Diabetes Self-Management Education (DSME) effectiveness in people with Type 2 Diabetes Mellitus (T2DM)- A Systematic review

 

Flosy Rodrigues e Menezes

PhD Research Scholar, Yenepoya University, Mangalore, Karnataka

Associate Professor, Medical -Surgical Nursing, Institute of Nursing Education, Bambolim, Goa, India.

*Corresponding Author E-mail: 090918mk@gmail.com

 

ABSTRACT:

Diabetes is a serious chronic disease affecting more than 77 million belong to India. The prevalence of diabetes in the population is 8.9%, according to the IDF. Individuals with diabetes are at risk for developing serious complications, including renal failure, vision impairment, blindness, lower extremity amputations, myocardial infarction, and stroke. So the Self-management and education are crucial for controlling diabetes and its associated complications. The purpose of this study to assess the effectiveness diabetes self-management education among patients with Type 2 diabetes mellitus. The keywords diabetes mellitus, management education, self-care, diabetes self-management education, DSME, and T2DM were used to search for relevant articles on Google Scholar, PubMed, ProQuest, and Science Direct. Following that, the articles were chosen based on inclusion and exclusion criteria. In addition, the data was extracted, grouped, and concluded. According to 15 studies, diabetes self-management education intervention has a significant impact on T2DM patients' lifestyle changes and self-care. Finally, diabetes self-management education has been shown to be effective in the treatment of type 2 diabetes mellitus. Furthermore, DSME has a positive effect on T2DM patients' lifestyle changes and self-care.

 

KEYWORDS: Diabetes, Diabetes self-management education (DSME), Type II- diabetes.

 

 

INTRODUCTION:

Diabetes mellitus (DM) is a chronic disease characterised by elevated blood glucose levels (hyperglycaemia) caused by metabolic disorders that prevent the patient from producing enough insulin. Certain behaviours and lifestyles, such as regular exercise, healthy eating patterns, avoiding smoking, and controlling fat and glucose in the blood, can help prevent and control the disease. 1 According to the World Health Organization, the number of people living with diabetes mellitus (DM) worldwide has reached 422 million, with 1.6 million deaths occurring each year.2

 

The India global diabetes prevalence in 20-79 year olds in 2021 was estimated to be 10.5% (536.6 million people), rising to 12.2% (783.2 million) in 2045. Diabetes prevalence was similar in men and women and was highest in those aged 75-79 years. Prevalence (in 2021) was estimated to be higher in urban (12.1%) than rural (8.3%) areas, and in high-income (11.1%) compared to low-income countries (5.5%). The greatest relative increase in the prevalence of diabetes between 2021 and 2045 is expected to occur in middle-income countries (21.1%) compared to high- (12.2%) and low-income (11.9%) countries. Global diabetes-related health expenditures were estimated at 966 billion USD in 2021, and are projected to reach 1,054 billion USD by 2045.

 

Part of the reason India and other parts of the world have increasing rates of diabetes is: a rise in middle-class populations global adoption of Western diet, tobacco use, eating more fast food sedentary lifestyles (less physical activity), lack of access to diabetes care and education.3

National disease control in India (2022) reported that Prevalence of DM and impaired fasting blood glucose (IFG) in India was 9.3% and 24.5% respectively. Among those with DM, 45.8% were aware, 36.1% were on treatment and 15.7% had it under control. The prevalence of DM and IFG is high among adults, while the levels of awareness, treatment and control are still low in India, and this varied notably between the age groups.

 

Diet, physical activity, monitoring blood glucose levels, adherence to proper medication consumption, good problem solving, coping skills, and risk reduction behaviour are the seven major behaviours associated with diabetes self-care management. 5 Continuous self-care will lower the likelihood of DM complications. However, the majority of DM patients do not practise adequate self-care techniques, such as controlling fasting blood glucose levels. 6

 

Diabetes management focuses on several aspects, including education, meal planning, lifestyle changes, physical activity, and habits. 7 According to one study, educational interventions have an impact on knowledge, physical activity, food intake, self-efficacy, and health literacy. 8 Diabetes self-management education (DSME) is critical for empowering people with diabetes to engage in and maintain lifestyle changes that have been shown to improve health outcomes. The process of facilitating the knowledge, attitudes, and abilities required for self-management is known as DSME. 9 Furthermore, DSME play an important role in influencing the self-care practises of diabetes mellitus patients. Based on this phenomenon, a literature review was prepared to highlight the efficacy of DSME in the treatment of T2DM.

 

METHODOLOGY:

During the month of October 2020, articles were collected and reviewed. Furthermore, published articles were obtained using the keywords diabetes mellitus, self-care, diabetes self-management education, and DSME from several electronic databases, including Google Scholar, PubMed, ProQuest, and Science Direct. In order to obtain relevant articles, the articles obtained from these databases were then selected based on the inclusion and exclusion criteria. Furthermore, cross-sectional, randomised controlled trials (RCT), systematic reviews, and quasi-experimental studies were used to select article designs. Following that, the data was extracted, grouped, and summarised;  147 articles were obtained via the selection process (inclusion and exclusion criteria). These articles were then critiqued, and 13 were found to be relevant to the criteria.

