Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Abstract

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes (1-7). Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Table 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial DSME is typically provided by a health professional, whereas ongoing support can be provided by personnel within a practice and a variety of community-based resources. DSME/S programs are designed to address the patient's health beliefs, cultural needs, current knowledge, physical limitations, emotional concerns, family support, financial status, medical history, health literacy, numeracy, and other factors that influence each person's ability to meet the challenges of self-management.It is the position of the American Diabetes Association (ADA) that all individuals with diabetes receive DSME/S at diagnosis and as needed thereafter (8). This position statement focuses on the particular needs of individuals with type 2 diabetes. The needs will be similar to those of people with other types of diabetes (type 1 diabetes, prediabetes, and gestational diabetes mellitus); however, the research and examples referred to in this article focus on type 2 diabetes. The goals of the position statement are ultimately to improve the patient experience of care and education, to improve the health of individuals and populations, and to reduce diabetes-associated per capita health care costs (9). The use of the diabetes education algorithm presented in this position statement defines when, what, and how DSME/S should be provided for adults with type 2 diabetes.

Diabetes education in primary care: a randomized clinical trial

“…Diabetes self-management education has been used to encourage lifestyle changes and improve medication compliance 4 . The efficacy of diabetes mellitus education has been widely accepted, and the certificated diabetes educator (CDE) is considered an important member of the multidisciplinary team responsible for patient care 5,6 . However, the efficacy of education in terms of HbA1c reduction has not been consistently demonstrated.…”

Carbohydrate knowledge in diabetic emergency department patients at an academic institution

“…[11] Regarding DSME, studies have shown improved outcomes such as decreasing Hb A1c level, receiving care within recommended guidelines, and adhering to prescription regimens leading to lower utilization trends. [16,18,28,29] Still, only 56.7% of Missouri diabetics have ever attended a DSME class, which is below the Healthy People 2020 goal of 62.5%. [1] Our results also suggest that those who visit with a nutritionist or diabetes educator have more knowledge to manage their diabetes.…”

“…[17] The seven key areas that self-care focus on include healthy eating, being active, monitoring blood sugars, medication adherence, problem solving for diabetes control, healthy coping, and reducing risks of complications. [18] While healthy eating incorporates many aspects, CC is one of the tools that may be needed, depending on an individual's goals. [9] The approach used in diabetes education is not only education of the patient but also the integration of techniques that promote effective self-management, such as goal setting and follow up.…”

“…[9] The approach used in diabetes education is not only education of the patient but also the integration of techniques that promote effective self-management, such as goal setting and follow up. [18,19] Currently, only 6.8% of privately insured people newly diagnosed with diabetes in the United States received DSME within the first 12 months. The age adjusted proportion of diabetic adults having ever attended a diabetes education class is just 57%.…”

Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial (Preprint)

“…The increasing prevalence of T2DM will put pressure on health systems to appropriately manage these patients to avoid diabetic complications. Optimizing self-management of glycemic control and other risk factors in conjunction with pharmacologic therapy may be an efficient way to improve patient outcomes [2][3][4][5]. While selfmanagement has been traditionally in person educational programs that are resource intensive, advances in mobile technology now provide the opportunity to deliver effective self-management support to patients in a convenient and potentially cost effective manner [6][7][8][9][10][11].…”