According to the American Diabetes Association, older adults suffer from diabetes more than any other age group – 25 percent of adults over age 60 have diabetes. Older adults with diabetes are at risk for heart attacks, stroke and kidney failure, and are also more likely to have memory problems, depression and difficulty with diabetes self-care. Older adults with diabetes often have high blood pressure, high cholesterol, erectile dysfunction and infections that heal slowly. Diabetes is the 7th leading cause of death in the U.S. Older adults with diabetes are two times more likely to develop dementia than adults without diabetes and 1 in 5 has vision problems as a result of diabetes. Kidney disease is more common in adults over age 70, who suffer from diabetes, and adults over age 75 are twice as likely to visit an emergency room for low blood sugar than the general population with diabetes. Half of adults over the age of 65 have prediabetes.
Diabetes self-management education has been shown to be effective in improving health behaviors, however, less than 60% of adults report having attended a diabetes class within the year after diagnosis. The American Association of Diabetes Educators has set standards for diabetes self-management education. Few programs, however, that meet these standards have been translated into widespread practice and shown to be effective. The Oasis Institute participated the national translation of an evidence-based diabetes education program, The Stanford Diabetes Self-Management Program (DSMP), also known as Better Choices, Better Health-Diabetes (BCBH-D), given via the Internet or in small face-to-face community groups. The National Council on Aging led the collaboration of five organizations, including Oasis. Anthem, Inc. affiliated health plans recruited participants from their members. Oasis offered community programs between October 2013 and October 2014. The Stanford Patient Education Research Center collected data and provided data analysis.
Participants of the DSMP were recruited through mailings, flyers in workplaces, case managers, and automated telephone calls. Prospective participants called a local number for details about the workshop, were screened for study eligibility, and were registered. The Diabetes Self-Management Program, developed by Stanford University Patient Education Center, is a workshop is given 2½ hours once a week for six weeks, in community settings such as churches, community centers, libraries and hospitals. People with type 2 diabetes attend the workshop in groups of 12-16. Workshops are facilitated from a highly detailed manual by two trained Leaders, one or both of whom are peer leaders with diabetes themselves. It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.
The 6-month study found that the community-based Diabetes Self-Management Program, was successfully disseminated to a heterogeneous national population of members of either insured or administered health plans. Participants had small but significant benefits in multiple measures and the study demonstrated that the program can be effective in improving diabetes management. The program showed promise for helping to meet some of the Healthy People 2020 diabetes objectives, and demonstrated clinically significant benefits for those with high HbA1c, and important benefits for those with depression and hypoglycemia, as well as nonadherers to medication and nonexercisers. The benefits differed by individual, but a large majority of the study population demonstrated meaningful improvements in at least one of the above areas. A later study was also conducted by Lorig, et al to determine whether the national translation of the Better Choices, Better Health-Diabetes self-management program was associated with improvements in health outcomes (including HbA1c) and health behaviors (including recommended medical tests) 1 year after intervention. Participants had small but significant benefits in multiple measures and improvements made at 6 months were maintained or amplified at 1 year.
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