Consensus recommendation
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Providers should discuss with all persons with diabetes the benefits and value of initial and ongoing DSMES.
This Consensus Report is an update of the 2015 joint position statement on DSMES.12 The panel of experts authoring this report includes representatives from the three national organizations that jointly published the original article (ADA, American Association of Diabetes Educators [AADE], and Academy of Nutrition and Dietetics), and, in an effort to widen the reach and stakeholder input, the American Academy of Family Physicians, American Academy of PAs, American Association of Nurse
Consensus recommendation Providers should discuss with all persons with diabetes the benefits and value of initial and ongoing DSMES.
The benefits of DSMES are multifaceted and include clinical, psychosocial, and behavioral outcomes benefits. Key clinical benefits are improved hemoglobin A1c (A1C) with reductions that are additive to lifestyle and drug therapy.13, 14, 15, 16 Based on recent data,13,14,16 DSMES results in an average A1C reduction of 0.45–0.57% when compared with usual care for
Consensus recommendation Health policy, payers, health systems, providers, and health care teams need to expand awareness, access, and utilization of innovative and nontraditional DSMES services.
A variety of DSMES approaches and settings need to be presented and discussed with people with diabetes, thus enabling self-selection of a method that best meets their specific needs.34 Historically, DSMES services were provided in a formal series of didactic classes where people with diabetes and their
Consensus recommendation Providers should initiate referral to and facilitate participation in DSMES at the four critical times 1) at diagnosis, 2) annually and/or when not meeting treatment targets, 3) when complicating factors develop, and 4) when transitions in life and care occur.
There are four critical times to provide and modify DSMES: 1) at diagnosis, 2) annually and/or when not meeting treatment targets, 3) when complicating factors develop, and 4) when transitions in life and care
For an individual and family, the diagnosis of diabetes is often overwhelming,58,59 with fears, anger, myths, and personal, family, and life circumstances influencing this reaction. Immediate care addresses these concerns through listening, providing emotional support, and answering questions. Providers typically first set the stage for a lifetime chronic condition that requires focus, hope, and resources to manage on a daily basis. A person-centered approach at diagnosis is essential for
The health care team and others support the adoption and maintenance of daily self-management tasks,8,40 as many people with diabetes find sustaining these behaviors difficult. They need to identify education and other needs expeditiously in order to address the nuances of self-management and highlight the value of ongoing education. Table 6 provides details of DSMES at this critical time. Annual assessment of knowledge, skills, and behaviors is necessary for those who achieve diabetes
The identification of diabetes-related complications or other individual factors that may influence self-management should be considered a critical indicator of the need for DSMES that requires immediate attention and adequate resources. During clinical care, the provider may identify factors other than diabetes that may influence the individual’s diabetes treatment and associated self-management plan (see Tables 5 and 6). These factors may require a change in self-management or affect an
Throughout the life span many factors such as aging, living situation, schedule changes, or health insurance coverage may require a re-evaluation of diabetes treatment and self-management needs (see Tables 5 and 6). Critical transition periods may include transitioning into adulthood, living on one’s own, hospitalization, and moving into an assisted living or skilled nursing facility, correctional facility, or rehabilitation center. They may also include life milestones: marriage, divorce,
Consensus recommendation Providers should 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.
MNT can reduce A1C by up to 2%, making it an essential component of initial and ongoing diabetes care.1,69,70 Additionally, MNT helps prevent, delay, or treat other complications commonly found with diabetes such as hypertension, cardiovascular disease, renal disease, celiac
Consensus recommendations Providers should identify and address barriers affecting participation with DSMES services following referral. Health policy, payers, health systems, providers, and health care teams should identify and address barriers influencing providers’ referrals to DSMES services.
Despite the proven value and effectiveness of DSMES, a looming threat to its success is low utilization due to a variety of barriers. In order to reduce barriers, a focus on processes that streamline
Consensus recommendation Health policy, payers, health systems, providers, and health care teams need to facilitate reimbursement processes and other means of financial support in consideration of cost savings related to the benefits of DSMES services.
