Factors predicting adequate glycemic control after participation in diabetes self-management education and support program: The role of behavioral change

Abstract

Objective: To explore the predictors of achieving adequate glycemic control at a 6-months follow-up in patients with type 2 diabetes (T2D) who participated in the diabetes self-management education and support (DSMES) program. Materials and Methods: A retrospective cohort study of T2D patients who completed the DSMES program (an initial visit and a 3-month follow-up) at Ramathibodi Hospital between 2014 and 2017 was conducted. Behavioral goals were set at the initial visit and whether these were achieved by the patients was assessed at a 3-month follow-up. Diabetes history, baseline, and 6-month hemoglobin A1C (HbA1c) values were collected. Multiple logistic regression analyses were performed to determine independent predictors of adequate glycemic control at 6-month, defined as HbA1c of less than 7% or less than 7.5% in those younger than 65 years or those 65 years or older, respectively. Results: Ninety-two patients were included, with a mean (SD) age 60.7 (10.9) years, an average diabetes duration of 9.1 (9.5) years and 51.1% were using insulin. Seventy-six patients (82.6%) reported that they achieved behavioral goals as set at the initial visit, and 56.5% had adequate glycemic control at 6-month. Multiple regression analysis adjusting for age, baseline HbA1c, and insulin use revealed that behavioral goal achievement at three months was independently associated with HbA1c achievement at six months (OR 3.473, 95% CI 1.005 to 12.001), while higher baseline HbA1c was associated with a lower likelihood of achieving adequate glycemic control (OR 0.727, 95% CI 0.540 to 0.979). Conclusion: Behavioral goal achievement was an independent predictor of adequate glycemic control in participants of the DSMES programs, suggesting that adherence to behavioral changes can improve clinical outcomes. Goal setting skills should be adopted by diabetes educators and incorporated as a key part of DSMES process.