Matthew Moore: A study from the University of Arkansas for Medical Sciences shows that providing a telehealth option for diabetes education can significantly improve outcomes for those with Type 2 diabetes. The study also compares two different models of diabetes self-management education and support programs, or DSMES. The standard model is individual-based, while the other is family-based.
Jennifer Andersen is an assistant professor at UAMS's Institute for Community Health Innovation based in northwest Arkansas, as well as someone with Type 1 diabetes. She says the typical procedure is that once a person is diagnosed with diabetes, they will go to their doctor's office to receive their DSMES.
Jennifer Andersen: Which makes it so that you have to drive somewhere to go get that education. This study is different because we administered DSME, so diabetes self-management education and support, via telehealth in two different models. We did our standard DSME, which is just the person themselves going to classes, in this case online, and learning the material that way. The other way that we did this was through family DSME. So that is the person with diabetes and a family member of their choosing who go to the class together. So both people are getting that education. Both folks are setting the goals for what they are going to do to help manage the person with diabetes's blood sugar. So that's a little different both in the fact that it's telehealth-delivered, which means you don't have to drive anywhere. And also because a portion of the participants had that family member support in the classroom.
Moore: Why was that important?
Andersen: So if you think about it, when one person in the household is diagnosed with diabetes, they need to make certain changes to their lifestyle. So things like eating more whole foods, eating less processed sugar, increasing their activity levels to be able to help get that blood glucose, the blood sugar, back under control. When you are the only person in the household who's doing that, it can be really hard for other people to understand what you are experiencing and why. Being able to bring a family member into that situation, so they are getting the knowledge and learning how that works too, has the ability — which our study ended up showing — to increase helpful behavior on the family member's part. So being able to have a family member do things like help fix healthier meals, hang out with the kids while you go out for a walk or walking with the person with diabetes, things like that. So it's an interesting piece that you don't get in that standard diabetes education.
Moore: I feel like an element of this is indirectly helping to create empathy for people in your life in this way, too.
Andersen: Indirectly, yeah. I mean, it is one of those things where if you just don't know what you don't know. So being able to have family members learn alongside the person with diabetes is a great way of being able to do that.
Moore: In the study, you talk about some elements — there are ways that there can be some harmful family behaviors, ways that perhaps someone who is ignorant or doesn't understand the way that their behaviors can affect someone with diabetes. Do you have some examples of that, or ways that people can be mindful of their family members who have diabetes?
Andersen: I mean, I will even give you kind of a personal anecdote just because I have seen it. In a situation where, say, there is a birthday party and there are cupcakes there and somebody says, "It's OK, it's one time, you can have that cupcake." But you know, you're walking into that room knowing that your glucose is high that day, or you're just not sure that it's something that you want to eat, because people have that agency to make those choices. Having that pressure can feel very negative, and a lot of times the family member doesn't necessarily recognize that as harmful, whereas the person can feel like that's a lot of pressure to do something that maybe they feel is not right for them at that time.
Moore: A big element of this is the telehealth portion of the education. Obviously, there's some great attributes to it — the fact that you don't have to drive 30 minutes one way to go to a doctor's office to get this sort of education, to get this sort of help. But one struggle that happens oftentimes with rural parts of Arkansas is reliable internet and being able to access telehealth in a way that, if you're doing a video conference, are you going to have enough bandwidth to be able to pull that off? How have you seen that challenge play out in your research?
Andersen: We actually, when we decided to do this, we made it a point to ensure that people had access to internet-capable devices and internet if they needed it. And a lot of times, that is cellular. I do know there are certain parts of Arkansas where getting cell service is really hard. We did not note that near as much. But there always will be a certain percentage of participants where this may not necessarily be feasible without some additional assistance in getting access to internet or internet-capable devices.
Moore: I don't know if your study found any data related to this, but I'm curious if this sort of family-oriented education process is potentially helping those who may be predisposed to Type 2 diabetes — who may be on the cusp of being pre-diabetic themselves — and these sorts of this education and this changing of a lifestyle in a familial setting is helping to keep them healthier, too.
Andersen: Those results are not published yet, but it is very promising. So we are seeing that there are signals there that the family DSMES, because we know that Type 2 diabetes has some genetic components, right? So if one person in the household has it, it's likely that somebody else within the household may develop it at some point if they don't already have it. So having that family member there and giving them the skills, possibly before they are even pre-diabetic or have been diagnosed as having diabetes, is something that is really important to be able to have that come across.
Moore: We've talked about the demographic group of rural people. When we think about another demographic style of people, we think of maybe the Marshallese community or the Hispanic/Latino community here in northwest Arkansas. Are we seeing similar results regardless of race or ethnicity?
Andersen: We are seeing similar results. One thing I will note is that the family DSMES actually came out of work that we did with the Marshallese community, where the family DSMES, because of the cultural significance of family within the Marshallese community, it actually works sometimes even a little bit better because there is that family component and people are able to work together.
Moore: So the study has been published. What's next? How do you anticipate things looking different or changing in the work that happens in this world?
Andersen: So what we would like to see next — because one of the concerns that has happened, because this was one of the first studies that ever looked at telehealth and compared standard DSME and family DSME, and we were able to show that the two programs operate similarly. We're able to do it within the accreditation that's required for DSME programs. It had high fidelity, meaning that both programs were done well within approximately the same time periods. Is being able to see both standard and family DSME programs be covered by insurance. And being able to see the use of telehealth expand in this area so that we can get the services to people where they are, where they need them, without having to add the extra burden of having to travel to the nearest city center to be able to get that care.
Moore: Jennifer Andersen is an assistant professor at UAMS with the Institute for Community Health Innovation. We spoke over Zoom last week.
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