Evidence-Based Best Practices for Diabetes Education and Self-Care in Appalachia: A Literature Review.

Introduction: The Appalachian Region has a higher prevalence of type 2 diabetes mellitus (T2DM) and associated adverse health outcomes. Although numerous papers report best practices for diabetes care and education, a clinician-friendly, synthesized summary of best practices tailored to Appalachian cultural preferences is lacking.

Purpose: This paper uses the Melnyk & Fineout-Overholt evidence-based framework to identify the best practices for T2DM care and education for Appalachian residents.

Methods: A comprehensive literature search using the databases CINAHL, Academic Search Complete, and PubMed was guided by a PICOT question. Quality appraisals were completed for fifty-two articles; thirty papers were selected to synthesize best practices, delivery methods, lifestyle modifications, and outcomes.

Results: Best practices for T2DM education are recognizing how culture and the social determinants of health (SDOH) influence care, using a multidisciplinary team, and screening for diabetes knowledge and distress. Beneficial education topics are nutrition, weight management, medication management, stress management, health maintenance screenings, and lifestyle modification including exercise. Access to care may be increased by using digital or online formats.

Implications: T2DM is a complex chronic health issue; strategies are needed to address health disparities and SDOH in Appalachia. Future research is needed to determine the best practices for the duration and frequency of diabetes education and to determine ways to engage residents in diabetes care. Partnerships with local organizations may create a support network for diabetes management. Decision-makers can use these best practices to pursue interventions that engage the Appalachian community in better diabetes care.