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Standards of Medical Care

Standards of Medical Care

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Published by Danish Ahmed Alvi

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Published by: Danish Ahmed Alvi on Jun 14, 2012
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01/31/2013

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Recommendations

c People with diabetes should receive
DSME according to national standards
and diabetes self-management support
whentheirdiabetesisdiagnosedandas
needed thereafter. (B)

c Effective self-management and quality
of life are the key outcomes of DSME
and should be measured and monitored
as part of care. (C)

c DSME should address psychosocial
issues, since emotional well-being is
associated with positive diabetes out-
comes. (C)

c BecauseDSMEcanresultincost-savings
and improved outcomes (B), DSME
should be adequately reimbursed by
third-party payers. (E)

DSME is an essential element of di-
abetes care (131–136), and national
standards for DSME (137) are based on
evidence for its benefits. Education helps
people with diabetes initiate effective self-
management and cope with diabetes when
they are first diagnosed. Ongoing DSME
and diabetes self-management support
(DSMS) also help people with diabetes
maintain effective self-management
throughout a lifetime of diabetes as they
face new challenges and as treatment ad-
vances become available. DSME helps pa-
tients optimize metabolic control, prevent
and manage complications, and maximize
quality of life in a cost-effective manner
(138).

S24 DIABETES CARE, VOLUME 35, SUPPLEMENT 1, JANUARY 2012

care.diabetesjournals.org

Position Statement

DSME and DSMS are the on-going
processes of facilitating the knowledge,
skill, and ability necessary for diabetes
self-care. This process incorporates the
needs, goals, and life experiences of the
person with diabetes. The overall objec-
tives of DSME and DSMS are to support
informed decision-making, self-care be-
haviors, problem-solving, and active col-
laboration with the health care team to
improve clinical outcomes, health status,
and quality of life in a cost-effective man-
ner (137).

Current best practice for DSME is a
skills-based approach that focuses on
helping those with diabetes make in-
formed self-management choices. DSME
has changed from a didactic approach
focusing on providing information to
more theoretically based empowerment
models that focus on helping those with
diabetes make informed self-management
decisions.Careofdiabeteshasshiftedtoan
approachthatismorepatientcenteredand
places the person with diabetes and his or
her family at the center of the care model
working in collaboration with health care
professionals. Patient-centered care is re-
spectful of and responsive to individual
patient preferences, needs, and values and
ensures that patient’s values guide all deci-
sion making (139).
Evidence for the benefits of DSME. Mul-
tiple studies have found that DSME is
associated with improved diabetes knowl-
edgeandself-carebehavior(131),improved
clinical outcomes such as lower A1C
(132,133,135,136,140,141), lower self-
reported weight (131), improved quality
of life (134,141,142), healthy coping
(143), and lower costs (144). Better out-
comes were reported for DSME inter-
ventions that were longer and included
follow-up support (DSMS) (131,145–149)
(150), that were culturally (151,152) and
age appropriate (153,154), that were tai-
lored to individual needs and prefer-
ences, and that addressed psychosocial
issues and incorporated behavioral strat-
egies (131,135,155–157). Both individual
and group approaches have been found
effective (158–161). There is growing evi-
dence for the role of community health
workers and peer (162,163) and lay leaders
(164) in delivering DSME and support in
addition to the core team (165).
Diabetes education is associated with
increased use of primary and preventive
services and lower use of acute, inpatient
hospital services (144). Patients who par-
ticipate in diabetes education are more
likely to follow best practice treatment

recommendations, particularly among
the Medicare population, and have lower
Medicare and commercial claim costs
(166,167).
National standards for DSME. The
nationalstandardsforDSMEaredesigned
to define quality DSME and to assist
diabetes educators in a variety of settings
to provide evidence-based education
(137).Thestandards,currentlybeingup-
dated, are reviewed and updated every
5 years by a task force representing key
organizations involved in the field of di-
abetes education and care.
Reimbursement for DSME. DSME,
when provided by a program that meets
national standards for DSME and is recog-
nized by ADA or other approval bodies, is
reimbursedaspartoftheMedicareprogram
asoverseenbytheCentersforMedicareand
Medicaid Services (CMS) (www.cms.gov).
DSME is also covered by most health insur-
ance plans.

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