 

RESULTS AND DISCUSSION:

This literature review focuses on the efficacy of DSME in T2DM. The number of sessions, time span, and methods used all contributed to the heterogeneity of DSME implementation. The study presented six articles with consistent findings indicating that DSME is beneficial to T2DM patients (Table 1).

 

Inclusion criteria:

1.     Research related to diabetes self-management education, DM management and self-care

2.     Research provides information regarding the effects of DSME

3.     The full text is available in English

 

Exclusion criteria:

1.     Publications in the form of news, quotes, abstracts, and editorial only.

2.     Research does not contain all components of the journal.

3.     Text Not in English

 

The DSME intervention provided to T2DM patients in resulted in improved knowledge and adherence to diet therapy, exercise, glucose monitoring, and wound care.10 Another study found that DSME improved medication adherence, self-management behaviour, knowledge, self-efficacy, and quality of life significantly. 11-13 Several studies have found that DSME interventions improve people's quality of life. 14-17 Smoking and alcohol consumption can also be avoided or reduced through these interventions. 10

 

Several interventions can also influence lifestyle changes, such as increasing the duration of exercises (cycling, walking, aerobics), decreasing smoking habits, and increasing fruit and vegetable consumption. 18 Lifestyle changes brought about by DSME interventions are expected to improve T2DM patients' clinical and health status. One study demonstrated the efficacy of DSME in controlling fasting blood glucose, random blood glucose, total cholesterol, and triglycerides. 11 Other studies have found that DSME can influence glycaemic control, body weight, and BMI control. 11,19-21

 

Another difference was discovered regarding the impact of DSME on HbA1c in addition to the homogeneity of the data in the article. According to Cunningham14, DSME has no appreciable impact on HbA1c. Contrary to other studies, this one shows that this intervention can have a significant impact on HbA1c. 21-26 DSME has been shown to have a favourable impact on T2DM patients' lifestyles and clinical or health status after reviewing a number of studies. However, a number of factors, including: I a lack of resources, ii) culture, iii) a connection to diabetes, and iv) a connection to the clinic, could affect the implementation process.

 

The impact of DSME on the development of T2DM disease is the primary focus of this systematic review. The DSME intervention is known to have positive effects on the onset of T2DM disease. The proven advantages support initiatives to promote T2DM development through dietary adjustments and self-care for T2DM patients. The clinical state and health status of the patient can be improved by making lifestyle changes like exercising regularly, eating more fruits and vegetables, and quitting smoking. 18 Blood sugar and HbA1c levels can reveal the clinical condition.

 

T2DM patients benefit from DSME by having better knowledge, behaviour, self-efficacy, and clinical conditions like blood sugar levels, HbA1c, and lipid profiles. 10,11,19- 21 The outcomes of studies involving HbA1c levels, however, varied. Future studies that take into account the determining factors that can affect it may be concerned about the difference between the presence or absence of this effect on HbA1c. The effectiveness of DSME is influenced by education providers and support systems, according to a number of studies in this review. 17,22,25,26

 

Table 1 Article Review

S.

no

Year

Title

Purpose of Research

Research Design

Sample Size

1

Isabel Mendez, MS et al  (2022)

Diabetes Self-Management Education and Association with Diabetes Self-Care and Clinical Preventive Care Practices

The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices.

Survey method (telephonic)

457888 adults

2

Hiwot Berhanu et al  (2022)

Diabetes mellitus self-management education at Jimma University Medical Center: evidence-based implementation project

The objective of this study was to improve knowledge and skill of healthcare providers and patients with diabetes by enhancing evidence-based practice through self-management education to increase compliance with best practice recommendations

Cross sectional study

 80 patients

3

Shatha Saleh Al Harbi et al  (2022)

The comparison of self-management group education and the standard care for patients with type 2 diabetes mellitus: An updated systematic review and meta-analysis

To investigate the efficacy of self-management group education versus the standard care for patients with type 2 diabetes mellitus (DM).

 

Systematic review and meta analyis

3446 records were screened

4.

M Heise et al  (2022)

Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study

To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress.

Population based survey method

796

participants

5

Emmanuel Kumah et al  (2021)

Diabetes self-management education interventions in the WHO African Region: A scoping review

The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews.

Systematic review

2000 to 2020 year analysed PubMed, Scopus, Medline, etc.

6

Gathu CW, Shabani J,

Kunyiha N, Ratansi R (2018)

Effect of diabetes self-management education on glycemic control among type 2 diabetic patients at a family medicine clinic in Kenya: A randomized controlled trial

The purpose of this study is to evaluate the efficacy of DSME and to compare the effects of DSME provided by certified diabetes educators and family physicians.

