Community-based diabetes self-management and support program: addressing quality of life and social vulnerability

In the United States, 38.4 million people have been diagnosed with diabetes, and it continues to rise. The increasing rate of diabetes has become a significant public health challenge due, in part, to the association between diabetes and decreased levels of physical and emotional well-being. Currently, there are few assessments of the impact of diabetes self-management programs on individuals with diabetes quality of life and social vulnerability. This study examined pre- to post-program quality of life outcomes for participants in a community-based diabetes-self management and support (DSMS) program and assessed the association between the change in quality of life pre- to post-program and social vulnerability.

Health Extension for Diabetes (HED) is a 4-month, community-based DSMS program delivered in the Southeast region of the United States. HED includes standardized education and personalized support to help participants manage their diabetes. The 12-Item Short Form Health Survey (SF-12) was utilized to assess participants' physical and mental quality of life pre- and post-program participation. The Centers for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) was used to determine individuals' social vulnerability level (low: 0-0.25, low-to-moderate: 0.2501-0.5, moderate-to-high: 0.501-0.75, high: 0.7501-1.0). Wilcoxon sign-ranked tests assessed changes in SF-12 pre- and post-HED and linear regressions examined the association between quality of life and social vulnerability level.

SF-12 scores indicated significant positive changes in physical and mental quality of life for all program participants (N = 1,006). All SVI subgroups were observed to have significant improvements in physical health scores. Individuals with moderate-to-high and high SVI scores showed significant improvement in mental health scores, while individuals with low and low-to-moderate SVI scores did not.

Participants of the community-based diabetes self-management and support program experienced improvements in quality of life across varying levels of social vulnerability, as measured by the SVI. While integrating upstream social determinants of health considerations into DSMS program design and delivery addresses health disparities, future research should consider the implementation of more general mental health resources to address the psychological burden associated with living with chronic disease.