Executive Summary

The increasing presence of type 2 diabetes is a detrimental health and economic problem
in the United States. Type 2 diabetes affects 29.1 million Americans or 9.3% of the population1.
Every year, 1.7 million new cases of diabetes are diagnosed in people aged 20 and older 1.
Prediabetes rates are elevated as well with 86 million Americans with the disease in 2012; an
increase of 10 million from 20102. The majority of the disease is present in people over 45 (24.6
million), men (15.5 million versus 13.4 million women), and minorities (American
Indians/Alaska Natives with a rate of 15.9%, followed by Non-Hispanic blacks at 13.2% and
Hispanics at 12.8%)1. The CDC estimated in 2012 that the combination of direct costs (medical
expenditures) and indirect costs (disability, work loss, and premature death) cost the United
States a total of $245 billion.
Diabetes is a chronic disease that requires continual education and support as the disease
is ever changing. Diabetes Self-Management Education (DSME) is the key concept defined by
the Academy of Nutrition and Dietetics as, the process facilitating the knowledge, skill, and
ability necessary for diabetes self-care as a healthcare professional3. It is important to recognize
the factors that influence a patients ability to successfully self-manage diabetes. Referrals for
self-management may include an outpatient visit to a registered dietitian for medical nutrition
therapy, community programs or support groups, mental health care workers, or various
specialists if appropriate3. Furthermore, an annual visit to assess patients yearly in their ability to
self-manage as well as their knowledge, skills and behaviors along with the identification of
barriers, coping strategies, and possible adjustments in therapy may also be appropriate3.
Education is required in the onset of the disease, but support is essential for the lifetime
of the illness. Diabetes Self-Management Support (DSMS)3 is, the support that is required for
implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing
basis. There are several crucial factors involving diabetes management can be barriers to
successful outcomes. Factors can include the healthcare system, the healthcare professional
involved, community resources, and the person with diabetes3. DSME/S is a concept that helps
address psychosocial issues and concerns that could be the major barrier to success3.
DSME/S is beneficial for diabetics, but the amount of those helped is extremely low.
6.8% of individuals with health insurance diagnosed with diabetes engage in DSME/S3. The
percentage is even lower for Medicare patients (4%). Barriers of this program can involve a lack

of knowledge about effectiveness, confusion about appropriate referral, lack of access to the
program, and the individuals own psychosocial and behavioral influences3.
DSME/S is an impressive curriculum, but even at the highest point of intervention, the
cost coverage is an issue which makes it easy to remove programs despite the successful health
outcomes and long term reduction of costs3. Diabetic patients frequently want to be involved
with their healthcare but find that the education and psychological amenities are not available3.
Even if these valuable education programs are available, the success of these programs is based
upon high consumption and will terminate if not utilized enough3. Awareness of the referral
system can assist with the success of these programs along with a proper reimbursement
arrangement.
Diabetes support groups are a vital source of community support that can provide a
variety of benefits. Studies show that diabetes support groups can lead to improved glycemic
control, HbA1C levels, and self-care behaviors4-7. Even in adverse conditions such as
underserved communities, positive benefits are an outcome of support groups. Shaw et al4
examined sources of support in underserved urban and rural communities through a survey. The
goal was to help with the development of a community-based diabetes intervention. Findings
suggested that for medically underserved communities, support from the healthcare system may
be difficult, therefore focusing on the diabetes support organizations that provide resources are a
plausible option. Socioeconomic resources may be scarce, but people who are involved with
supportive organizations may feel more success in following their self-care routine than those
who are in a less supportive organization or not involved at all5. Overall, the study suggested that
family, friends and neighborhood resources could possibly serve as support for diabetes self-care
as these influences had positive findings with foot care, physical activity (within the rural
community) and the likeliness of performing at least 3 self-care behaviors on a consistent basis.
Peers as leaders for self-management support have been examined as a possible effective
community support measure5-7. The Peer-Led, Empowerment Based Approach to SelfManagement Efforts in Diabetes (PLEASED)5 showed that peer support is a practical and
convincing option for diabetes self-management. In another study comparing peer leaders and
community health workers6, both programs were effective but the peer led group continued
improvement in HbA1c levels beyond the DSME program. Overall, diabetes is a complex
disease that involves multiple dimensions that need to be addressed when treating an individual.

Tackling this issue is crucial through the awareness of education and support groups. Both can
aid in the solution to help alleviate these factors by improving motivation to sustain positive
health outcomes, prevention of diabetes as well as its health complications and providing
emotional and social encouragement to maintain self-care behaviors. Development of an
improved referral and reimbursement system along with financial assistance and enhanced
enrollment influence the success of these much needed programs.

References:
1. Centers for Disease Control and Prevention (CDC). National diabetes statistics report:
estimates of diabetes and its burden in the United States, 2014. 2014.
http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf . Accessed
September 30, 2015.
2. American Diabetes Association website. Statistics about diabetes. American Diabetes
Association. http://www.diabetes.org/diabetes-basics/statistics/. Updated May 18, 2015.
Accessed September 30, 2015.
3. Powers MA, Bardsley J, Cypress M, et al. Diabetes self-management education and support in
type 2 diabetes: a joint position statement of the American Diabetes Association, the American
Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. JAND.
2015;115(8): 1-12.
http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20and%20practice%
20papers/position%20papers/diabetesselfmanagementeducationsupporttype2diabetes.ashx.
Accessed September 30, 2015.
4. Shaw BA, Gallant MP, Riley-Jacome M et al. Assessing sources of support for diabetes selfcare in urban and rural underserved communities. Jour of Comm Health. 2006;31(5): 393-412.
http://search.proquest.com.cse.idm.oclc.org/socscijournals/docview/224042164/D9D7D73F3A1
E4E82PQ/3?accountid=10328. Accessed September 30 2015.
5. Tang TS, Funnell MM, Sinco B, et al. Peer-led, empowerment-based approach to selfmanagement efforts in diabetes (PLEASED): a randomized controlled trial in an african
american community. Annals of Family Medicine. 2015;13(1): s27-s35.
http://www.annfammed.org/content/13/Suppl_1/S27.long. Accessed September 30, 2015.
6. Tang TS, Funnell M, Sinco B, et al. Comparative effectiveness of peer leaders and community
health workers in diabetes self-management support: results of a randomized control trial.
Diabetes Care. 2014;37: 1525-1534.
http://care.diabetesjournals.org.cse.idm.oclc.org/content/37/6/1525.abstract. Accessed September
30, 2015.

7. Philis-Tshmikas A, Fortmann A, Lleva-Ocana L et al. Peer-led diabetes education programs in

high-risk mexican americans improve glycemic control compared with standard approaches.
Diabetes Care. 2011;34:1926-1931.
http://care.diabetesjournals.org/content/34/9/1926.full.pdf+html. Accessed September 30, 2015.