Technology Disparities and Therapeutic Inertia: A Call to Action for the Diabetes Care and Education Specialist

MacLeod, Janice; Scher, LaurieAnn; Greenwood, Deborah A.; Isaacs, Diana; Albanese‐O’Neill, Anastasia; O’Neill, Megan; Golden, Lisa; Scalzo, Patty

doi:10.1177/2633559x211032227

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…Use of digital technology (e.g., cloud-based, telehealth, data management platforms, apps, and social media) enhances the ability to employ a technology enabled self-management feedback loop with four key elements-twoway communication, analysis of PGHD, customized education, and person-centered feedback -to provide real-time engagement in self-management, as well as enable and empower PWD to effectively communicate with their care team (26). Disparities and inequities in access, adoption, and optimization of diabetes technology have become increasingly apparent in the COVID-19 pandemic (11). A framework identified specifically for Diabetes Care and Education Specialists to address these inequities that can be used as a practice model to aid in the incorporation of technology into their DSMES services is the ICC Framework (Identify, Configure, Collaborate) (132,133).…”

Section: Discussionmentioning

confidence: 99%

“…The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health (SDOH), and the ever-increasing technological engagement platforms and systems. Because the National Standards aim to promote health equity, technological advancements can often be used to achieve equitable access to DSMES (11); however, technology is not a requirement for delivery of DSMES.…”

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confidence: 99%

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2022 National Standards for Diabetes Self-Management Education and Support

et al. 2022

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By the most recent estimates, 34.2 million people in the U.S. have diabetes (1). At the same time, 88 million people are at increased risk for developing type 2 diabetes. The U.S. also sees an increasing prevalence of both type 1 and type 2 diabetes in children and adolescents (2). Thus, more than 122 million Americans are at risk for developing devastating complications associated with chronic hyperglycemia (1). Diabetes self-management education and support (DSMES) is a critical element of care for all people with diabetes (PWD). "The purpose of DSMES is to give PWD the knowledge, skills, and confidence to accept responsibility for their self-management. This includes collaborating with their healthcare team, making informed decisions, solving problems, developing personal goals and action plans, and coping with emotions and life stresses" (3). DSMES interventions include activities that support PWD to implement and sustain the self-management behaviors and strategies to improve diabetes and related cardiometabolic conditions and quality of life on an ongoing basis. Despite progress in diabetes treatment modalities, glycemic and cardiometabolic outcomes continue to decline in the U.S. (4). Now, more than ever, the provision of DSMES is a vital component of the full treatment for diabetes.PWD are at risk for distress, life stress, and clinical depression, which can lead to poor health outcomes (5). The National Standards for Diabetes Self-Management Education and Support (hereinafter referred to as the National Standards) encourage the DSMES team to acknowledge and address the emotional burden of living with and managing diabetes-diabetes distress-and to consider the multitude of daily demands and decisions required of PWD, their families, and caregivers (6-9). To further illustrate, PWD generally visit their primary care physician (PCP)/other qualified healthcare professional two to four times per year, where the average appointment lasts 15-20 min and addresses four or more health conditions (10). This equates to the person with diabetes (PWD) spending less than 1% of their life with their healthcare professionals (10). Therefore, diabetes management decisions largely fall on PWD and/or caregivers, further highlighting the importance of increasing access to DSMES services that support ongoing self-management and decision making.The National Standards define timely, evidence-based, quality DSMES services that meet or exceed the Centers for Medicare & Medicaid Services quality standards. While the acronym DSMES is used in the literature and in current practice, it is important to note that the term diabetes self-management training (DSMT) is exclusively used when describing the Medicare benefit for diabetes self-management. The Medicare benefit for DSMT was established by the Balanced Budget Act (BBA) of 1997 with a final rule (65 FR 83130) published on 29 December 2000, implementing the BBA provisions and DSMT regulations (Title 42 of the Code of Federal Regulation sections 410.140 to 410.146). The DSMT benefit...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

2022 National Standards for Diabetes Self-Management Education and Support

et al. 2022

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“…26 Disparities and inequities in access, adoption, and optimization of diabetes technology have become increasingly apparent in the COVID-19 pandemic. 11 A framework identified specifically for Diabetes Care and Education Specialists to address these inequities that can be used as a practice model to aid in the incorporation of technology into their DSMES services is the ICC Framework (Identify, Configure, Collaborate). 132,133 Data support that technology can aid in better outcomes; however, additional assessment and judgment to determine whether there are barriers to use and whether those barriers can be overcome must be considered.…”

Section: Discussionmentioning

confidence: 99%

2022 National Standards for Diabetes Self-Management Education and Support

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Beck

et al. 2022

The Science of Diabetes Self-Management and Care

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Purpose: The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. Conclusion: The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.

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“…Use of digital technology (e.g., cloud-based, telehealth, data management platforms, apps, and social media) enhances the ability to employ a technology enabled self-management feedback loop with four key elements-two-way communication, analysis of PGHD, customized education, and personcentered feedback-to provide real-time engagement in selfmanagement, as well as enable and empower PWD to effectively communicate with their care team (26). Disparities and inequities in access, adoption, and optimization of diabetes technology have become increasingly apparent in the COVID-19 pandemic (11). A framework identified specifically for Diabetes Care and Education Specialists to address these inequities that can be used as a practice model to aid in the incorporation of technology into their DSMES services is the ICC Framework (Identify, Configure, Collaborate) (132,133).…”

Section: Discussionmentioning

confidence: 99%