Several common payment models and newer emerging models that reimburse for DSMES services are described below. For a list of diabetes education codes that can be submitted for reimbursement, see Supplementary Table 2 (available at www.jandonline.org
This Consensus Report is a resource for the entire health care team and describes the four critical times to refer to DSMES services with very specific recommendations for ensuring that all adults with diabetes receive these benefits. Diabetes is a complex condition that requires the person with diabetes to make numerous daily decisions regarding their self-management. DSMES delivered by qualified personnel using best practice methods has a profound effect on the ability to effectively
The authors would like to acknowledge Mindy Saraco (Managing Director, Scientific and Medical Affairs) from the ADA for her help with the development of the Consensus Report and related meetings and presentations, as well as the ADA Professional Practice Committee for providing valuable review and feedback. The authors also acknowledge Leslie Kolb, Chief Science and Practice Officer, Association of Diabetes Care & Education Specialists, for her review and support of the Consensus Report. The
M. A. Powers is with HealthPartners, Bloomington, MN.
Building positive health behaviors is fundamental for achieving diabetes treatment goals and maximizing quality of life.1,2 To this end, diabetes self-management education and support (DSMES) is essential, as it is an ongoing process that addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects to facilitate the knowledge, decision-making, and skills required for optimal diabetes self-care.3 Over the past decade, scientific organizations have published position statements and consensus reports to guide the management of older adults with diabetes.4
Diabetes distress prevalence is reported to be 18%-45% with an incidence of 38%-48% over 18 months (Aikens, 2012). Diabetes self-management education and support (DSMES) is recommended for all people with diabetes, and is effective in improving the likelihood of a patient achieving their glycemic target (Powers et al., 2020). However, the challenges of self-management heightens when social circumstance impact a person’s ability to participate.
M. A. Powers is with HealthPartners, Bloomington, MN.
J. K. Bardsley is with the Medstar Health Research Institute, MedStar Diabetes Institute, and MedStar Health System Nursing, Hyattsville, MD.
M. Cypress is an independent Independent consultant, Albuquerque, NM.
M. M. Funnell is with the University of Michigan Medical School, Ann Arbor, MI.
D. Harms is with MercyOne Clive Internal Medicine, Clive, IA.
A. Hess-Fischl is with the Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL.
B. Hooks is with Martin Army Community Hospital, Fort Benning, GA.
D. Isaacs is with the Cleveland Clinic Diabetes Center, Cleveland, OH.
E. D. Mandell is with Johnson & Wales University, Providence, RI.
M. D. Maryniuk is with Maryniuk & Associates, Boston, MA.
A. Norton is with DiabetesSisters, Chicago, IL.
J. Rinker is with the Association of Diabetes Care & Education Specialists, Chicago, IL.
S. Uelmen is with the Association of Diabetes Care & Education Specialists, Chicago, IL.
L. M. Siminerio is with the University of Pittsburgh, Pittsburgh, PA.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST M. A. Powers reports research funding from Abbott Nutrition, is a senior advisor for ADA’s Nutrition Interest Group, and is a member of ADA/American Heart Association Science Advisory Group for Know Diabetes by Heart. J. K. Bardsley reports being a past chair of the Certification Board for Diabetes Care and Education, is the program chair for the Association of Diabetes Care & Education Specialists annual meeting, and has been a consultant to Joslin Diabetes Center. M. M. Funnell is on an advisory board of Eli Lilly. D. Harms is the treasurer for the American Academy of Nurse Practitioners Certification Board of Commissioners and Vice President of the American Nurse Practitioner Foundation. A. Hess-Fischl reports receiving an honorarium from ADA as an Education Recognition Program auditor and is a participant in a speakers bureau sponsored by Abbott Diabetes Care and Xeris. D. Isaacs reports being a participant in a speakers bureau/ consultant for Xeris Pharmaceuticals, Novo Nordisk, Dexcom, and Lifescan. M. D. Maryniuk reports being a paid consultant of Diabetes – What to Know, Arkray, and DayTwo. A. Norton reports being a participant in speakers bureaus sponsored by Boehringer Ingelheim, Novo Nordisk, and Xeris. L. M. Siminerio reports research grant funding from Becton Dickinson. S. Uelmen has received honoraria from ADA. No other potential conflicts of interest relevant to this article were reported.
FUNDING/SUPPORT This activity was funded by the ADA and the Association of Diabetes Care & Education Specialists.