Increased Utilization of Diabetes Self-Management Education Is Necessary

The International Diabetes Federation (IDF) recognized the need to focus on the education aspect of diabetes management and provide a forum to discuss the latest information available on its delivery at this year’s World Diabetes Congress.

Diabetes self-management education and support (DSME/S) has long been accepted and valued in contributing to improved outcomes and reduced costs for those with diabetes. However, there has been inconsistency in the knowledge of what comprises an effective intervention. 

A systematic review was undertaken by the American Association of Diabetes Educators (AADE) and presented at AADE 2015 to answer 2 specific questions:  “Does the provision of quality DSME/DSMS improve glycemic control?” and “Can the evidence base provide insight to define what quality DSME/DSMS looks like?” 

The answers were very enlightening.

As previously reported and understood, engaging adults with type 2 diabetes in DSME results in statistically significant and clinically meaningful improvement in HbA1c. In addition, data demonstrate that DSME that involves both group and individualized engagement results in the greatest improvement in HbA1c more than group or individual engagement alone. The data also show DSME is more likely to result in statistically significant improvements when a team, rather than a single individual, is involved in its provision.¹

The evidence also suggests that limiting DSME contact time to 10 hours may not be sufficient. This finding is important because Medicare limits reimbursement for DSME in the first year of receiving the benefit to 10 hours.¹

Yet despite the evidence of the impact of DMSE/S, data from the Centers for Disease Control and Prevention indicate that 6.8% of adults with diabetes who have private insurance engage in DSME during the year in which they are diagnosed.² Additionally, data from the Centers for Medicare and Medicaid Services indicate that 5% of adults with diabetes covered by Medicare engage in DSME during the year in which they are diagnosed.³ And finally, data from National Health and Nutrition Examination Survey suggest that 45% of people with diabetes do not achieve glycemic targets.⁴

To help correct the discrepancy between having an intervention that has been shown to improve outcomes and the actual utilization of that intervention, a position paper was developed by 3 organizations — the American Diabetes Association (ADA), the AADE, and the Academy of Nutrition and Dietetics (AND) — in collaboration with representatives of the National Diabetes Education Program (NDEP). There is still a gap in the knowledge by those with diabetes and healthcare providers on what DMSE entails, how and when to access it, and the expectations for those who participate in the process. This position statement provides clinicians with the information required to better understand the educational process and expectations for DSME/S and the integration of DMSE/S into routine care.⁵

To accomplish this, a practical and straightforward diabetes education algorithm, was created that defines when, what, and how DSME/S should be provided for adults with type 2 diabetes. The algorithm is available on all the organizations’ websites

It is our hope that this focus on DMSE/S will help to increase the understanding and utilization of this important intervention.

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.

References

1. Scherr D, Bardsley J. W08 – A Systematic Review of the Literature of the Effect of DSME on HbA1c for People with Type 2 Diabetes. Presented at the AADE 2015; August 5-8, 2015; New Orleans, LA.
2. Li R, Shrestha SS, Lipman R, Burrows NR, Kolb LE, Rutledge S. Diabetes Self-Management Education and Training Among Privately Insured Persons with Newly Diagnosed Diabetes — United States, 2011–2012. MMWR. 2014;63(46):1045-1049.
3. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. Use of Medicare’s Diabetes Self-Management Training Benefit. Health Educ Behav. 2015;42(4):530-538.
4. Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is Glycemic Control Improving in U.S. Adults? Diabetes Care. 2008;31(1):81-86.
5. Powers MAA, Bardsley J, Cypress M, et al. Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educ. 2015;41(4):417-430.
6. Bardsley JK. Self-management support in primary care – AADE review on effectiveness. Presented at the World Diabetes Congress; November 30-December 4, 2015; Vancouver, Canada.