They also serve as a guide for nonaccredited and nonrecognized providers and programs. Because of the dynamic nature of health care and diabetes-related research, the Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes education community.
Members of the Task Force included experts from the areas of public health, underserved populations including rural primary care and other rural health services, individual practices, large urban specialty practices, and urban hospitals.
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They also included individuals with diabetes, diabetes researchers, certified diabetes educators, registered nurses, registered dietitians, physicians, pharmacists, and a psychologist. The Task Force was charged with reviewing the current National Standards for Diabetes Self-Management Education for their appropriateness, relevance, and scientific basis and updating them based on the available evidence and expert consensus. This name change is intended to codify the significance of ongoing support for people with diabetes and those at risk for developing the disease, particularly to encourage behavior change, the maintenance of healthy diabetes-related behaviors, and to address psychosocial concerns.
Currently, there are significant barriers to the provision of education and support to those with prediabetes. And yet, the strategies for supporting successful behavior change and the healthy behaviors recommended for people with prediabetes are largely identical to those for individuals with diabetes. As barriers to care are overcome, providers of DSME and diabetes self-management support DSMS , given their training and experience, are particularly well equipped to assist individuals with prediabetes in developing and maintaining behaviors that can prevent or delay the onset of diabetes.
Many people with diabetes have or are at risk for developing comorbidities, including both diabetes-related complications and conditions e. In addition, the diagnosis, progression, and daily work of managing the disease can take a major emotional toll on people with diabetes that makes self-care even more difficult 9. In the course of its work on the Standards, the Task Force identified areas in which there is currently an insufficient amount of research.
In particular, there are three areas in which the Task Force recommends additional research:. What training should be required for those community, lay, or peer workers without training in health or diabetes who are to participate in the provision of DSME and to provide DSMS? Finally, the Standards emphasize that the person with diabetes is at the center of the entire diabetes education and support process. It is the individuals with diabetes who do the hard work of managing their condition, day in and day out. DSME: The ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care.
This process incorporates the needs, goals, and life experiences of the person with diabetes or prediabetes and is guided by evidence-based standards. The overall objectives of DSME are to support informed decision making, self-care behaviors, problem solving, and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life. DSMS: Activities that assist the person with prediabetes or diabetes in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis beyond or outside of formal self-management training.
The type of support provided can be behavioral, educational, psychosocial, or clinical 11 — The provider s of DSME will document an organizational structure, mission statement, and goals. For those providers working within a larger organization, that organization will recognize and support quality DSME as an integral component of diabetes care. In the business literature, case studies and case report investigations of successful management strategies emphasize the importance of clear goals and objectives, defined relationships and roles, and managerial support.
Business and health policy experts and organizations emphasize written commitments, policies, support, and the importance of outcomes reporting to maintain ongoing support or commitment 16 , Documentation of an organizational structure that delineates channels of communication and represents institutional commitment to the educational entity is critical for success.
Perceived support from family and friends among adults with type 2 diabetes
According to The Joint Commission, this type of documentation is equally important for both small and large health care organizations Health care and business experts overwhelmingly agree that documentation of the process of providing services is a critical factor in clear communication and provides a solid basis from which to deliver quality diabetes education.
The provider s of DSME will seek ongoing input from external stakeholders and experts in order to promote program quality. Often, but not always, this external input is best achieved by the establishment of a formal advisory board. The result is effective, dynamic DSME that is patient centered, more responsive to consumer-identified needs and the needs of the community, more culturally relevant, and more appealing to consumers 17 , 19 , The provider s of DSME will determine who to serve, how best to deliver diabetes education to that population, and what resources can provide ongoing support for that population.
Currently, the majority of people with diabetes and prediabetes do not receive any structured diabetes education 19 , While there are many barriers to DSME, one crucial issue is access Providers of DSME can help address this issue by:. Clarifying the specific population to be served. Understanding the community, service area, or regional demographics is crucial to ensuring that as many people as possible are being reached, including those who do not frequently attend clinical appointments 9 , 17 , 22 — Different individuals, their families, and communities need different types of education and support Identifying access issues and working to overcome them.
It is essential to determine factors that prevent individuals with diabetes from receiving self-management education and support. The assessment process includes the identification of these barriers to access 32 — These barriers may include the socioeconomic or cultural factors mentioned above, as well as, for example, health insurance shortfalls and the lack of encouragement from other health providers to seek diabetes education 35 , A coordinator will be designated to oversee the DSME program.
