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Aims: Understanding the relationship between ethnicity and self-management is important due to disparities in healthcare access, utilization, and outcomes among adults with type 2 diabetes from different ethnic groups in the US., Methods: Self-reports of self-management and interest in improving self-management from US people with diabetes (PWD) in the 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) study, a multinational, multi-stakeholder survey, were analyzed, including 447 non-Hispanic White, 241 African American, 194 Hispanic American, and 173 Chinese American PWD (>18 years)., Results: Overall, self-management behavior was highest for medication taking and lowest for physical activity. Non-Hispanic Whites had lowest physical activity and highest adherence to insulin therapy. Chinese Americans had lowest foot care and highest healthy eating. Overall, interest was highest for improving healthy eating and physical activity. Chinese Americans and Hispanic Americans were more interested than non-Hispanic Whites in improving most self-management behaviors. Chinese Americans were more interested than African Americans in improving most self-management behaviors. Healthcare providers telling PWD that their A1c needs improvement was associated with lower self-rated glucose control, which was associated with higher PWD interest in improving self-management behaviors., Conclusions: Diabetes care providers should use patient-centered approaches and consider ethnicity in tailoring self-management support., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Strategies for management of pre-diabetes within the community setting are needed. An adaptation of the successful Diabetes Prevention Program lifestyle intervention delivered by trained diabetes educators was evaluated. Results indicate that trained diabetes educators offer an important community resource for health care providers for their patients with pre-diabetes., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Purpose: The purpose of this article is to present the results of the process evaluation and patient experience in completing the Diabetes Self-management Assessment Report Tool (D-SMART), an instrument within the AADE Outcome System to assist diabetes educators to assess, facilitate, and track behavior change in the provision of diabetes self-management education (DSME)., Methods: The D-SMART was integrated into computer and telephonic systems at 5 sites within the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) network. Data were obtained from 290 patients with diabetes using the system at these programs via paper-and-pencil questionnaires following baseline D-SMART assessments and electronic system measurement of system performance. Process evaluation included time of completion, understanding content, usability of technology, and satisfaction with the system. Patients were 58% female and 85% Caucasian and had a mean age of 58 years. Fifty-six percent of patients had no more than a high school education, and 78% had Internet access at home., Results: Most patients reported completing the D-SMART at home (78%), in 1 attempt (86%) via the Internet (55%), and in less than 30 minutes. Seventy-six percent believed the questions were easy to understand, and 80% did not need assistance. Age was negatively associated with ease of use. Moreover, 76% of patients believed the D-SMART helped them think about their diabetes, with 67% indicating that it gave the diabetes educator good information about themselves and their diabetes. Most (94%) were satisfied with the D-SMART. Level of satisfaction was independent of the system being used., Conclusions: The D-SMART was easily completed at home in 1 attempt, content was understandable, and patients were generally satisfied with the wording of questions and selection of answers. The D-SMART is easy to use and enhanced communication between the patient and clinician; however, elderly patients may need more assistance. Computer-based and telephonic D-SMARTs appear to be feasible and useful assessment methods for diabetes educators.

Purpose: The purpose of this article is to ascertain patients' self-identified and mutually identified or agreed on (working with diabetes educators) behavior change goals and examine the diabetes educators' response to these goals during the provision of diabetes self-management education., Methods: The American Association of Diabetes Educators Outcome System was integrated into Web-based, touch-screen, and telephonic systems within 8 sites within the Pittsburgh Regional Initiative for Diabetes Education network. Data from patients and their diabetes educators were obtained from the Diabetes Self-management Assessment Report Tool (D-SMART) and Diabetes Educator Tool (D-ET)., Results: Nine hundred fifty-four individuals with diabetes (type 1 and type 2) using the D-SMART self-identified healthy eating (74%) and being active (54%) as the most common behavior change goals. From that sample, 527 patients identified goals that were mutually identified or agreed on with their diabetes educator: healthy eating (94%), being active (59%), monitoring (49%), taking medication (26%), reducing risks (19%), problem solving (18%), and healthy coping (18%)., Conclusion: The most common behavior change goals identified by patients (self-identified or mutually identified with their diabetes educator) were healthy eating and being active. The behavior change goal least addressed by patients and educators alike was healthy coping. Mutually identified goals among educators and patients may improve targeted appropriate educational strategies to support patients in meeting their goals.

Objective: To determine the use of psychosocial strategies by health care providers in treating patients with diabetes and the factors associated with use of these strategies., Research Design and Methods: Cross-sectional survey of national samples of generalist and diabetes specialist physicians (n = 2,705) and nurses (n = 1,122) from the multinational study of Diabetes Attitudes, Wishes and Needs. Respondents were from 13 countries in Asia, Australia, Europe, and North America. Two psychosocial strategies were examined: provider psychosocial care, which provides psychosocial support by diabetes care providers to their own patients, and psychosocial specialist care, which refers diabetic patients to psychosocial specialists., Results: Compared with physicians, nurses perceived significantly higher prevalence and severity of psychosocial problems and used psychosocial strategies significantly more frequently, even though they rated their own psychosocial skills lower. Among both physicians and nurses, diabetes specialists were significantly more likely than generalists to utilize psychosocial strategies. Physicians and nurses used psychosocial strategies significantly more when they believed that more patients have psychosocial problems and that problems interfere more with diabetes control. Referral to psychosocial specialists was significantly more likely when physicians and nurses perceived that professional psychological resources were more available. There were substantial country differences in all factors studied. Compared with other countries, U.S. providers provided more psychosocial care themselves but were less likely to refer to psychosocial specialists., Conclusions: Psychosocial strategies are important parts of the diabetes care provider repertoire; understanding their determinants may facilitate efforts to increase their use.

Diabetes mellitus has been cited by the current Secretary of Health and Human Services, Donna Shalala, as one of the most serious health problems in the African American population. This article provides background on the incidence and causes of diabetes in Blacks, reviews the problems African Americans face in the prevention and treatment of the disease, and describes the American Diabetes Association's African American program which was developed to respond to these problems. The program's overall goal is to improve the health of African Americans by raising their awareness about diabetes, its risk factors, and ways to avoid or delay the onset of the disease and its complications. This article includes discussion on how these goals will be pursued through a coordinated strategy in three key areas: coalition building, advocacy efforts, and grass roots programs.