Diabetes self-management education on the sustainability of metabolic control in type 2 diabetes patients: Diabetes share care program in Taiwan

• Published in: Journal of the Formosan Medical Association Vol. 123; no. 2; pp. 283 - 292
• Main Authors: Lai, Ying-Chuen, Chen, Yi-Shuan, Jiang, Yi-Der, Wang, Chiou-Shiang, Wang, I-Ching, Huang, Hsiu-Fen, Peng, Hui-Yu, Chen, Hui-Chuen, Chang, Tien-Jyun, Chuang, Lee-Ming
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.02.2024; Elsevier
• Subjects: Diabetes education; Diabetes Mellitus, Type 2 - therapy; Diabetes self-management education; Diabetes share care program; Glycated Hemoglobin; Glycemic control; Health Behavior; Humans; Pay-for-performance; Self-Management; Self-monitoring of blood glucose; Taiwan; Taiwan; Diabetes education; Glycemic control; Pay-for-performance; Diabetes self-management education; Self-monitoring of blood glucose; Diabetes share care program
• ISSN: 0929-6646; 1876-0821
• DOI: 10.1016/j.jfma.2023.09.010

Diabetes self-management education (DSME) improves glycemic and metabolic control. However, the frequency, duration and sustainability of DSME for improving metabolic control have not been well studied. The Diabetes Share Care Program (DSCP) stage 1 provided DSME every 3 months. If participants entering DSCP stage 1 ≥ 2 years and HbA1c < 7%, they can be transferred to stage 2 (DSME frequency: once a year). Three-to-one matching between DSCP stage 1 and stage 2 groups based on the propensity score method to match the two groups in terms of HbA1c and diabetes duration. We identified 311 people living with type 2 diabetes in DSCP stage 1 and 86 in stage 2 and evaluated their metabolic control and healthy behaviors annually for 5 years. In the first year, HbA1c in the DSCP stage 2 group was significantly lower than that in the stage 1 group. In the first and the fifth years, the percentage of patients achieving HbA1c < 7% was significantly higher in the DSCP stage 2 group than the stage 1 group. There was no significant difference in other metabolic parameters between the two groups during the 5-year follow-up. Self-monitoring of blood glucose (SMBG) frequency was associated with a reduced HbA1c after 5 years (95% CI: −0.0665 to −0.0004). We demonstrated sustainable effects of at least 2-year DSME on achieving better glycemic control for at least 1 year. SMBG contributed to improved glycemic control. The results may be applied to the reimbursement strategy in diabetes education.