Department of Research & Evaluation News

A large study conducted within Kaiser Permanente Southern California found that people with type 2 diabetes who primarily received diabetes self-management education and support were more likely to achieve healthy blood sugar levels than those whose care focused mainly on physician visits.

“For people living with type 2 diabetes, this study shows that actively participating in diabetes self-management education and support can make a real difference in achieving healthier blood sugar levels,” said the study’s lead author,  Taynara Formagini, PhD, MSc, a behavioral and public health scientist with the Kaiser Permanente Southern California Department of Research & Evaluation.

“For those with type 2 diabetes, it means that the more you engage with educational resources and learn how to manage your condition, the better your chances are for reaching your glucose goals and improving your overall health,” she added.

The study published in May, 2026, in the Journal of General Internal Medicine.

Working to achieve better health through better A1c

Diabetes affects millions of adults in the United States, and high blood sugar can lead to serious health problems. Nearly half of adults with type 2 diabetes do not meet their blood sugar goals. Doctors check this with an A1c blood test, which shows a person’s average blood sugar over the past 3 months. That’s why it’s important to learn which kinds of support help patients manage diabetes in the places where they get care, like Kaiser Permanente.

In Kaiser Permanente Southern California, diabetes self-management education and support is delivered through the Center for Healthy Living, which helps members build practical skills for day-to-day diabetes management.

“Health education is important, but information alone doesn’t always lead to lasting behavior change,” Anna Marie G. Salvador, MPH, a co-author in this study and senior manager at the Center for Healthy Living. “Through multi-session programs, motivational interviewing, and group learning, we help members build real-life skills and confidence so healthy changes can stick at home and in everyday life.”

The study looked at whether different types of diabetes care visits were linked to better blood sugar levels among a diverse group of adults with high blood sugar. Researchers analyzed electronic health records from more than 317,000 Kaiser Permanente Southern California members. The individuals were followed for up to 2 years.

Study evaluated 3 different care models

This study evaluated 3 components of a diabetes management program used in Kaiser Permanente Southern California. Researchers compared outcomes among patients whose diabetes care visits was primarily delivered through:

• Primary care: Primary care physician visits typically focus on monitoring blood sugar, adjusting treatment plans and making referrals.
• Diabetes team care: Also known as population care management, involves teams of nurses and pharmacists who help manage patients with complex needs, often through more frequent medication adjustments and follow-up.
• Diabetes self-management education and support: Classes and coaching that help patients learn how to manage diabetes day to day—like eating well, staying active, and taking medicines the right way.

The study found that diabetes self-management education and support was linked to better blood sugar results, even after taking into account patients’ socioeconomic characteristics and health. Patients in this group were more likely to reach their goal—an A1c under 7% on 2 tests in a row within 2 years. The findings were similar across racial and ethnic groups.

Number of doctor visits versus blood sugar levels

The study also looked at how the number of diabetes-related visits was tied to blood sugar results. In general, having more visits helped people reach their A1c goal, up to a point. After that, for most types of care, the extra visits did not help as much. One clear exception was diabetes self-management education and support. People who used these education and coaching services more often were more likely to have better blood sugar levels, even at higher numbers of visits.

Overall, fewer than one-third of patients achieved sustained blood sugar control during the study period, reflecting the challenges of managing diabetes and the strict definition used in the analysis.

“Expanding access to diabetes education and support may help improve diabetes management for more individuals and lead to more equitable diabetes care,” Dr. Formagini said. “However, we still need more research to learn which mix of diabetes care strategies helps people keep their blood sugar in a healthy range over time.”

This study adds to what we already know because many past studies were smaller or done in settings that don’t reflect everyday care. This study helps show what works in a large health system, like Kaiser Permanente, researchers said.

The research was supported by a grant from the Regional Research Committee of Kaiser Permanente Southern California.

In addition to Dr. Formagini and Anna Marie G. Salvador, other Kaiser Permanente Southern California researchers on this study included Minyong Kim, MPH, who initiated the project and led it in the early stages; Xing Wei, MPH; Stephanie Tovar, MS; Ray Nanda, MD; Timothy Hsieh, MD; John P. Martin, MD; Karen J. Coleman, PhD; and Bechien U. Wu, MD, MPH.