ABSTRACT
The American Diabetes Association has recommended that diabetes self-management education and support (DSMES) teams improve diabetes outcomes by identifying and responding to patients' social needs. This study examines demographic patterns in how hemoglobin A1c (A1c) is related to individual social needs, reported urgency of those needs, and interest in obtaining assistance. A total of 1125 unique persons who had been referred for DSMES and had completed a social needs screener via our electronic medical record were included. The majority (51.9 %) had an A1c < 8 % at their most recent assessment and most respondents (52.5 %) reported having at least 1 unmet social need (n = 591), Those who reported having at least 1 social need, tended to have higher A1c levels compared with those who reported no social needs (median of 8.0 % versus 7.7 %; p < 0.05). Among Black individuals the associations were stronger (median A1c of 8.2 % among those with versus 7.2 % among those without a reported social need; p < 0.05). However, among White individuals, there was no difference in A1c between these two groups. Among those who reported a social need, those who also reported they needed assistance (35.7 %) tended to have higher A1c levels than those who did not (median 8.3 % versus 7.8 %; p < 0.10). This relationship did not vary by race. Ongoing study of the relationship between unmet social needs and glycemic control is warranted to help identify effective clinical workflows to help providers incorporate consideration of social needs into their medical decision making.
ABSTRACT
Diabetes self-management education and support (DSMES) can help people achieve optimal disease control, yet these services often remain underutilized. People referred to these programs by their provider can become disengaged in the program at several key steps. This study applies Classification and Regression Tree analysis to 3796 people with diabetes at a single health system based in the Detroit metropolitan area who were referred for DSMES provided by the health system to determine demographic patterns of those who were successfully contacted to schedule program intake appointments, those who did not attend their intake appointment, and those who began but did not complete their personalized DSMES program. White people > 43 years of age, those with a prior A1C value > 8.9 and those with Medicaid insurance had the highest rate of not being successfully contacted for their intake appointment. Those who did not attend their intake appointment tended to have Medicaid insurance, be younger than 48 years, and have A1C > 8.1. Within the Medicare or private insurance groups, those who did not attend were more likely to be female, of Black race and not partnered. Older males with a lower A1C (≤8.3%) had the lowest rate (34.0%) of failing to complete their DSMES plan. The data showed that almost half of those referred were not successfully contacted. The overall low completion rate of 13.2% confirms the need to examine factors predictive of participation and completion. This study highlights process improvement changes to improve personalization of outreach and engagement.
