Position statement: Self-management education and support crucial and underused

Diabetes self-management education and support (DSME/S) is proven to be effective, but the numbers of patients who are referred to and receive it are “disappointingly small,” according to a recent statement by 3 health organizations.

The joint position statement by the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics offers strategies for providing education and support services to adults with type 2 diabetes. The statement was published online on June 5 by Diabetes Care with the goal of ultimately improving the patient experience and health, as well as reducing diabetes-associated per capita health care costs.

Diabetes-related distress—the negative emotional responses of being overwhelmed, hopeless, and helpless—among patients is particularly common, with prevalence rates of 18% to 35% and an 18-month incidence of 38% to 48%, according to the statement. However, diabetes-related distress is responsive to intervention, including DSME/S, the statement says.

The statement details 4 critical times to assess, provide, and adjust DSME/S: 1) with a new type 2 diabetes diagnosis; 2) every year for maintenance and preventing complications; 3) when new factors influence self-management; and 4) when care transitions occur. The statement recommends annual visits for diabetes education in order to assess all areas of self-management, review behavioral changes and coping strategies, and make adjustments in therapy.

Because diabetes is a complex disease that requires appropriate decision making regarding food, physical activity, and medications, self-management is crucial, according to the statement. Some DSME/S programs include medical nutrition therapy delivered by a registered dietitian nutritionist, and other programs provide basic nutrition guidance and rely on referrals for the therapy, the statement says.

Even though CMS and many private payers reimburse for DSME/S and medical nutrition therapy, barriers to care contribute to the low number of people with type 2 diabetes who receive it, according to the statement. Barriers can include a misunderstanding of the necessity and effectiveness of DSME/S, confusion regarding referrals, lack of access to services, and patient psychosocial and behavioral factors, the statement says.

“It is imperative that the health care community, responsible for delivering quality care, mobilizes efforts to address the barriers and explores resources for DSME/S in order to meet the needs of adults living with and managing type 2 diabetes,” according to the statement.

ACP offers patient self-management tools, including one for patients with diabetes.