Targeted diabetes education improves self-reported health in underserved community
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Diabetes education guides targeted toward a group of low-income, predominantly Hispanic adults from an underserved community in Los Angeles were associated with improved perceived health and diabetes knowledge, according to study data.
In a study published in Diabetes Technology & Therapeutics, researchers created low literacy education guides in English and Spanish to teach adults with type 1 diabetes about type 1 diabetes management, insulin pen and pump use, and more. Although there were no changes in mean HbA1c at 1 year, participants reported having less diabetes distress, greater diabetes knowledge, improved self-reported health and a trend toward reduced depression.
“We’ll never get anywhere unless we have teaching tools targeted toward a specific population,” Anne L. Peters, MD, professor of clinical medicine at Keck School of Medicine at the University of Southern California, Los Angeles, and an Endocrine Today Editorial Board Member, told Healio. “We can create teaching tools that are helpful, but they have to be coupled with a more intensive program to help patients adjust their insulin so they can have better outcomes in terms of glycemia.”
Creating community-tailored diabetes education
Peters and colleagues created education materials based on feedback from two focus groups consisting of four to six English- and Spanish-speaking adults with type 1 diabetes. Education guides for essential type 1 diabetes management, carbohydrate counting, and insulin pen and pump use were created with a fifth-grade reading level in both English and Spanish.
The study’s second phase included 63 adults aged 18 years and older with type 1 diabetes who attended an appointment at a clinic in an underserved area of East Los Angeles (55% women; 81% Hispanic/Latino). Most of the participants were from a lower socioeconomic status and received MediCal or another form of relief to pay for their health care. Participants were provided copies of the educational guides and invited to participate in educational group classes on type 1 diabetes management, carbohydrate counting, insulin self-adjustment, sick day management, physical activity and insulin adjustment. Additional classes were offered for those interested in using an insulin pen or insulin pump. Participants completed questionnaires to measure diabetes distress, hypoglycemia fear, diabetes knowledge, depression and self-reported perceived health at baseline, 6 months and 12 months. Diabetic ketoacidosis and severe hypoglycemia were self-reported. Participants wore masked continuous glucose monitors for 2 weeks at enrollment. HbA1c and CGM data were obtained at baseline, 6 months and 12 months.
Improvements in self-reported health
Of the 63 participants, 51 remained in the study at 6 months and 43 completed the intervention at 12 months. The study cohort maintained glycemic values above target range throughout the study. No improvements in HbA1c, CGM metrics or severe hypoglycemia were observed at 6 and 12 months. There was a decline in DKA rates at 6 months (P = .038) and 12 months (P = .017).
There were improvements in most patient-reported outcomes at 12 months, including self-reported health (P = .01), diabetes knowledge (P < .01) and diabetes distress (P = .04). The cohort reported an increase in fear of hypoglycemia at 6 and 12 months (P < .001 for both). A trend toward improvements in depression was observed, but the change was not significant.
“The patients in our population have such a hard time dealing with diabetes because their lives are so busy and they have so many competing needs,” Peters said. “The intervention did seem to help them to feel better about their diabetes, but it’s more than an education that’s going to make [them] manage their diabetes more safely. They need a lot more help.”
Peters said the improvements in self-reported health were encouraging but believes combining the educational classes with more intensive care, where treatment decisions could be made weekly, may help those with diabetes also experience improved glycemic control.
“You have to do a lot more for these patients,” Peters said. “But I think [the intervention] was a good step for us to show how much better patients felt. I didn’t know we’d make that much of a difference even though we didn’t change HbA1c.”
For more information:
Anne L. Peters, MD, can be reached at annepete@med.usc.edu.
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