Benefits of diabetes self-management for health plan members: a 6-month translation study
Open accessAbstract
BACKGROUND: Diabetes self-management education has been shown to be effective in controlled trials. However, few programs that meet American Association of Diabetes Educators standards have been translated into widespread practice. OBJECTIVE: This study examined the translation of the evidence-based Better Choices, Better Health-Diabetes program in both Internet and face-to-face versions. METHODS: We administered the Internet program nationally in the United States (n=1010). We conducted face-to-face workshops in Atlanta, Georgia; Indianapolis, Indiana; and St. Louis, Missouri (n=232). Self-report questionnaires collected health indicator, health behavior, and health care utilization measures. Questionnaires were administered on the Web or by mail. We determined hemoglobin A1c (HbA1c) from blood samples collected via mailed kits. Paired t tests determined whether changes between baseline and 6 months differed significantly from no change. Subgroup analyses determined whether participants with specific conditions benefited (high HbA1c, depression, hypoglycemia, nonadherence to medication taking, and no aerobic exercise). We calculated the percentage of participants with improvements of at least 0.4 effect size in at least one of the 5 above measures. RESULTS: Of the 1242 participants, 884 provided 6-month follow-up questionnaires. There were statistically significant improvements in 6 of 7 health indicators (including HbA1c) and in 7 of 7 behaviors. For each of the 5 conditions, there were significant improvements among those with the condition (effect sizes 0.59-1.1). A total of 662 (75.0%) of study participants improved at least 0.4 effect size in at least one criterion, and 327 (37.1%) improved in 2 or more. CONCLUSIONS: The Diabetes Self-Management Program, offered in two modes, was successfully disseminated to a heterogeneous national population of members of either insured or administered health plans. Participants had small but significant benefits in multiple measures. The program appears effective in improving diabetes management.
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Improvements in self-efficacy, knowledge, and activation are likely necessary for improvements in outcomes such as QOL and healthcare resource use.
“Improvements in self-efficacy, knowledge, and activation are likely necessary for improvements in other key outcomes such as QOL and healthcare resource use. The current evidence on self-management models of care supports this concept.”
From A Multimedia Self-management Intervention to Prepare Cancer Patients and Family Caregivers for Lung Surgery and Postoperative Recovery (2017) · cites this paper as [35]
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- Authors
- Lorig, K., Ritter, P. L., Turner, R. M., English, K., Laurent, D. D., & Greenberg, J.
- Affiliations
- Stanford Medicine (US)
- Carelon Research (United States) (US)
- Anthem (United States) (US)
- National Council on Aging (US)
- Corresponding author
- Ritter, Philip L
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2016-06-24
- Volume
- 18
- Issue
- 6
- Pages
- e164
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4950850
- OpenAlex
- W2467159028
- Cited by
- 43
- References
- 29
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 6 · 2018: 5 · 2017: 5 · 2016: 3
- FWCI
- 6.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- 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 › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- diabetes self-management education, program dissemination, health plans, health insurance beneficiaries, HbA1c, glycemic control, health behavior, health care utilization, depression, hypoglycemia, medication adherence, aerobic exercise, online intervention, face-to-face workshops
- MeSH terms
- Adult, Aged, Aged, 80 and over, Depression, Diabetes Mellitus, Type 2, Female, Georgia, Health Status Indicators, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Indiana, Male, Middle Aged, Patient Education as Topic, Surveys and Questionnaires, Self Care, Health Behavior, Exercise, Internet, Medication Adherence, Translational Research, Biomedical, Self Report
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