Going Beyond Education: A Practical Framework for Diabetes Self-Management and Decision-Making

Abstract

Historically, "diabetes educators" were expected to be knowledgeable and supportive advocates and coaches who provided comprehensive education for people living with diabetes, a description that fails to communicate the depth of "innovative clinical care, education, management, and support offered by the specialty." 1 As the science that guides diabetes education and care advanced, so did our professional organization, our profession, and our practices. 2 To reflect this, the Association of Diabetes Care and Education Specialists (ADCES) recently redefined our title and role as "diabetes care and education specialists (DCES[s]), who, as integral members of the care team, provide collaborative, comprehensive and person-centered care and education to people with diabetes and related conditions." 1 This is more than just a name change; it requires taking on new responsibilities, and it provides DCESs with the opportunity to evaluate the efficacy and relevance of diabetes selfmanagement education and support (DSMES) programs and services. So, as you changed your title, did you also change your practice? What Makes an Educator a Specialist?

Growing Up: A 50-Year Journey From Compliance to Collaboration

“…Much of the self-discovery and problem-based learning is derived from the personal behavioral experiments PWD create at each session. 5,6 We use the I-SMART framework because it focuses on the personal “why” (I = importance and decision-making) rather than just the “how” (SMART). 5 We also use the Michigan 5 M’s Framework for Self-Management and Decision-Making 5,6 to integrate all aspects (eg, psychosocial, behavioral, and clinical) into each session and content area, as an overall framework for the program, and to help PWD make and evaluate their self-management decisions.…”

Caring for people with diabetes

“…Nurses can use this framework to assess, structure, and organize messages when providing education. Patients can also use this framework to connect the multiple aspects of self-management, make informed and wise decisions, and evaluate their subsequent outcomes such as blood glucose readings 22…”

“…Patients can also use this framework to connect the multiple aspects of self-management, make informed and wise decisions, and evaluate their subsequent outcomes such as blood glucose readings. 22 A new recommendation in the 2022 Standards of Medical Care is to consider assessing cognition and depression among adults 65 years of age and older. People with diabetes at all ages are at risk for experiencing distress, stress, and clinical depression.…”

The Michigan Men’s Diabetes Project Randomized Clinical Control Trial: A Pilot/Feasibility Study of a Peer-Led Diabetes Self-Management and Support Intervention for Black Men With Type 2 Diabetes

“…When using this philosophy, participants reflect on their self-management practices, discuss the emotional aspects of living with diabetes, and play an active role in structured, person-centered processes for establishing goals and resolving issues ( Funnell, 2023 ; Funnell et al, 2005 ). Educational strategies include self-discovery and problem-based learning, self-determined goal setting, shared decision-making, creating equal partnerships, and using person-centered communication and nonstigmatizing language ( Funnell, 2023 ; Kloss et al, 2022 ).…”