Diabetes Self-Management Education Program Effect on Glycemic Control and Insulin Dosing in Poor Diabetes Literacy Patients from Urban Areas in Mexico City—Therapeutic Education Underuse and Insulin Overuse

  • SILVA-TINOCO R
  • MEZA D
  • MARTINEZ D
  • et al.
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Abstract

Limited evidence exists on the efficacy of Diabetes Self-Management Education (DSME) in primary care urban population in low- and middle-income countries. This study evaluated the effect on glycemic control and insulin dosing in patients who attended an interdisciplinary educative structured program at Clínica Especializada en el Manejo de la Diabetes in México City-Iztapalapa in 2017. Intervention lasted 5 months and included individual and group sessions in a shared medical appointments model aimed at promoting self-care. In 252 patients with type 2 diabetes, diabetes literacy and self-care activities were assessed from the 10-item Spoken Knowledge in Low Literacy in Diabetes (SKILL-D, score 0-100) and the Summary of Diabetes Self-Care Activities (SDSCA, days/week), respectively. Women represented 67% and 59.6% had elementary or less education. Mean age was 55±10 years old, mean duration of diabetes was 13±8 years and 66% were on insulin treatment. SKILL-D and SDSCA scores increased from 22±19 to 80±16 and 2.5±1.4 to 4.7±1 days/week, respectively. HbA1c decreased from 9.3±2.1 to 6.7±1.1% (mean variation 2.5±2.1%; p<0.001) and daily total insulin dose decreased from 37±17 to 23±13 units (mean variation 13.5±14.7 units; p<0.001). Only in 22% another drug agent was added, in 18% insulin was discontinued and in 3% insulin started. Diabetes literacy and self-care activities were poor at the beginning of the study. This is a real-world study that showed that a non-pharmacological approach focused on promoting self-care, such as DSME, had in important effect on HbA1c reduction and insulin dosing in urban areas patients with low literacy, but also suggested an insulin over-prescription practice with lack of adherence/prescription to/of lifestyle interventions, before participation in this program.

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SILVA-TINOCO, R., MEZA, D. G., MARTINEZ, D. G., OROZCO, J., ROMERO-IBARGUENGOITIA, M. E., DE LA TORRE-SALDAÑ, V. A., … CUATECONTZI, E. T. (2018). Diabetes Self-Management Education Program Effect on Glycemic Control and Insulin Dosing in Poor Diabetes Literacy Patients from Urban Areas in Mexico City—Therapeutic Education Underuse and Insulin Overuse. Diabetes, 67(Supplement_1). https://doi.org/10.2337/db18-658-p

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