Health care organizations push for diabetes self-management education and support

A new consensus report urged clinicians to discuss self-management education and support with all diabetes patients and provide referrals at four critical points in care, including diagnosis.

A new consensus report from several medical organizations provides guidance for clinicians and policymakers on diabetes self-management education and support (DSMES) in adults with type 2 diabetes.

The report was coauthored by the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of Physician Assistants, the American Association of Nurse Practitioners, and the American Pharmacists Association. It was published online June 8 by The Diabetes Educator and Diabetes Care and offers four recommendations for clinicians:

  1. 1. Discuss with all persons with diabetes the benefits and value of initial and ongoing DSMES.
  2. 2. Initiate referral to and facilitate participation in DSMES at four critical times: at diagnosis, annually and/or when not meeting treatment targets, when complicating factors develop, and when transitions in life and care occur.
  3. 3. Ensure coordination of the medical nutrition therapy plan with the overall management strategy, including the DSMES plan, medications, and physical activity, on an ongoing basis.
  4. 4. Identify and address barriers affecting participation with DSMES services following referral.

The report offers a summary of benefits of DSMES to discuss with diabetes patients, including reductions in ED visits, hospital admissions, and hypoglycemia; promotion of lifestyle behaviors including healthful meal planning and engagement in regular physical activity; enhancement of self-efficacy and empowerment; and improvements in quality of life. The report also addresses what tasks should be handled by clinicians and the clinical care team versus a diabetes education specialist.

Additional recommendations are intended for policymakers, payers, health systems, clinicians, and health care teams, including expanding awareness, access, and utilization of innovative and nontraditional DSMES services; identifying and addressing barriers to referrals to DSMES services; and facilitating reimbursement and other financial support for DSMES.

“Despite proven benefits and demonstrated value of DSMES, the number of people with diabetes who are referred to and receive DSMES is significantly low. Barriers will not disappear without intentional, holistic interventions recognizing the roles of the entire health care team, individuals with diabetes, and systems in overcoming issues of therapeutic inertia,” the report said.