgül, B., & Aptı, A. (2023) · Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi · doi:10.46413/boneyusbad.1320337 · Cited by 3 · see citing works
Weise, S., Oelschläger, C., Unverzagt, S., Abendroth, J., Heise, M., & Frese, T. (2025) · European Journal of General Practice · doi:10.1080/13814788.2024.2447723 · Cited by 3 · see citing works
Self-citationWahyudi, R., Mufidah, N., & Firdausita, S. (2023) · IJNP (Indonesian Journal of Nursing Practices) · doi:10.18196/ijnp.v6i2.16880 · Cited by 2 · see citing works
Yasmin, R., Ilyas, A., Mir, S., Tauseef, A., Nazi, & Shuaib, N. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs22166973 · Cited by 1 · see citing works
A Research Study on Effect of Diabetes, Awareness, Guideline and its Treatment
Abbasi, S. K., Omar, A., Shabbir, T., Ullah, K., Tauseef, A., & Masood, S. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs22167613
Arslan, Z. C., Tüzün, S., Öner, C., Hacıağaoğlu, N., Çeti̇n, H., & Şimşek, E. E. (2024) · Health Education Research · doi:10.1093/her/cyae029
Healy, K. V., Rähse, T., Weise, S., Fink, A. M., Frese, T., & Knöchelmann, A. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108466
Self-citationLamoureux, O., Aravindhan, A., Chan, A. W. D., Man, R. E. K., Tan, N. C., Tang, W. E., Wong, W. T., Soo, W. F., Lim, S. W., Wee, S. Y.-M., et al. (2024) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2023-270
Vijay, V., Trueman, P., Arunraj, M., Palani, G., Devarajan, A., Kumpatla, S., & Viswanathan, V. (2026) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-026-01659-2
Çavuşoğlu, E., & Heshmati, N. (2026) · Sağlık Bilimlerinde Değer · doi:10.33631/sabd.1780880
Darwis, N., Zulkifli, A., & Amiruddin, R. (2026) · International Journal of Statistics in Medical Research · doi:10.6000/1929-6029.2026.15.30
Tyson, A., Faizo, L., Reagan, K., Banturaki, A., & Olwedo, P. O. (2026) · Health Science Reports · doi:10.1002/hsr2.73259
- Authors
- Heise, M., Heidemann, C., Baumert, J., Du, Y., Frese, T., Avetisyan, M., & Weise, S.
- Affiliations
- Martin Luther University Halle-Wittenberg (DE)
- Robert Koch Institute (DE)
- Corresponding author
- Heise, M.
- Heidemann, C.
- Baumert, J.
- Du, Y.
- Frese, T.
- Avetisyan, M.
- Weise, S.
- Venue
- Primary Care Diabetes
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 16
- Issue
- 3
- Pages
- 387-394
- ISSN
- 1751-9918 (ISSN-L)
- OpenAlex
- W4223564216
- Cited by
- 15
- References
- 51
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 2
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Primary care diabetes (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Publication server of the Robert Koch Institute (Robert Kock Institute) (submittedVersion, cc-by)
- Digitalen Hochschulbibliothek Sachsen-Anhalt (Universitäts- und Landesbibliothek Sachsen-Anhalt) (cc-by)
- Funders
- Bundesministerium für Gesundheit (GE20150323, GE20160358, GE20190305)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- diabetes self-management education, diabetes knowledge, information needs, information sources, diabetes complications, patient education, psychosocial burden
- MeSH terms
- Self-Management, Diabetes Mellitus, Diabetes Mellitus, Type 2, Educational Status, Humans, Self Care, Health Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
