Effekte von Diabetesschulung auf Lebensstil und Selbstmanagementverhalten

Diabetesschulung und Lebensstil
Objective Whether participation in structured diabetes self-
management education programs (DSME) for participants
with diabetes mellitus is associated with a healthy lifestyle
in routine care apart from randomized- controlled studies
remains unclear and is this studies’ research question.
Research design and methods We identified 1300
persons with diabetes mellitus drawn from the cross-
sectional population- based analysis German Health Update
2014/2015 (GEDA 2014/2015), which integrated the modules
of the European Health Interview Survey (EHIS) wave 2. Of
those, 816 were ever-DSME participants and 484 never-
participants. We conducted multivariable weighted logistic
regression analyses for lifestyle differences comparing
ever-DSME and never-DSME participants. Lifestyle was
defined by physical activity (PA), current smoking, fruit/
vegetable consumption and body mass index (BMI). Age,
sex, socioeconomic status, living together, limitation due to
health problems for at least for 6 months, self-efficacy and
attention to one’s health were included as confounders in the
regression models.
Results Ever-DSME participants engaged significantly more
often in cycling at least 1 day per week (OR 1.62, 95% CI:
1.15–2.30) and performed significantly more often aerobic
endurance training of 150 min per week (including walking:
OR 1.42, 95% CI: 1.03–1.94, without walking: OR 1.48, 95%
CI: 1.08–2.03) compared with never-DSME participants.
Ever-DSME participants were significantly more often ex-
smoker compared with never-DSME participants (OR 1.39,
95% CI: 1.03–1.88). DSME attendance was not significantly
associated with current smoking, BMI and fruit or vegetable
consumption.
Conclusion DSME participation is associated with a
moderately healthier lifestyle particularly for PA even in
routine healthcare. Study results emphasize the importance
of a broadly dissemination of DSME access for nationwide
diabetes healthcare. Future studies should adjust for DSME
participation when investigating lifestyle in persons with
diabetes.
Diabetesschulung und Selbstmanagement
1) Objective: 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.
Methods: We included 796 ever- and 277 never-DSME participants of the population-based survey “Disease knowledge and information needs - Diabetes mellitus (2017)” from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME- participation with these outcomes.
Results: DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48–4.33), treatment (2.41; 1.36–4.26), acute complications (1.91; 1.07–3.41) and diabetes in everyday life (1.83; 1.04–3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04–2.18) and acute complications (1.71; 1.71–2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56–8.60) and diabetes care specialists (5.62; 3.61–8.75) as information sources. DSME participation was not associated with disease distress.
Conclusion: DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.

2) Objective
Few studies on diabetes self-management considered the patterns and relationships of dif-
ferent self-management behaviours (SMB). The aims of the present study are 1) to identify
patterns of SMB among persons with diabetes, 2) to identify sociodemographic and dis-
ease-related predictors of SMB among persons with diabetes.

Research design and methods
The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female;
56.0% male) with diabetes (type I and II) from the population-based study German Health
Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to dis-
tinguish different patterns of self-management behaviours among persons with diabetes.
The assessment of SMB was based on seven self-reported activities by respondents (die-
tary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-
examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-manage-
ment behaviour.

Results
Latent class analysis suggested a distinction between three patterns of SMB. Based on
modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes
self-management with above-average frequency in all seven indicators of SMB. 32.1%
showed a nonadherent pattern with a below-average commitment in all seven forms of
SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent
with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet
nonadherent with regard to all other forms of SMB. In multivariable regression analyses,
participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage
points), followed by attentiveness towards one’s personal health (31.0 percentage points).
Respondents with a duration of illness of less than 10 years (19.5 percentage points),
employed respondents (7.5 percentage points), as well as respondents with a high socio-
economic status (24.7 percentage points) were more likely to show suboptimal forms of dia-
betes self-management.

Discussion
In the present nationwide population-based study, a large proportion of persons with diabe-
tes showed suboptimal self-management behaviour. Participation in a DSME program was
the strongest predictor of good self-management. Results underline the need for continual
and consistent health education for patients with diabetes.