45% of the 25.6 million adults with type 2 diabetes have inadequate glycemic control. Racial and ethnic minorities and individuals living in poverty having the highest rates of inadequate glycemic control. Every year, poorly controlled diabetes is responsible for $58 billion in medical expenditures to treat diabetes related chronic complications, 691,000 hospitalizations averaging 5 days, 10.6 million emergency department visits, and 901,000 disability adjusted life years lost. Increasingly, individuals with diabetes hae access to diabetes self-management education through various mediums (primary care setting, group class, internet, telephone). Experimental studies have shown diabetes self-management education to be associated with improvements in glycemic control. However, the extent of access to diabetes self-management education and its impact on diabetes related outcomes in usual practice is largely unknown. It is unclear whether differential access to diabetes self-management education contributes to socioeconomic disparities in glycemic control. Furthermore, is not known whether diabetes self-management education actually changes patterns of health care utilization, medical expenditures, or health related quality of life in usul practice. Therefore, using the Medical Expenditure Panel Survey and the National Health Interview Survey, the specific aims of this research are: 1) To describe the socioeconomic determinants of receipt of any diabetes self-management education 2) To quantify the association of any recent diabetes self-management education on changes in diabetes related health care utilization and medical expenditures over a 12 month period 3) To quantify the association of diabetes self-management education with changes in health related quality of life. Multivariable logistic regression and two part models will be utilized. Ultimately, this research wll discover whether diabetes self- management education is associated with reduced health care utilization, reduced medical expenditures, and improvements in health related quality of life. This study is directly in line with the AHRQ research portfolio areas of interest including care management, patient-centered outcomes, and health information technology and focuses on AHRQ priority populations including low-income and minority individuals. This research will be carried out under the context of (a) a highly motivated MD-PhD applicant who has demonstrated excellence in the pursuit of a degree in the academically rigorous, multidisciplinary field of Population Health Sciences (b) exceptional research training and mentoring by Dr. Elizabeth Jacobs, Dr. John Mullahy, Dr. Maureen Smith, and other members of the dissertation committee (c) a world-class institutional environment.

Public Health Relevance

A large proportion of adults with type 2 diabetes do not have adequate control of their condition. This can have devastating individual consequences as well as consequences to the US health care system. This proposal aims to understand the association between receiving diabetes self-management education and important diabetic outcomes (use of health services, cost of health services, and health related quality of life) in adults with type 2 diabetes.

National Institute of Health (NIH)
Dissertation Award (R36)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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University of Wisconsin Madison
Public Health & Prev Medicine
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United States
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