Joint Position Statement Addresses Importance of DSME

Nurse-managed protocols improved outpatient care in chronic illnesses
Nurse-managed protocols improved outpatient care in chronic illnesses
AADE, ADA and AND released position statement on when a patient should be referred for diabetes self-management education.

Joan K. Bardsley, MBA, RN, CDE, FAADE, discusses a presentation on a joint position statement from three organizations on the importance of diabetes self-management education.

NEW ORLEANS — A joint position paper on diabetes self-management education and support  (DMSE/S) recently released by three stakeholder diabetes organization was presented at AADE 2015, the annual meeting of the American Association of Diabetes Educators.

Authors representing each organization, including the American Diabetes Association (ADA), the AADE and the Academy of Nutrition and Dietetics (AND), discussed four critical time periods during which the need for DSME for a person with diabetes should be assessed. Specifically, these time periods were identified as diagnosis; on a yearly basis for health maintenance and prevention of complications; when new complications that influence self-management occur; and during transitions of care.

In addition to providing evidence for the need for education at these times, an algorithm was developed to summarize the critical times when health care providers should assess, offer and adjust self-management education. The algorithm identified areas of focus and action steps that should be considered by both the health care provider (HCP) at these times as well as during diabetes education.  

The intent of the algorithm is to provide clear guidance on when to refer, suggested focus of HCP visits and what educational focus will occur.  

Maggie Powers, PhD RD, CDE, of the International Diabetes Center, who represented the ADA, underscored the need for the position paper.

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and perform complex care activities, she noted. DSME/S provides the foundation to help people with diabetes navigate these decisions and activities. It has also been shown to improve health outcomes. Yet only 6.8% of individuals with newly diagnosed type 2 diabetes with private health insurance receive DSME/S within 12 months of diagnosis, and only 4% of Medicare participants received DSME/S and/or medical nutrition therapy.

Linda Siminerio, RN, PhD, of the University of Pittsburgh Diabetes Institute, provided the evidence behind the value of DSME/S as well as barriers that prevent referrals to intervention. Those who participate in DSME have a dramatic decline in HbA1c (0.76%), she noted, with its effectiveness directly correlating to the amount of time spent with the educator. She also said that sustained improvement requires time and follow-up.

However, the Centers for Medicare & Medicaid Services (CMS) has stated that only recognized programs can bill Medicare for diabetes self-management training (DSMT) services; that it only covers 10 hours of initial education; and that a patient must have a referral. DSME programs struggle to cover their costs, even operating at peak service load.

Melinda Maryniuk, RD, CDE, LD, of the Joslin Diabetes Center, who represented AND, detailed the specifics of the four critical times and the focus areas of both care and education. Guiding principles and key elements of initial and ongoing DSME/S that focused on engagement, information sharing, psychosocial and behavioral support, integration with other therapies, coordination of care across specialties, and facility-based care and community organizations were discussed.

Representing AADE, I was able to review the actual algorithm and elicit feedback from the audience on dissemination.

It was clear from the overwhelming response of the audience that the position paper needs to be provided to HCPs through wide distribution networks. It was also evident that the joint nature of the paper demonstrated the power of collaboration around a critical topic. 

Joan K. Bardsley, MBA RN CDE FAADE, is Assistant Vice President of Special Projects at MedStar Health Research Institute, and 2014 President of the American Association of Diabetes Educators.


  1. Bardsley J, Powers M, Maryniuk M, Siminerio L. F10 – Providing Persons with Diabetes – Diabetes Self-Management Education and Support: A Position Statement. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.