Program Reinforcement Impacts Self Management (PRISM)

As the diabetes burden worsens, the need for people to become more involved in
self-management will increase. Research has demonstrated that diabetes self-management
education (DSME) can improve HbA1C levels by 0.76%. While the rates of diabetes are
increasing, the numbers of educators available are shrinking. This is a particular hardship
in underserved and military communities where the supply of health care providers is already
scarce. Our investigative team has led efforts in supporting DSME in the PA state-wide
deployment of the Chronic Care Model (CCM) and reported findings nationally on innovative
ways to increase the pool of education services by integrating educators into primary care,
establishing nurse clinics in underserved communities and demonstrating that an educator
position could be sustained by reimbursement. A 0.76% reduction associated to DSME can be
considered an enormous benefit and is equivalent to the impact of most pharmacologic
treatments for diabetes. Unfortunately, however the benefits of DSME decrease over time.
This suggests that sustained improvements require contact and follow-up. SMS is defined as
the process of ongoing support of patient self-care, to sustain the gains following DSME.
There is often confusion among the terms self-management education (DSME) and
self-management support (SMS). DSME is associated with the provision of knowledge and skills
training delivered by a health care professional, e.g. nurses, dietitians, etc. SMS is
defined as the process of making and refining changes in health care systems (and the
community) to support patient self-care and maintain the gains made following DSME. We know
that SMS is currently provided by diabetes educators, but only one 3-6 month follow up is
usual care. It has been suggested that SMS can be provided by community workers, peers with
diabetes, and office staff within community sites, like PCP offices, and wellness centers,
etc. The National Standards for DSME and American Diabetes Association (ADA) Education
Recognition Program (ERP) require that SMS approaches be delivered and documented, yet no
evidence has been provided to define who should deliver it and how often. This uncertainty
has led to many programs delivering SMS in an unstructured, non-standardized and at times
haphazard fashion. Practical approaches designed for providing SMS have the potential to
sustain improvements. The objective of this study is to compare Self-Management Support
(SMS) interventions following Diabetes Self-Management Education (DSME) and determine which
will be more likely to maintain improvements in behavioral and clinical outcomes following
DSME while achieving patient satisfaction.

Inclusion Criteria:

- A person with diabetes referred for diabetes education

Exclusion Criteria:

- Gestational diabetes and pregnancy

- If a person has recently had diabetes education, they will not be enrolled in the
study