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 Table of Contents  
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 38-40

How well a culturally adapted diabetes self-management education program (DSME) improves the glycemic control and distress among diabetes patients?

1 Department of Community and Family Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
2 Division of Diabetes and Metabolism, Department of Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India

Date of Submission04-Jun-2021
Date of Acceptance06-Sep-2021
Date of Web Publication28-Feb-2022

Correspondence Address:
Meenakshi Khapre
Department of Community and Family Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCDM.JCDM_11_21

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Diabetes self-management education (DSME), considered as the cornerstone of treatment for all people with diabetes, helps people with diabetes, or newly diagnosed diabetics, learn how to successfully manage their disease. The goal of DSME is to help people practice diabetes self-care behaviors daily and be as healthy as possible.

Keywords: Diabetes mellitus, diabetes-related distress, diabetes self-management education

How to cite this article:
Anjali M, Khapre M, Kant R, Asha T J. How well a culturally adapted diabetes self-management education program (DSME) improves the glycemic control and distress among diabetes patients?. J Cardio Diabetes Metab Disord 2021;1:38-40

How to cite this URL:
Anjali M, Khapre M, Kant R, Asha T J. How well a culturally adapted diabetes self-management education program (DSME) improves the glycemic control and distress among diabetes patients?. J Cardio Diabetes Metab Disord [serial online] 2021 [cited 2023 Oct 4];1:38-40. Available from: http://www.cardiodiabetic.org/text.asp?2021/1/2/38/338607

  Introduction Top

Diabetes mellitus accounts for world’s third-largest, chronic, non-communicable disease after cardiovascular diseases and cancer.[1] Till date, the countries with the largest burden of diabetes are China, India, and the USA and it is anticipated to remain so until 2030. The Indian scenario is quite alarming with around 77 million people living with diabetes and is projected to be 101 million by 2030 and 134 million by 2045,[2] wherein adults aged 20–79 years, a total of 463 million (9.3%), living with diabetes are estimated to be around 578 million and 700 million by 2030 and 2045, respectively. Globally, India ranks first in the number of incident cases of diabetes among 0–14 and 0–19 year age groups.[2]

Living with diabetes can be difficult at times, as it affects the patient physically as well as psychologically.[3] Health care of diabetes in India is a major concern considering lack of proper support systems, non-availability of trained paramedical personnel, and absence of appropriate healthcare insurance schemes for diabetes. Being a chronic disease, it should be emphasized more on building up adequate infrastructure and support service and a team care approach to care.[4] The emotional burden and worries about diabetes, fear of its management and complications, unmet needs of support from the family, friends, and healthcare personnel have been recognized as diabetes-related distress (DRD).[5] Even being a common and manageable emotion disorder, diabetes distress remains largely undetected posing difficulty on self-management and glycemic control whereby necessitating its timely diagnosis and management.[6]

Diabetes self-management education (DSME) considered as the cornerstone of treatment for all people with diabetes is a collaborative and ongoing process intended to facilitate the development of knowledge, skills, and abilities required for successful self-management of diabetes,[7] with special focus on healthy eating, being physically active, compliant with medications, monitoring of blood sugar, healthy coping skills, risk reduction behaviors, and good problem-solving skills, hence enhancing patient skills and confidence in managing health problems.[8] DSME showed significant improvements in glycemic control, blood pressure, body weight, self-management behaviors, social support, and diabetes-related distress.[9],[10] DSME offers consistent positive changes mainly related to healthy eating, though even a small amount of weight loss (≥2%) in diabetic patients seems to mediate significant improvements in cardiovascular risk factors.[11] The effect of DSME on psychological status was supported by a significant reduction in anxiety score and depression score at 3–6-month post-intervention.[12]

A standard DSME is characterized by a defined internal structure with an up-to-date, evidence-based, flexible curriculum with an individualized education plan based on each participant’s concerns and needs.[13] The DSME team, supervised by a quality coordinator, ensures effective implementation of the standards of the services. Team members providing the services include either a registered nurse or a dietitian or a pharmacist with training and experience in DSME or a certified diabetes educator.[13] Other healthcare workers or diabetes paraprofessionals with appropriate training and experience may also contribute to the team. The providers must be aware of the demographic characteristics, perception of diabetes, barriers that prevent access to DSME as well as cultural background of the population.[14] In a systematic review of culturally tailored self-management interventions for South Asians with type 2 diabetes, which was based on Leininger’s sunrise model, apart from inclusion of language and culturally specific education, none of the studies addressed religious, political, economic, legal, philosophical, kinship, and social factors of the population, which eventually highlights the importance of integration of culturally congruent care while designing a DSME.[15]

Considering the chronicity and rising burden of diabetes in India, steps must be taken to promote standard diabetes educational programs, suitable for Indian population. The National Diabetes Educator Program was developed with the objective of creating professional diabetes educators in India, and over 1000 diabetes educators had been trained through a network of 96 diabetologists and physicians within a one-year period.[4] Recent years have witnessed research supporting the need for such programs in integration within primary care settings to improve glycemic control and to decrease complication profile by empowering patients and improving self-care practices.[16]

