Joint Guidance Outlines Diabetes Self-Management Education

A joint position statement from 3 diabetes organizations that outlines when, how, and what type of diabetes self-management and support (DSME/S) should be delivered to patients with type 2 diabetes was released Friday during a press conference at the American Diabetes Association (ADA) 75th Scientific Sessions.

The ADA, American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics collaborated on the statement, which provides an algorithm with guidance to healthcare providers regarding when to refer patients with diabetes to certified diabetes educators and other trained staff for education and support. DSME/S, recognizing that an individual with diabetes is their own primary care provider, refers to the information and skills they need for proper self-care and the support they need to implement those skills and behaviors.
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“There is confusion as to why diabetes education is needed. When diabetes education should occur, what is needed in diabetes education, and how it should be provided. In fact, this confusion leads to patients not receiving the needed services of diabetes education and support,” said coauthor Margaret Powers, PhD, RD, CDE, research scientist, International Diabetes Center at Park Nicollet, and president-elect, Health Care & Education for ADA. “Our goal with this paper was to reduce this confusion and provide clear guidelines and expectations for clinicians and for patients.”

She noted that diabetes education is critical because 95% of diabetes care is provided by patients at home every day.

Research has shown that DSME/S improves diabetes outcomes, including lowering hemoglobin A1c levels; reducing onset and/or advancement of diabetes complications, which is really what the care of diabetes is about; helping people improve their lifestyle behaviors; decreasing diabetes distress and depression; and improving quality of life, explained coauthor Martha M. Funnell, MS, RD, CDE, research scientist, University of Michigan School of Medicine, and past chair of the National Diabetes Education Program. Diabetes education is also cost-effective in decreasing hospital admissions and readmissions, which is a major focus of the health system currently.

“We know diabetes education works,” she said. “But we also know the number of people who receive education is alarmingly small.” She cited data from a recent study of people age 18 to 64 years that showed that less than 7% have been to a formal diabetes education program.

The algorithm relies on 5 guiding principles and represents how DSME/S should be provided through patient engagement, information sharing, psychosocial and behavioral support, integration with other therapies, and coordinated care.

Specifically, the algorithm defines 4 critical times for assessing the need for DSME/S referral: (1) with a new diagnosis of type 2 diabetes; (2) annually for health maintenance and prevention of complications; (3) when new complicating factors influence self-management; and (4) when transitions in care occur. The statement also provides guidance on the type of information and support patients might need at these 4 critical junctures. The algorithm also outlines the content to be taught, roles, and action steps recommended for both the referring provider and for the diabetes educator.

The joint statement was published online concurrently in Diabetes Care, The Diabetes Educator, and the Journal of the Academy of Nutrition and Dietetics.

—Eileen Koutnik-Fotopoulos