Journal of Cardio-diabetes and metabolic disorders

: 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?

M Anjali1, Meenakshi Khapre1, Ravi Kant2, TJ Asha1,  
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

Correspondence Address:
Meenakshi Khapre
Department of Community and Family Medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand.


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.

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
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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.


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