2751-LB: Implementing a Population Health–Enhanced DSMES Program

Introduction and Objective: People with T2DM who are Black and of lower SES often carry a higher disease burden in the US. Social determinants of health (SDoH) influence this, such as nutrition access and transportation to appointments. The ADA designed the Diabetes Self-Management Education and Support (DSMES) Program to standardize education but SDoH still act as barriers to care. Methods: We conducted a feasibility study with 50 patients to evaluate a new DSMES program with embedded Population Health services at our urban community hospital from Jul-Dec 2025. We enrolled patients with uncontrolled T2DM in individual or group visits per patient preference. We recorded demographics, social factors and baseline disease characteristics. We taught the standard ADA educational curriculum and offered extra nutrition and transport services. Our primary outcomes were of engagement (DSMES hours/patient or percent sessions attended); support services (UberHealth use); and T2DM control (A1c change). We used Wilcoxon signed-rank tests to compare our primary metrics before and after the program. Results: Forty individuals (65% female, 60% non-Hispanic Black) and 10 group participants (70% female, 70% NH Black) were included. We spent 1-2 hours with most (N=24) individuals. Excluding one patient lost to follow-up, the group participants who completed the program attended a median (IQR) of 100% (83.3%, 100%) of 6 sessions. To support transportation needs, we provided UberHealth for 16.7% of individuals and 60% of group participants. The Wilcoxon signed-rank test showed a significant decrease in A1c from program start to end for individuals, with a median (IQR) decrease of -2.1 (-3.65, -0.5) after a mean follow-up time of 27 weeks (Z= -4.486, P<0.0001, r= -0.75), and for group participants, with a decrease of -1.3 (-3.1, -0.6) after a mean follow-up time of 21 weeks (Z= -2.497, P=0.0098, r= -0.79). Conclusion: Implementing individual and group DSMES programs with supplemental support services for Baltimore City patients with T2DM was feasible at our urban community hospital. Disclosure E.B. Costello: None. L.M. Davis: None. E. Getlan: Stock/Shareholder; Current; Dexcom, Inc.