97 Diabetes Spectrum Volume 23, Number 2, 2010 Abstract Feature Article / Anderson et al. Daren Anderson, MD, Assistant Professor of Medicine, Yale School of Medicine, VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516. Self-Management Goal Setting in a Community Health Center: The Impact of Goal Attainment on Diabetes Outcomes Daren R. Anderson, MD, Joan Christison-Lagay, MAT, MPH, and Elizabeth Procter-Gray, PhD, MPH Self-management education is a cru- cial element of diabetes care. Current diabetes care guidelines recommend that all patients receive self-man- agement education that focuses on behavior change. 1,2 This emphasis on behaviors separates the self-manage- ment approach from more traditional diabetes education programs. In the past, diabetes education has taken a more didactic approach, emphasizing the acquisition of knowledge about diabetes. Although such programs can improve patients’ level of diabetes knowledge, they are less successful at improving diabetes outcomes than programs focused on behaviors. 3 There is growing evidence that self-management emphasizing empowerment, self-efficacy, and spe- cific health behaviors can improve diabetes outcomes. 4–6 Whether delivered in group settings or on an individualized basis, self-manage- ment can improve glycemic control, which over time can prevent or delay serious diabetes-related complica- tions. Among Spanish-speaking patients, diabetes self-management programs designed with language and cultural considerations can improve health status, glycemic con- trol, and health behaviors. 7–9 One unique aspect of self- management is its patient-centered approach to behavior change. Patients are encouraged to choose their own goals and in particular to choose only those goals that they feel they can realistically achieve. It has been suggested that for self-manage- ment goals to be successful, patients Objective. This study sought to eval- uate the details of self-management goal setting in a largely Hispanic population of patients with type 2 diabetes, to evaluate the impact of various factors on goal attainment and to assess the impact of self-man- agement on glycemic control. Setting. The intervention was conducted at Community Health Center, Inc., a large, multisite federally qualified health center in Connecticut caring for an ethnically and racially diverse population of medically underserved patients. Methods. Patients with type 2 diabetes participated in a diabetes self-management program delivered by diabetes educators. We evaluated factors associated with successful goal attainment and the impact of goal setting on glycemic control. Results. During a 3-year period, 488 patients participated in the self- management program and set a total of 2,133 goals. Hispanic patients and those with depression were as successful as others at setting and attaining goals. Goals focusing on medications and healthy eating were more often successfully attained. Successful goal attainment was independently associated with achiev- ing or maintaining an A1C value of < 7.0%. Conclusions. Underserved, largely Spanish-speaking patients success- fully set and attained specific goals, with a preference for those focused on healthy eating and medication taking. This evaluation suggests an association between the successful achievement of individual goals and glycemic control. Downloaded from http://diabetesjournals.org/spectrum/article-pdf/23/2/97/503685/97.pdf by guest on 11 July 2022