The streamlined 2022 revision of the National Standards for Diabetes Self-Management Education and Support (DSMES) was published in Diabetes Care. Key goals include combining quality coordination and DSMES under one standard, personalizing patient support, reducing administrative burden with a clear documentation structure, emphasizing organizational support for DSMES services, and clarifying metrics and outcomes for Continuous Quality Improvement.
The DSMES, called the “National Standards” by the American Diabetes Association (ADA) and the Association of Diabetes Care & Education Specialists (ADCES), was revised by a Taskforce of 22 diabetes care and education specialists who said their goal was to give people with diabetes (PWD) the skills and knowledge to confidently accept responsibility and self-manage their disease. The group noted that “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 2022 revision, last issued in 2017, has been streamlined from 10 to 6 main goals:
Support for DSMES Services
Support from internal leadership and sponsor organizations, according to the professionals who drafted the 2022 National Standards, is key to delivering effective DSMES services. At minimum, they said support should include referring PWD to a qualified healthcare professional and a diabetes care and education specialist. An effective support structure should be focused on increasing utilization of DSMES services.
Population and Service Assessment
It is important for DSMES teams, according to the Taskforce, to identify and understand their target population’s demographic features to tailor DSMES to patient needs. This includes identifying and addressing potential barriers to services, such as socioeconomic, cultural, and health insurance.
The DSMES team can include nurses, pharmacists, dieticians, social workers, exercise physiologists, as well as providers who are Board Certified in Advanced Diabetes Management or Certified Diabetes Care and Education Specialists, according to the Taskforce. The team should be focused on delivering person-centered quality information about diabetes management. In order to ensure continued delivery of quality care, DSMES team members should have documented continuing education. A quality coordinator should have an understanding of the team’s skills, as well as marketing, healthcare administration, and business management.
Delivery and Design of DSMES Services
Recent advances in technology have expanded the possibilities of how DSMES services can be delivered, the Taskforce noted. The most effective strategies include interactive teaching styles which include meaningful discussions that are culturally adapted to the target population. Regardless of the structure of the specific DSMES program, in addition to ongoing support and follow-up, the core content must include: pathophysiology of diabetes and treatment options; healthy coping skills; nutritional eating; active lifestyle components; medication adherence; disease monitoring; acute and chronic risk reduction; and problem solving and behavioral change strategies.
The 4 most crucial timepoints in the life of a PWD are at diagnosis, when the patient is not meeting treatment goals, when complications develop, and when life or care transformations occur. Each DSMES intervention, the Taskforce said, should focus on what each patient needs during these challenging times and to create a DSMES plan based on the PWD’s preferred deliver method and timing. The steps for formulating a person-centered DSMES plan are assessing the unique needs of the patient by evaluating their health status, learning level, lifestyle, and psychosocial needs. All of these components should be addressed in the plan and the team should use jargon-free, culturally relevant information during DSMES session. Throughout DSMES care, PWD should be assessed for self-management outcomes. Ideally, the ongoing assessment process would be supported by online information portals, electronic health records, text messaging, and similar platforms.
Measuring and Demonstrating Outcomes of DSMES Services
DSMES outcomes can be grouped into 5 core features: process, clinical, psychosocial, patient-reported, and patient-generated outcomes. These outcomes, according to the Taskforce, over a wide range of data, from session attendance to glycemic control and risk-reduction behaviors.
“Implementation science is an emerging and cost-effective way to study real-world methods that promote integration of research and evidence into practice and policy,” the Taskforce said. “DSMES is an area well established for healthcare professionals to utilize a robust body of evidence to evaluate outcomes, reduce costs, and decrease health disparities while addressing and reducing health inequities.”
Disclosure: Multiple authors declared affiliations with private industry. Please see the original reference for a full list of authors’ disclosures.
Davis J, Fischl AH, Beck J, et al. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care. 2022;45(2):484-494. doi:10.2337/dc21-2396