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Text-Messaging to Support Diabetes Self-Management in a Rural Health Clinic: A Quality Improvement Project

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Clinical Issue

The prevalence of diabetes mellitus has more than doubled over the past 30 years nationwide (Centers for Disease Control and Prevention [CDC], 2014). In fact, diabetes afflicts 29.1 million Americans and contributes to the death of more than 200,000 individuals annually (CDC, 2014). As of 2012, the national prevalence of diabetes was 9% (South Carolina Department of Health and Environmental Control [SCDHEC], 2014) and 1.4 million Americans are diagnosed with diabetes annually. Diabetes is the seventh leading cause of death in the U.S. and is the underlying cause of many co-morbid conditions and complications (CDC, 2014). Consequently, primary care offices are inundated with an ever-expanding population of patients with diabetes who have multiple comorbid conditions and, often, one or more vascular complications.

In 2010, the hospitalization rates for strokes were 1.5 times higher in adults with diabetes than in non-diabetic adults; additionally, diabetes was cited as the primary cause in 44% of new cases of renal failure (CDC, 2014). Moreover, disease management costs an average of $245 billion each year secondary to microvascular and macrovascular complications, including stroke, myocardial infarction, diabetic retinopathy, kidney disease, and amputations, to list a few (CDC, 2014). Notably, the statistics support that current interventions are limited as evidenced by the increase in disease prevalence and associated conditions.

Diabetes is a chronic disease that requires lifelong treatment extending beyond medicinal therapy. Ongoing patient self-management and support are required to thwart or decrease diabetes associated complications and must be initiated immediately upon diagnosis. Diabetes self-management education (DSME) is an evidence-based standard and is defined as the ongoing process to improve the knowledge, skills, and ability essential for diabetes self-management (American Diabetes Association [ADA], 2014). The goal of DSME is to promote active participation in disease management through education, behavior modification, and active collaboration with healthcare personnel...