Evaluation of a Nova Scotia diabetes assistance program for people with type 2 diabetes

Objective: This study was intended to evaluate the impact of a province-wide Diabetes Assistance Program (financial and self-management support) in a representative sample of individuals with diabetes and unmet financial needs. The impact of the program was evaluated on individuals managed with insulin or oral antihyperglycemic agents alone and also on individuals with good, suboptimal or poor diabetes control. METHODS: Participants were recruited from the entire population of individuals approved for the Nova Scotia Diabetes Assistance Program into this pre/post cohort study of people with type 1 or 2 diabetes. Participants were recruited by letter, and data were obtained via phone interview. Participants were assessed with regard to glycemic control, self-care and quality of life. RESULTS: The Diabetes Assistance Program was unable to show a strong net benefit for the entire study sample, but there were significant findings when initial degree of glycemic control was considered, and to a lesser extent, method of control. The strongest positive impact was for those patients with poor control (glycated hemoglobin [A1C] >8.5%), who had significant improvements in glycemic control (absolute reduction in A1C of 0.9%), self-care and quality of life were observed. Minor positive effects were also demonstrated for those with suboptimal control. Those with good control demonstrated an increase in A1C. CONCLUSION: This study demonstrates the value of providing support for those with poor glycemic control. Interestingly, those with good control did not benefit from support. These data suggest that efforts to support individuals with diabetes should be directed at those most likely to benefit.