Factors Influencing Patient Completion of Diabetes Self-Management Education

Abstract

Achievement of high participation rates in research trials of diabetes self-management education (DMSE) is a major challenge. Subjects may initially agree to participate but then fail to attend the assigned educational sessions, or they may attend the sessions only sporadically. From a research perspective, if consented subjects are not exposed to the educational intervention, they do not benefit, which in turn reduces the ability to demonstrate a positive effect.1 DMSE programs are usually limited to only a small number of sessions, each covering a distinct topic or task, with a logical progression to the next session. Individuals who fail to attend even a single session are unlikely to achieve the full benefits. Furthermore, non-attendance raises questions about the generalizability of a DSME trial's results to clinical populations.2,3 The issue of nonattendance extends beyond research studies to clinical diabetes education programs in health care systems. Knowledge of factors influencing DSME attendance is limited and often conflicting.4–6 Characteristics reported to be associated with missed clinic appointments in general include full-time work, younger age, non-white ethnicity, smoking, elevated blood pressure, and elevated initial A1C levels. Better understanding of factors influencing completion of DSME in research trials could also carry over into the clinical setting, enabling implementation of interventions that attain better adherence to DSME. This study evaluated subject characteristics associated with non-completion of group and individual DSME interventions, using data from an established clinical trial of diabetes education called Journey for Control of Diabetes: The IDEA (Interactive Dialogue to Educate and Activate). This trial afforded the opportunity to evaluate factors that affected attendance at scheduled group and individual DSME sessions in research study participants with type 2 diabetes of longstanding duration in suboptimal glycemic control. ### Study context The IDEA study was a behavioral intervention to evaluate diabetes outcomes …