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Program Reinforcement Impacts Self Management (PRISM) (PRISM)

This study has been completed.
Penn State University
Information provided by (Responsible Party):
Linda Siminerio, University of Pittsburgh Identifier:
First received: April 19, 2011
Last updated: March 6, 2017
Last verified: March 2017
Patients who receive DSME (Diabetes Self Management Education) will be enrolled in a 4 arm, randomized study with each group receiving a different method of follow up. The 4 arms will be evaluated based on clinical indicators, goal achievement and patient satisfaction.

Condition Intervention
Diabetes Mellitus
Behavioral: Office Staff Support
Behavioral: Peer Support
Behavioral: Usual Care Support
Behavioral: Educator Support

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Supportive Care
Official Title: Program Reinforcement Impacts Self Management

Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Hemoglobin A1C (HbA1C, %) [ Time Frame: 6 months ]

Secondary Outcome Measures:
  • Total Cholesterol (mg/dL) [ Time Frame: 6 months ]
  • High Density Lipoprotein (HDL, mg/dL) [ Time Frame: 6 months ]
  • Low Density Lipoprotein (LDL, mg/dL) [ Time Frame: 6 months ]
  • Change in Diabetes Empowerment Scale- Short Form (DES-SF) Scores [ Time Frame: 6 months ]

    The DES-SF is a validated, 8 item scale that measures the self-efficacy of patients with diabetes. Responses are selected from a 5-point Likert scale (Strongly Disagree (1), Somewhat Disagree (2), Neutral (3), Somewhat Agree (4), Strongly Agree (5)). The scale is scored by averaging the scores of all completed items (sum of scores divided by 8).

    A positive number represents an improvement in overall patient self-efficacy (empowerment) from the baseline score and 6 month follow up time point.

  • Body Mass Index [ Time Frame: 6 months ]
    Body Mass Index is a weight-to-height ratio, calculated by dividing one's weight in kilograms by the square of one's height in meters and used as an indicator of obesity and underweight.

  • Diastolic Blood Pressure [ Time Frame: 6 months ]
    Diastolic blood pressure is the pressure when the heart is at rest between beats.

  • Systolic Blood Pressure [ Time Frame: 6 months ]
    Systolic blood pressure is the pressure when the heart beats while pumping blood.

Enrollment: 141
Study Start Date: April 2011
Study Completion Date: October 2013
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Office Staff follow up education
A designee in the office staff shall be assigned to follow up with the patient for goal attainment. The office staff will call patients monthly to monitor goal attainment. It will be suggested that they phone the participant monthly but researchers will observe how and if they provide follow up.
Behavioral: Office Staff Support
Office staff of primary care practices trained to provide diabetes support were tasked to follow up with patients via phone following completion of diabetes self-management education.
Peer follow up education
A person with diabetes trained as a "peer" shall meet the participant at their 6 week follow up visit and then call the participant monthly to monitor goal attainment.
Behavioral: Peer Support
Community peers trained to provide diabetes support were tasked to follow up with patients via phone following completion of diabetes self-management education.
Usual Care
ADA Recognition maintains the standard that a follow up to diabetes education must occur from 3-6 month post education. This one phone call will be made by the diabetes educator.
Behavioral: Usual Care Support
Diabetes educators provided patient follow up support according to traditional clinical guidelines following completion of diabetes self-management.
Educator support follow up
A diabetes educator will provide follow up support and make monthly call to the patient to ascertain goal attainment.
Behavioral: Educator Support
Diabetes educators provided patient follow up support that was problem-focused and patient centered.

Detailed Description:
As the diabetes burden worsens, the need for people to become more involved in self-management will increase. Research has demonstrated that diabetes self-management education (DSME) can improve HbA1C levels by 0.76%. While the rates of diabetes are increasing, the numbers of educators available are shrinking. This is a particular hardship in underserved and military communities where the supply of health care providers is already scarce. Our investigative team has led efforts in supporting DSME in the PA state-wide deployment of the Chronic Care Model (CCM) and reported findings nationally on innovative ways to increase the pool of education services by integrating educators into primary care, establishing nurse clinics in underserved communities and demonstrating that an educator position could be sustained by reimbursement. A 0.76% reduction associated to DSME can be considered an enormous benefit and is equivalent to the impact of most pharmacologic treatments for diabetes. Unfortunately, however the benefits of DSME decrease over time. This suggests that sustained improvements require contact and follow-up. SMS is defined as the process of ongoing support of patient self-care, to sustain the gains following DSME. There is often confusion among the terms self-management education (DSME) and self-management support (SMS). DSME is associated with the provision of knowledge and skills training delivered by a health care professional, e.g. nurses, dietitians, etc. SMS is defined as the process of making and refining changes in health care systems (and the community) to support patient self-care and maintain the gains made following DSME. We know that SMS is currently provided by diabetes educators, but only one 3-6 month follow up is usual care. It has been suggested that SMS can be provided by community workers, peers with diabetes, and office staff within community sites, like PCP offices, and wellness centers, etc. The National Standards for DSME and American Diabetes Association (ADA) Education Recognition Program (ERP) require that SMS approaches be delivered and documented, yet no evidence has been provided to define who should deliver it and how often. This uncertainty has led to many programs delivering SMS in an unstructured, non-standardized and at times haphazard fashion. Practical approaches designed for providing SMS have the potential to sustain improvements. The objective of this study is to compare Self-Management Support (SMS) interventions following Diabetes Self-Management Education (DSME) and determine which will be more likely to maintain improvements in behavioral and clinical outcomes following DSME while achieving patient satisfaction.

Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • A person with diabetes referred for diabetes education

Exclusion Criteria:

  • Gestational diabetes and pregnancy
  • If a person has recently had diabetes education, they will not be enrolled in the study
  Contacts and Locations
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Please refer to this study by its identifier: NCT01343056

United States, Pennsylvania
Pennsylvania State University
Hershey, Pennsylvania, United States, 17033
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States, 15213
Sponsors and Collaborators
University of Pittsburgh
Penn State University
Principal Investigator: Linda Siminerio, RN, PhD, CDE University of Pittsburgh
Principal Investigator: Robert Gabbay, MD, PhD Penn State University
  More Information

Responsible Party: Linda Siminerio, Linda Siminerio, RN, PhD, CDE, Executive Director, University of Pittsburgh Identifier: NCT01343056     History of Changes
Other Study ID Numbers: PRO10090392
Study First Received: April 19, 2011
Results First Received: December 7, 2015
Last Updated: March 6, 2017

Keywords provided by University of Pittsburgh:
Diabetes Self Management Education (DSME)
Self Management Support (SMS)

Additional relevant MeSH terms:
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases processed this record on May 25, 2017