State of Diabetes Self-Management Education in the European Union Member States and Non-EU Countries: The Diabetes Literacy Project

Henna Riemenschneider, Sarama Saha, Stephan Van Den Broucke, Helle Terkildsen Maindal, Gerardine Doyle, Diane Levin-Zamir, Ingrid Muller, Kristin Ganahl, Kristine Sørensen, Peter Chang, Dean Schillinger, Peter E.H. Schwarz, Gabriele Müller

Research output: Contribution to journalArticlepeer-review


Background. Diabetes self-management education (DSME) is considered essential for improving the prevention and care of diabetes through empowering patients to increase agency in their own health and care processes. However, existing evidence regarding DSME in the EU Member States (EU MS) is insufficient to develop an EU-wide strategy. Objectives. This study presents the state of DSME in the 28 EU MS and contrasts it with 3 non-EU countries with comparable Human Development Index score: Israel, Taiwan, and the USA (ITU). Because type 2 diabetes mellitus (T2DM) disproportionately affects minority and low-income groups, we paid particular attention to health literacy aspects of DSME for vulnerable populations. Methods. Data from multiple stakeholders involved in diabetes care were collected from Feb 2014 to Jan 2015 using an online Diabetes Literacy Survey (DLS). Of the 379 respondents (249 from EU MS and 130 from ITU), most were people with diabetes (33% in the EU MS, 15% in ITU) and care providers (47% and 72%). These data were supplemented by an expert survey (ES) administered to 30 key informants. Results. Access to DSME varies greatly in the EU MS: an average of 29% (range 21% to 50%) of respondents report DSME programs are tailored for people with limited literacy, educational attainment, and language skills versus 63% in ITU. More than half of adult T2DM patients and children/adolescents participate in DSME in EU MS; in ITU, participation of T1DM patients and older people is lower. Prioritization of DSME (6.1 ± 2.8 out of 10) and the level of satisfaction with the current state of DSME (5.0 ± 2.4 out of 10) in the EU MS were comparable with ITU. Conclusion. Variation in availability and organization of DSME in the EU MS presents a clear rationale for developing an EU-wide diabetes strategy to improve treatment and care for people with diabetes.

Original languageEnglish
Article number1467171
JournalJournal of Diabetes Research
StatePublished - 2018
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported by grant FP7-Health-2012-Innovation- 1/306186 of the European Commission. The authors would like to thank the Diabetes Literacy Consortium and the following affiliated partners for contributing to the study: Universit Catholique de Louvain, Belgium: Stephan van den Broucke, Gerard Van der Zanden, Marie Housiaux, Louise Schinckus, and Loveness Dube; Technische Universit t Dresden, Germany: Peter E. H. Schwarz, Henna Riemenschneider, Gabriele M ller, Sarama Saha, and Caroline Lang; University College Dublin, Ireland: Gerardine Doyle and Sarah Gibney; Ludwig Boltzmann Institute for Health Promotion Research, Austria: J rgen Pelikan, Florian R thling, and Kristin Ganahl; Maastricht University, the Netherlands: Helmut Brand, Kristine S rensen, and Timo Clemens; University of Southampton, UK: Lucy Yardley, Don Nutbeam, Paul Little, Ingrid Muller, Ali Rowsell, and Victoria Hayter; Clalit Health Services, Israel: Diane Levin-Zamir and Ziv Har-Gil; University of California, San Francisco, USA: Dean Schillinger and Courtney Lyles; Taipei Medical University, Taiwan, and National Taipei Hospital, Ministry of Health & Welfare, Taiwan: Peter Chang, Duong Van Tuyen, Alice Lin, Candy Kuo, and Jenny Jao; Aarhus University, Denmark: Helle Terkildsen Maindal and Gillian Rowlands.

Publisher Copyright:
© 2018 Henna Riemenschneider et al.

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


Dive into the research topics of 'State of Diabetes Self-Management Education in the European Union Member States and Non-EU Countries: The Diabetes Literacy Project'. Together they form a unique fingerprint.

Cite this