RCT

96 Sample

7

Yuan C, Lai CW, Chan LW,

et al. (2014)

The effect of diabetes self-management education on body weight, glycaemic control, and other metabolic markers in patients with type 2 diabetes mellitus

To assess the effect (DSME) on metabolic markers and atherosclerotic parameters in type 2 diabetes patients.

Quasi Experimental

76 Sample

8

Vaibhav S.

et al 2014

A Study of Newly Diagnosed Type 2 Diabetes Mellitus Patients from Rural Areas

To study the  clinical and biochemical  profile of newly diagnosed type 2 diabetes  m el l it us patients who belong to rural areas.

Experimental

105 samples

9

Carmienke S, Baumert J,

Gabrys L, et al. (2020)

Participation in structured diabetes mellitus self-management education program and association with lifestyle behavior: results from a population-based study

Whether participation in structured diabetes self-management education (DSME) programs for participants with diabetes mellitus is associated with healthy lifestyles in routine care apart from randomized controlled studies remains unclear and is a question of this study.

Cross-sectional population-based analysis

15 participants

10

Hailu FB, Moen A,

Hjortdahl P (2019)

Diabetes self-management education (DSME) - Effect on knowledge, self-care behaviour, and self-efficacy among type 2 diabetes patients in Ethiopia: A controlled clinical trial

Diabetic patients must be equipped with the necessary knowledge to perform self-care activities according to confidence. Researchers prepared a diabetes self-management education (DSME) intervention and assessed how this influenced diabetes knowledge levels, self-care behaviour, and self-reported patient self-efficacy.

Quasi-Experiment

220 Participants

11

Brunisholz KD, Briot P,

Hamilton S, et al. (2014)

Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure

This study aims to determine the impact of the DSME intervention by measuring HbA1c and diabetes bundle components so that diabetes care can be improved.

A retrospective case-control study

 4.587 participants

12

Sugiyama T, Steers WN, Wenger NS, et al. (2015)

Effect of a community-based diabetes self-management empowerment program on mental health-related quality of life a causal mediation analysis from a randomized controlled trial

The aim of this systematic review and meta-analysis is to investigate the association between DSME or support(DSME/S) and glycaemic control among T2DM patients. 

RCT

516 Participants

13

Zheng F, Liu S, Liu Y, Deng L (2019)

Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in China; A randomized controlled trial

This study is aimed at assessing the effectiveness of a simple outpatient diabetes self-management education program

RCT

60 Participants

14

Azami G, Soh KL, Sazlina SG, Salmiah MS, et al. (2018) 

Effect of a nurse-led diabetes self-management education program on glycosylated haemoglobin among adults with type 2 diabetes

The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education   on glycosylated haemoglobin

Quasi-Experiment

71 participants

15

Kusnanto, Widyanata KAJ, Suprajitno, Arifin H (2019)

DM-calendar app as a diabetes self-management education on adult type 2 diabetes mellitus: a randomized controlled trial

The aim was to evaluate the effect of diabetes mellitus calendar app as a Diabetes Self-Management Education (DSME) program on self-efficacy, HbA1c levels, lipid profile, and insulin in adult type 2 diabetes mellitus (T2DM).

RCT

30 Participants

16

Rasoul AM, Jalali R Abdi A, Salari N, et al. (2019)

The effect of self-management education through weblogs on the quality of life of diabetic patients

The aim of determining the effect of self-management education through weblogs on the quality of life of affect the patients.

Quasi Experiment

98 participants

 

Kargar Jahromi M Ramezanli S, Taheri L.(2014)

Effectiveness of diabetes self-management education on quality of life in diabetic elderly females

The aim of the present study was to determine the effectiveness of diabetes self-management education on quality of life in elderly females with diabetic mellitus (type 2) in Shiraz, Iran, 2013

Quasi Experiment

90 Participants

17

Qayyum AA, Lone SW Ibrahim MN, et al. (2010)

Effects of diabetes self-management education on glycaemic control in children with insulin-dependent diabetes mellitus

To evaluate the effect of diabetes self-management education (DSME) on glycaemic control (HbA1c) in Pakistani children suffering from type-1 diabetes mellitus

Quasi Experiment

50 Participants

CONCLUSION:

The 13 articles that were reviewed led to the conclusion that the DSME intervention significantly improves T2DM patients' ability to change their lifestyles and take care of themselves. As a result, it enhances the clinical or physical condition of T2DM patients.

 

 

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Received on 04.04.2023         Modified on 02.06.2023

Accepted on 17.07.2023       ©A&V Publications All right reserved

Int.  J. of Advances in Nur. Management. 2023; 11(3):210-214.

DOI: 10.52711/2454-2652.2023.00048