Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial

Mary E. Lacy; Jessica Elliott; Vance Drakeford; Laura Wright; Brent McKune; Key C. Douthitt; Aaron J. Kruse-Diehr; James W. Keck

doi:10.1177/21501319261428883

Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial

Mary E. Lacy
, Jessica Elliott
, Vance Drakeford
, Laura Wright
, Brent McKune
, Key C. Douthitt
, Aaron J. Kruse-Diehr
, James W. Keck

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Diabetes self-management education and support (DSMES) is an evidence-based intervention that improves outcomes for people with diabetes, but uptake is <10%. We conducted a pilot pragmatic trial to increase DSMES in rural primary care clinics that integrated health information technology with a quality improvement (QI) learning collaborative. Methods: Two healthcare systems from rural Kentucky participated in the study. Within each system, 2 clinics received the intervention and 1 clinic served as a control (N = 6 clinics). Each intervention clinic identified a QI team (5-6 individuals) who participated in a 9-month QI learning collaborative followed by 5 months of follow-up. Our primary outcome was DSMES referrals; secondary outcomes were DSMES attendance and percentage with A1c >9%. Results: The 6 study clinics served 1,803 patients with diabetes; n = 1083 (60.1%) from 4 intervention clinics and n = 720 (39.9%) from 2 control clinics. DSMES referrals significantly increased in the intervention clinics compared to the control clinics (31.7% vs 0.1%, P < .001) and continued to increase throughout 5-month follow-up (40.0% vs 0.1%, P < .001). Conclusions: A structured QI intervention can significantly increase DSMES referral rates in primary care clinics. Findings highlight the potential of systems-level approaches to address persistent gaps in diabetes care delivery in rural settings. Clinical Trial Registry: Using Practice Facilitation and Operationalizing Referral Information Technology to Increase DSMES Utilization (Clinicaltrials.gov registration number no. NCT05472142). Clinicaltrials.gov URL (https://clinicaltrials.gov/study/NCT05472142).

Original language	English
Journal	Journal of Primary Care and Community Health
Volume	17
DOIs	https://doi.org/10.1177/21501319261428883
State	Published - Jan 1 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by funding from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, through grant R34DK132548. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We would like to acknowledge the Kentucky Department for Public Health’s Diabetes Prevention and Control Program (KDPCP) for their work leading the Diabetes Learning Collaboratives. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by funding from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, through grant R34DK132548. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funders	Funder number
National Institute of Diabetes and Digestive and Kidney Diseases
Diabetes Learning Collaboratives
Department for Public Health, Cabinet for Health and Family Services
National Institutes of Health (NIH)	R34DK132548

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

diabetes mellitus
diabetes self-management education and support (DSMES)
primary care
quality improvement
rural health

ASJC Scopus subject areas

Community and Home Care
Public Health, Environmental and Occupational Health

Access to Document

10.1177/21501319261428883

Cite this

Lacy, M. E., Elliott, J., Drakeford, V., Wright, L., McKune, B., Douthitt, K. C., Kruse-Diehr, A. J., & Keck, J. W. (2026). Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial. Journal of Primary Care and Community Health, 17. https://doi.org/10.1177/21501319261428883

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title = "Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial",

abstract = "Background: Diabetes self-management education and support (DSMES) is an evidence-based intervention that improves outcomes for people with diabetes, but uptake is <10\%. We conducted a pilot pragmatic trial to increase DSMES in rural primary care clinics that integrated health information technology with a quality improvement (QI) learning collaborative. Methods: Two healthcare systems from rural Kentucky participated in the study. Within each system, 2 clinics received the intervention and 1 clinic served as a control (N = 6 clinics). Each intervention clinic identified a QI team (5-6 individuals) who participated in a 9-month QI learning collaborative followed by 5 months of follow-up. Our primary outcome was DSMES referrals; secondary outcomes were DSMES attendance and percentage with A1c >9\%. Results: The 6 study clinics served 1,803 patients with diabetes; n = 1083 (60.1\%) from 4 intervention clinics and n = 720 (39.9\%) from 2 control clinics. DSMES referrals significantly increased in the intervention clinics compared to the control clinics (31.7\% vs 0.1\%, P < .001) and continued to increase throughout 5-month follow-up (40.0\% vs 0.1\%, P < .001). Conclusions: A structured QI intervention can significantly increase DSMES referral rates in primary care clinics. Findings highlight the potential of systems-level approaches to address persistent gaps in diabetes care delivery in rural settings. Clinical Trial Registry: Using Practice Facilitation and Operationalizing Referral Information Technology to Increase DSMES Utilization (Clinicaltrials.gov registration number no. NCT05472142). Clinicaltrials.gov URL (https://clinicaltrials.gov/study/NCT05472142).",

