Examining patient risk factors, comorbid conditions, participation, and physician referrals to a rural diabetes self-management education program

Diabetes Educ. Jul-Aug 2010;36(4):603-12. doi: 10.1177/0145721710369705. Epub 2010 May 17.


Purpose: The purpose of this study was to examine patients' diabetes risk factors, comorbid conditions, and patient participation in and primary care practitioner (PCP) referrals to a rural diabetes self-management education (DSME) program.

Methods: A total of 295 patients in a rural community were identified by their PCP as having type 2 diabetes (T2D). Using patient information that was collected and entered into a diabetes data management system, patients' risk factors, comorbid conditions, and patient participation in and PCP referral patterns to a DSME program were examined.

Results: Of the 295 patients with T2D, 162 (65%) reported that they had never received any DSME services. Despite educator efforts to improve patient participation and PCP awareness of local DSME services, 123 (76%) of the 162 patients never received a subsequent referral for DSME. Those patients who did receive a referral had a higher number of risk factors and comorbid conditions than those who did not receive a referral. Eighty-three percent of the patients who received a PCP referral attended the DSME program.

Conclusions: The findings reaffirm concerns that DSME patient participation and PCP referral practices are poor. Advocacy efforts should force policies and procedures that will make DSME a mandatory service and universally accessible. Unless referral practices are attended to, it is doubtful that the United States will reach the Healthy People 2010 objective for diabetes education.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Comorbidity
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / rehabilitation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic*
  • Pennsylvania
  • Referral and Consultation
  • Risk Factors
  • Rural Health
  • Self Care*
  • Societies, Medical