The coordinator will have oversight responsibility for the planning, implementation, and evaluation of education services. Coordination is essential to ensure that quality diabetes self-management education and support is delivered through an organized, systematic process 37 , As the field of DSME continues to evolve, the coordinator plays a pivotal role in ensuring accountability and continuity in the education program 39 — This oversight includes designing an education program or service that helps the participant access needed resources and assists him or her in navigating the health care system 37 , 50 — Historically, nurses and dietitians were the main providers of diabetes education 3 , 4 , 60 — In recent years, the role of the diabetes educator has expanded to other disciplines, particularly pharmacists 65 — Reviews comparing the effectiveness of different disciplines for education have not identified clear differences in the quality of services delivered by different professionals 3 — 5.
However, the literature favors the registered nurse, registered dietitian, and pharmacist serving both as the key primary instructors for diabetes education and as members of the multidisciplinary team responsible for designing the curriculum and assisting in the delivery of DSME 1 — 7 , Expert consensus supports the need for specialized diabetes and educational training beyond academic preparation for the primary instructors on the diabetes team 69 — Professionals serving as instructors must document appropriate continuing education or comparable activities to ensure their continuing competence to serve in their instructional, training, and oversight roles Reflecting the evolving health care environment, a number of studies have endorsed a multidisciplinary team approach to diabetes care, education, and support.
The disciplines that may be involved include, but are not limited to, physicians, psychologists and other mental health specialists, physical activity specialists including physical therapists, occupational therapists, and exercise physiologists , optometrists, and podiatrists 68 , 74 , More recently, health educators e.
While DSME and DSMS are often provided within the framework of a collaborative and integrated team approach, it is crucial that the individual with diabetes is viewed as central to the team and that he or she takes an active role. Certification as a diabetes educator CDE by the National Certification Board for Diabetes Educators NCBDE is one way a health professional can demonstrate mastery of a specific body of knowledge, and this certification has become an accepted credential in the diabetes community An additional credential that indicates specialized training beyond basic preparation is board certification in Advanced Diabetes Management BC-ADM offered by the AADE, which is available for nurses, dietitians, pharmacists, physicians, and physician assistants 68 , 74 , Individuals who serve as lay health and community workers and peer counselors or educators may contribute to the provision of DSME instruction and provide DSMS if they have received training in diabetes management, the teaching of self-management skills, group facilitation, and emotional support.
For these individuals, a system must be in place that ensures supervision of the services they provide by a diabetes educator or other health care professional and professional back-up to address clinical problems or questions beyond their training 88 — For services outside the expertise of any provider s of DSME and DSMS, a mechanism must be in place to ensure that the individual with diabetes is connected with appropriately trained and credentialed providers. A written curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, will serve as the framework for the provision of DSME.
The needs of the individual participant will determine which parts of the curriculum will be provided to that individual.
Individuals with prediabetes and diabetes and their families and caregivers have much to learn to become effective self-managers of their condition. DSME can provide this education via an up-to-date, evidence-based, and flexible curriculum 8 , The curriculum is a coordinated set of courses and educational experiences. It also specifies learning outcomes and effective teaching strategies 92 , The curriculum must be dynamic and reflect current evidence and practice guidelines 93 — Recent education research endorses the inclusion of practical problem-solving approaches, collaborative care, psychosocial issues, behavior change, and strategies to sustain self-management efforts 12 , 13 , 19 , 74 , 86 , 98 — The following core topics are commonly part of the curriculum taught in comprehensive programs that have demonstrated successful outcomes 2 , 3 , 5 , 91 , — :.
Monitoring blood glucose and other parameters and interpreting and using the results for self-management decision making. The content areas will be able to be adapted for all practice settings.
Approaches to education that are interactive and patient centered have been shown to be effective 12 , 13 , — Also crucial is the development of action-oriented behavioral goals and objectives 12 — 14 , Creative, patient-centered, experience-based delivery methods—beyond the mere acquisition of knowledge—are effective for supporting informed decision making and meaningful behavior change and addressing psychosocial concerns , The diabetes self-management, education, and support needs of each participant will be assessed by one or more instructors.
The participant and instructor s will then together develop an individualized education and support plan focused on behavior change. The assessment process is used to identify what those needs are and to facilitate the selection of appropriate educational and behavioral interventions and self-management support strategies, guided by evidence 2 , 63 , — The education and support plan that the participant and instructor s develop will be rooted in evidence-based approaches to effective health communication and education while taking into consideration participant barriers, abilities, and expectations.