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note = "Publisher Copyright: {\textcopyright} The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).",

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Lacy, ME, Elliott, J, Drakeford, V, Wright, L, McKune, B, Douthitt, KC, Kruse-Diehr, AJ & Keck, JW 2026, 'Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial', Journal of Primary Care and Community Health, vol. 17. https://doi.org/10.1177/21501319261428883

Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial. / Lacy, Mary E.; Elliott, Jessica; Drakeford, Vance et al.
In: Journal of Primary Care and Community Health, Vol. 17, 01.01.2026.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics

T2 - Findings From a Pilot Pragmatic Cluster-Randomized Trial

AU - Lacy, Mary E.

AU - Elliott, Jessica

AU - Drakeford, Vance

AU - Wright, Laura

AU - McKune, Brent

AU - Douthitt, Key C.

AU - Kruse-Diehr, Aaron J.

AU - Keck, James W.

N1 - Publisher Copyright: © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

PY - 2026/1/1

Y1 - 2026/1/1

N2 - Background: Diabetes self-management education and support (DSMES) is an evidence-based intervention that improves outcomes for people with diabetes, but uptake is <10%. We conducted a pilot pragmatic trial to increase DSMES in rural primary care clinics that integrated health information technology with a quality improvement (QI) learning collaborative. Methods: Two healthcare systems from rural Kentucky participated in the study. Within each system, 2 clinics received the intervention and 1 clinic served as a control (N = 6 clinics). Each intervention clinic identified a QI team (5-6 individuals) who participated in a 9-month QI learning collaborative followed by 5 months of follow-up. Our primary outcome was DSMES referrals; secondary outcomes were DSMES attendance and percentage with A1c >9%. Results: The 6 study clinics served 1,803 patients with diabetes; n = 1083 (60.1%) from 4 intervention clinics and n = 720 (39.9%) from 2 control clinics. DSMES referrals significantly increased in the intervention clinics compared to the control clinics (31.7% vs 0.1%, P < .001) and continued to increase throughout 5-month follow-up (40.0% vs 0.1%, P < .001). Conclusions: A structured QI intervention can significantly increase DSMES referral rates in primary care clinics. Findings highlight the potential of systems-level approaches to address persistent gaps in diabetes care delivery in rural settings. Clinical Trial Registry: Using Practice Facilitation and Operationalizing Referral Information Technology to Increase DSMES Utilization (Clinicaltrials.gov registration number no. NCT05472142). Clinicaltrials.gov URL (https://clinicaltrials.gov/study/NCT05472142).

AB - Background: Diabetes self-management education and support (DSMES) is an evidence-based intervention that improves outcomes for people with diabetes, but uptake is <10%. We conducted a pilot pragmatic trial to increase DSMES in rural primary care clinics that integrated health information technology with a quality improvement (QI) learning collaborative. Methods: Two healthcare systems from rural Kentucky participated in the study. Within each system, 2 clinics received the intervention and 1 clinic served as a control (N = 6 clinics). Each intervention clinic identified a QI team (5-6 individuals) who participated in a 9-month QI learning collaborative followed by 5 months of follow-up. Our primary outcome was DSMES referrals; secondary outcomes were DSMES attendance and percentage with A1c >9%. Results: The 6 study clinics served 1,803 patients with diabetes; n = 1083 (60.1%) from 4 intervention clinics and n = 720 (39.9%) from 2 control clinics. DSMES referrals significantly increased in the intervention clinics compared to the control clinics (31.7% vs 0.1%, P < .001) and continued to increase throughout 5-month follow-up (40.0% vs 0.1%, P < .001). Conclusions: A structured QI intervention can significantly increase DSMES referral rates in primary care clinics. Findings highlight the potential of systems-level approaches to address persistent gaps in diabetes care delivery in rural settings. Clinical Trial Registry: Using Practice Facilitation and Operationalizing Referral Information Technology to Increase DSMES Utilization (Clinicaltrials.gov registration number no. NCT05472142). Clinicaltrials.gov URL (https://clinicaltrials.gov/study/NCT05472142).

KW - diabetes mellitus

KW - diabetes self-management education and support (DSMES)

KW - primary care

KW - quality improvement

KW - rural health

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UR - https://www.scopus.com/pages/publications/105032429237#tab=citedBy

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DO - 10.1177/21501319261428883

M3 - Article

C2 - 41805383

AN - SCOPUS:105032429237

SN - 2150-1319

VL - 17

JO - Journal of Primary Care and Community Health

JF - Journal of Primary Care and Community Health

ER -

Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics: Findings From a Pilot Pragmatic Cluster-Randomized Trial

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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