Type 1 diabetes (T1D) is a serious auto-immune disease with a global prevalence of 5-7%, affecting around 9 million people in the occidental world in 2021. Living with diabetes is a complex task that requires the acquisition of many skills, appropriate self-care and psychological support. Appropriate Diabetes Self-Management (DSM) is a complex task to sustain and a minority of PwT1D remains free of T1D related complications.
Structured DSM education and support (DSMES) interventions have demonstrated strong benefits for PwT1D that include improvement in 1) general knowledges 2) know-how about insulin and technology use 3) quality of life 4) self-care 5) emotion regulation and 6) problem solving. Most importantly, participation to DSMES programs is associated with improved clinical and biological outcomes and a decreased morbidity, however less than 10% of PwT1D attend a structure DSMES program and their implementation remains insufficient.
The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework including the evolution to Pragmatic Robust Implementation and Sustainability Model (PRISM) are effective to address multi-levels contexts like reduced availability and access to DSMES programs for T1D.
The aim of this present narrative review is to analyze the literature about existing validated DSMES interventions and programs for adult PwT1D using the RE-AIM framework and develop an implementation guidance in order to assess existing issues (dissemination and accessibility) and the potential of digital DSMES programs.
The literature confirms that structured group-based DSME programs combined with appropriate use of diabetes and technology, are effective in reducing HbA1c level, the frequency and severity of hypoglycemia, and diabetes related distress. There are few programs available, and only a few countries have managed to implement structured DSMES programs on a national scale. The curriculum is somewhat outdated and need to better integrate recent advances in technology, such as automated insulin delivery systems. Learning theories need to take into account the existence of a bidirectional interplay between affective states and cognitive skills.
Given the numerous and multifaceted barriers to implement DSMES programs in routine care, their digitalization seems very appealing to promote their access and attendance. The use of the RE-AIM + PRISM frameworks is relevant to develop a guidance addressing issues related to the implementation of DSMES programs, regardless of the mode of delivery (digital or in person). Further research in science implementation is needed to confirm the potential of digital DSMES programs.
