title: One-Year Outcomes of Diabetes Self-Management Training Among Medicare Beneficiaries Newly Diagnosed With Diabetes.
abstract: BACKGROUND
  Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes.
  
  
  OBJECTIVE
  Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown.
  
  
  METHODS
  Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis.
  
  
  METHODS
  Twenty percent random sample of Medicare beneficiaries newly diagnosed with diabetes during 2009-2011 who used DSMT (N=14,680), matched to a nonuser comparison group.
  
  
  METHODS
  We compared health service utilization and costs between DSMT users and nonusers. Health service utilization included any utilization of the hospital or emergency department (ED) and any hospitalizations due to diabetes-related ambulatory care sensitive conditions as well as the number of hospitalizations and ED visits within the follow-up year. Costs included all Medicare Parts A and B expenditures.
  
  
  RESULTS
  Multivariate regression results found that DSMT users had 14% reduced odds of any hospitalization, lower numbers of hospitalizations and ED visits (approximately 3 fewer per 100 for each), and approximately $830 lower Medicare expenditures (95% CI, -$1198, -$470) compared with nonusers. Odds of any hospitalization due to diabetes-related ambulatory care sensitive conditions and any ED visit were lower for DSMT users compared with nonusers, but the reductions were not statistically significant.
  
  
  CONCLUSIONS
  Findings demonstrate benefits from DSMT use, including lower health service utilization and costs. The low cost of DSMT relative to the reduction in Medicare expenditures highlights an opportunity to reduce the burden of diabetes on both individuals and the health care system.
authors.affiliation: *Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services †Retired from Centers for Medicare & Medicaid Services, Baltimore, MD ‡CVS/Caremark, Cumberland, RI.
authors.forename: Larisa M
authors.initials: LM
authors.lastname: Strawbridge
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Lloyd
authors.forename: Ann
authors.initials: A
authors.lastname: Meadow
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Riley
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Howell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D012648:Self Care; D014481:United States