Referrals and utilization of diabetes self-management education and support (DSMES) among patients with type 1 and type 2 diabetes at a regional medical center in Kentucky

BACKGROUND: The goal of this study was to examine referral and attendance patterns for diabetes self-management education and support (DSMES) among patients with both type 1 (T1D) and type 2 diabetes (T2D) at a regional medical center in Kentucky, and to identify demographic and clinical factors associated with these outcomes. METHODS: We analyzed electronic health records of adults with diabetes (n = 10,587; n = 817 with T1D and n = 9,770 with T2D) who received care from 1/1/2016-12/31/2019 at University of Kentucky HealthCare. We compared DSMES referral and attendance rates by various demographic and clinical factors and used logistic regression models to examine the association between these factors and DSMES referrals/attendance. RESULTS: DSMES referrals were made for 6.9% (n = 726) of our sample, and 40.2% (n = 292) of those referred attended DSMES. Referral rates were 11.6% for T1D and 6.5% for T2D. Attendance rates were 41.1% for T1D and 40.1% for T2D. Referrals was more common among females (OR 1.67, 95% CI 1.42-1.96), non-Hispanic Black and Hispanic individuals (OR 1.36, 95% CI 1.12-1.65 and OR 1.56, 95% CI 1.03-2.35), and less common among those aged 65+ (OR 0.31, 95% CI 0.20-0.48), those with public insurance (OR 0.75, 95% CI 0.63-0.88), and rural residents (OR 0.48, 95% CI 0.40-0.57). Patients with obesity (OR 1.42, 95% CI 1.18-1.71) and ≥ 9% A1C (OR 2.35, 95% CI 1.65-3.34) were also more likely to be referred. No factors were associated with DSMES attendance. CONCLUSIONS: Despite clear guidelines recommending DSMES referrals for patients with diabetes, DSMES referral rates were low, and less than half of patients who were referred ultimately attended DSMES. Variation in referral rates across demographic and clinical characteristics highlights opportunities to improve and standardize referral processes.