Talking Circles Improve Diabetes Self-Management

Talking Ciricles identified by the Indian Health Service (IHS) as a best practice, have not been evaluated for improving adherence in American Indians with uncontrolled type 2 diabetes mellitus (DM2). Thirty-nine adult American Indians with uncontrolled DM2, defined by a HbA1c level of >7.0, participanted in a quasi-experimental, mixed-methods approach to diabetes self-management education (DSME). The experimental group participated in a culturally appropriate TC led by a tribal elder and received DSME; the control group received only traditional DSME. TCs were audio-recorded and analyzed qualitatively on context, meanings, intent, and consequences expressed, and concepts and categories were abstracted from the transcript and coded using descriptive terms or phrases that best illustrated the spoken narrative. The IHS Standards of Care for Diabetes quantitative measures, a completed Summary of Diabetes Self-Care Activities assessment, and a two question Quality of Life survey were used for all study participants upon enrollment and then every 3 months for one year.  HbA1c levels were compared by paired t-test. Themes identified by TC participants were spirituality, gratitude, sharing, and humor. Major topics of discussions were the experiences of living with DM2 including challenges and coping. A statistically significant decrease in HbA1c in baseline vs 3 months and 6 months vs 12 months (p=0.05) was achieved for the experimental group, but not the control group.  TCs may have utility in improving diabetes self-management adherence in American Indian adults with uncontrolled DM2.  Further studies are warranted, including extending the use of the TCs after completion of traditional DSME education sessions.