Better Self-Management of Diabetes

Type 2 diabetes affects almost 10 percent of Missourians, a figure more than 30 percent higher than the national average. The prevalence of diabetes is 17 percent higher in rural communities than in cities. Rural residents with diabetes are more likely to be elderly, poor, have multiple chronic conditions, and worse health status. They may have difficulty accessing appropriate care due to lower physician availability and longer travel distances and time. In addition to medical care, management of type 2 diabetes requires sustained lifestyle modifications - diet, physical activity and complex medication regimens - that are critical to maintain disease control and improve cardiovascular health.

Traditional diabetes education has emphasized disease knowledge and technical skills, but has demonstrated limited success in changing health behaviors and outcomes; however, teaching patients disease-related self-management skills increases their confidence to take action regarding their disease and improves health outcomes.

This program implements a clinically rigorous, community-based medical practice-community partnership intervention to improve diabetes self-management in rural Missouri. We will mobilize diabetic patients, their families, neighbors and health care providers to work together, especially targeting our efforts for those who are uninsured or underinsured.

Our vision is to systematically link energetic patients, physicians and community leaders in two rural Missouri counties (Howard and Callaway) with the resources of the University of Missouri (MU) to develop and test a sustainable self-management model potentially replicable in other communities in the Midwest and nationally. The intervention will include a three-component program to improve diabetes self-management and implement evidence-based care by:

1. Developing and implementing a strategic plan for diabetes self-management using community partnerships in each county;
2. Training community members with type 2 diabetes to lead self-management support groups; and
3. Helping practices develop an enhanced care model to support self-management among patients with diabetes.

The enhanced care model will include patient registries and use nurses to coordinate evidence-based care with patients (e.g., identify the need for an annual eye examination and contacting the patient to arrange this). We will develop this program in two mid-Missouri rural counties (Howard and Callaway). We are requesting a total budget of $1.3 million. We will serve an estimated 10,392 individuals, for an average cost per person served of $124 ($42/year).

For more information, contact:
Joseph LeMaster, MD, MPH

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