The instructor will use clear health communication principles, avoiding jargon, making information culturally relevant, using language- and literacy-appropriate education materials, and using interpreter services when indicated , — Evidence-based communication strategies such as collaborative goal setting, motivational interviewing, cognitive behavior change strategies, problem solving, self-efficacy enhancement, and relapse prevention strategies are also effective , — Periodic reassessment can determine whether there is need for additional or different interventions and future reassessment 6 , 72 , — A variety of assessment modalities, including telephone follow-up and other information technologies e.
Evidence suggests that the development of standardized procedures for documentation, training health professionals to document appropriately, and the use of structured standardized forms based on current practice guidelines can improve documentation and may ultimately improve quality of care , — The participant and instructor s will together develop a personalized follow-up plan for ongoing self-management support. While DSME is necessary and effective, it does not in itself guarantee a lifetime of effective diabetes self-care To sustain the level of self-management needed to effectively manage prediabetes and diabetes over the long term, most participants need ongoing DSMS Some patients benefit from working with a nurse case manager 6 , 86 , Case management for DSMS can include reminders about needed follow-up care and tests, medication management, education, behavioral goal setting, psychosocial support, and connection to community resources.
The effectiveness of providing DSMS through disease management programs, trained peers and community health workers, community-based programs, information technology, ongoing education, support groups, and medical nutrition therapy has also been established 7 — 11 , 86 , 88 — 90 , , — While the primary responsibility for diabetes education belongs to the provider s of DSME, participants benefit by receiving reinforcement of content and behavioral goals from their entire health care team Additionally, many patients receive DSMS through their primary care provider.
The provider s of DSME and DSMS will monitor whether participants are achieving their personal diabetes self-management goals and other outcome s as a way to evaluate the effectiveness of the educational intervention s , using appropriate measurement techniques. Effective diabetes self-management can be a significant contributor to long-term, positive health outcomes. The AADE Outcome Standards for Diabetes Education specify behavior change as the key outcome and provide a useful framework for assessment and documentation.
The AADE7 lists seven essential factors: physical activity, healthy eating, taking medication, monitoring blood glucose, diabetes self-care—related problem solving, reducing risks of acute and chronic complications, and psychosocial aspects of living with diabetes 93 , , Differences in behaviors, health beliefs, and culture as well as their emotional response to diabetes can have a significant impact on how participants understand their illness and engage in self-management. Assessments of participant outcomes must occur at appropriate intervals. For some areas, the indicators, measures, and time frames will be based on guidelines from professional organizations or government agencies.
The provider s of DSME will measure the effectiveness of the education and support and look for ways to improve any identified gaps in services or service quality using a systematic review of process and outcome data. Diabetes education must be responsive to advances in knowledge, treatment strategies, education strategies, and psychosocial interventions, as well as consumer trends and the changing health care environment.
By measuring and monitoring both process and outcome data on an ongoing basis, providers of DSME can identify areas of improvement and make adjustments in participant engagement strategies and program offerings accordingly. The Institute for Healthcare Improvement suggests three fundamental questions that should be answered by an improvement process :. Once areas for improvement are identified, the DSME provider must designate timelines and important milestones including data collection, analysis, and presentation of results Measuring both processes and outcomes helps to ensure that change is successful without causing additional problems in the system.
Outcome measures indicate the result of a process i. Process measures are often targeted to those processes that typically impact the most important outcomes. Duality of Interest. No potential conflicts of interest relevant to this article were reported. This version received final approval in July National Center for Biotechnology Information , U.
Journal List Diabetes Care v. Diabetes Care. Published online Dec Piette , PhD, 13 Andrew S. Carla E. Edwin B. John D. Andrew S. Author information Copyright and License information Disclaimer. Corresponding author. Corresponding authors: Linda Haas, vog. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See " National standards for diabetes self-management education. This article has been cited by other articles in PMC. What is the impact of using a structured curriculum in DSME? The Institute for Healthcare Improvement suggests three fundamental questions that should be answered by an improvement process : What are we trying to accomplish?
How will we know a change is an improvement? What changes can we make that will result in an improvement? Article Information Acknowledgments. References 1. Centers for Disease Control and Prevention. Brown SA.
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National Standards for Diabetes Self-Management Education and Support
Individual patient education for people with type 2 diabetes mellitus. Diabetes educators: implementing the chronic care model. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos: Latinos en Control. She has taken an active role, both in obtaining medical care an din the day to day management of both family health and lifestyle. An advocate of using planning to attain your goals, she teaches workshops across Canada for writers, women in business, and others. Account Options Sign in. Google Libros.
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