Health outcomes of a diabetes supply and diabetes self-management education program in an at-risk population
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The purpose of this quasi-experimental, pretest-posttest design study was to determine if providing diabetes supplies and diabetes self-management education to uninsured or underinsured diabetics improved health outcomes. Health outcomes included diabetes self-management skills and serum fructosamine. Self-management skills were measured with a Likert scale. Serum fructosamine was measured with a capillary blood sample analyzed in the Duet™ Glucose monitor. The study used a convenience sample of uninsured or underinsured Type 1 and Type 2 diabetics with serum fructosamine levels greater than 310 umol/liter. The sample size of twenty was determined by power analysis. Twenty-five participants were enrolled from May 1999 through May 2000, and twenty completed the study. The setting was a nonprofit community agency in a large southern metropolitan area. Participants met individually with the researcher every two weeks for four sessions. A fifth session was held one month after session four. At each session a module of the "I'm in Control" diabetes education program (Oklahoma State Department of Health, 1997) was reviewed, and participants were given insulin and diabetic supplies. Data were collected at the first and fifth session. A dependent! test (one-tailed, a= .05) was used to compare the means of the pretest-posttest serum fructosamine levels. Data analysis revealed a statistically significant difference between the pretest-posttest scores(!= -4.199, df= 19,12 = .000). Scores decreased an average of 95 umol/liter. The first hypothesis (At-risk persons with diabetes will have lower mean glucose levels following participation in a diabetes supply and diabetes self-management program.) was supported. The means of the pretest-posttest self-management skills inventory were analyzed with a dependent 1 test (one-tailed, a= .05). There was a statistically significant difference in the pretest-posttest scores (1 = 6.43, df= 19, 12 =.000). The second hypothesis (At-risk persons with diabetes will have improved diabetes self-management skills following participation in a diabetes supply and diabetes self-management program.) was supported. Findings suggest that an individualized program for uninsured or underinsured diabetics improves self-management skills and lowers mean glucose levels. Eliminating the financial barrier in this population facilitated "personal readiness" to learn and implement self-management skills.