Rural areas with limited access to quality diabetes care can utilize community health workers (CHWs) as home-based diabetes educators following a core training in intervention policies and procedures combined with an extended participatory training in diabetes.[17] Comparing a standard DSME with family DSME, the latter addresses self-management within a family context by using family motivational interviewing and family goal setting and focussing on family behavioral changes.[18] Family DSME proved a significant increase in the probability of glucose monitoring and annual doctor visits; the reason can be attributed to the post-intervention support provided by family members.[19] Creative solutions incorporating technology such as telehealth, electronic health records (EHRs), and mobile applications will offer endless opportunities for individualized and contextualized DSME, especially amidst the COVID-19 pandemic.[20]

One of the challenges of DSME is sustainability in behavioral change. Most of the studies proved beneficial effects only in a short-term period (3-month post-intervention). It is important to determine the amount or “dose” of education required for long-term maintenance. For patients who have not met glycemic targets, reinforcing diabetes self-management education is a necessary component of ongoing diabetes care.[21]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Zheng F, Liu S, Liu Y, Deng L Effects of an outpatient diabetes self-management education on patients with type 2 diabetes in China: A randomized controlled trial. J Diabetes Res 2019;2019:1073131.  Back to cited text no. 1
Patterson CC, Karuranga S, Salpea P, Saeedi P, Dahlquist G, Soltesz G, et al. Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019;157:107842.  Back to cited text no. 2
Deshpande AD, Harris-Hayes M, Schootman M Epidemiology of diabetes and diabetes-related complications. Phys Ther 2008;88:1254-64.  Back to cited text no. 3
Joshi S, Joshi SR, Mohan V Methodology and feasibility of a structured education program for diabetes education in India: The National Diabetes Educator Program. Indian J Endocrinol Metab 2013;17:396-401.  Back to cited text no. 4
Chew BH, Mukhtar F, Sherina MS, Paimin F, Hassan NH, Jamaludin NK The reliability and validity of the Malay version 17-Item Diabetes Distress Scale. Malays Fam Physician 2015;10:22-35.  Back to cited text no. 5
Fisher L, Gonzalez JS, Polonsky WH The confusing tale of depression and distress in patients with diabetes: A call for greater clarity and precision. Diabet Med 2014;31:764-72.  Back to cited text no. 6
Haas L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, et al. National standards for diabetes self-management education and support. Diabetes Educ 2012;38:619-29.  Back to cited text no. 7
Tomky D, Cypress M, Dang D, Maryniuk M, Peyrot M, Mensing C AADE Position Statement; AADE7TM Self-Care Behaviors. Diabetes Educ 2008;34:445-50.  Back to cited text no. 8
Shrivastava SR, Shrivastava PS, Ramasamy J Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord 2013;12:14.  Back to cited text no. 9
Azami G, Soh KL, Sazlina SG, Salmiah MS, Aazami S, Mozafari M, et al. Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. J Diabetes Res 2018;2018:4930157.  Back to cited text no. 10
Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al; Look AHEAD Research Group. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011;34:1481-6.  Back to cited text no. 11
Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N, et al. The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. Patient Educ Couns 2018;101:1427-32.  Back to cited text no. 12
Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al; 2017 Standards Revision Task Force. 2017 National Standards for Diabetes Self-Management Education and Support. Diabetes Educ 2018;44:35-50.  Back to cited text no. 13
Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, et al. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos: Latinos en control. Diabetes Care 2011;34:838-44.  Back to cited text no. 14
Navodia N, Wahoush O, Tang T, Yost J, Ibrahim S, Sherifali D Culturally tailored self-management interventions for South Asians with type 2 diabetes: A systematic review. Can J Diabetes 2019;43:445-52.  Back to cited text no. 15
Gehlawat M, Lakshminarayanan S, Kar SS Structured diabetes education program for improving self-care behavior in primary care settings of Puducherry: Evidence from a randomized controlled trial. Indian J Community Med 2019;44:107-12.  Back to cited text no. 16
Hill-Briggs F, Batts-Turner M, Gary TL, Brancati FL, Hill M, Levine DM, et al. Training community health workers as diabetes educators for urban African Americans: Value added using participatory methods. Prog Community Health Partnersh 2007;1:185-94.  Back to cited text no. 17
Baig AA, Benitez A, Quinn MT, Burnet DL Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci 2015;1353:89-112.  Back to cited text no. 18
Felix HC, Narcisse MR, Long CR, McElfish PA Effects of a family diabetes self-management education intervention on the patients’ supporters. Fam Syst Health 2020;38:121-9.  Back to cited text no. 19
Dong Y, Wang P, Dai Z, Liu K, Jin Y, Li A, et al. Increased self-care activities and glycemic control rate in relation to health education via WeChat among diabetes patients: A randomized clinical trial. Medicine (Baltimore) 2018;97:e13632.  Back to cited text no. 20
Beverly EA, Fitzgerald SM, Brooks KM, Hultgren BA, Ganda OP, Munshi M, et al. Impact of reinforcement of diabetes self-care on poorly controlled diabetes: A randomized controlled trial. Diabetes Educ 2013;39:504-14.  Back to cited text no. 21


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