Once the patient is educated, they should be allowed to take charge of their care.
DSMES is an important tool that helps in averting diabetes complications. With an excess of 79 million Americans being diagnosed with prediabetes or at an increased risk of developing diabetes, DSMES incorporates lifestyle changes designed for individuals with prediabetes to delay and even prevent progression to diabetes status. Participants are the ones who do the most in the daily management of their condition and the educators’ primary role should be to make the patient’s work easier.
DSMES are designed in reference to the National Standards for Diabetes Self-Management Education and support. Diabetes educators apply the DSMES standards as teaching tools for evidence-based education of diabetes patients. No single approach is identified as a solution to all problems as each patient is unique and should be treated according to their specific needs. The 10 DSMES program standards as outlined in the ADA guideline include;
Standard 1: Internal structure
All providers are expected to have an organizational structure with a mission statement and goals. DSME should be used and applied by the organization in providing diabetes care to its patients
Standard 2: External input
The community and other individuals with vested interest in the DSME program such as health care professionals, and people with diabetes should be involved in order to boost its quality. This will make it more effective, useful in different patient situations, more culturally relevant and attractive to the educators and patients alike.
Standard 3: Access
One of the major hindrances to DSME among both diabetic and prediabetic patients is access. Providers of DSME are better placed to determine who and how best to serve and this is only possible if they understand the community to ensure enough penetration in order to reach those who have no access to health care. Due to varying needs of different individual patients, families and communities, providers should offer different education alternatives. Barriers to diabetes self-management and support should also be identified and addressed where possible to lighten the burden for the patient.
Standard 4: Program coordination
Proper coordination is essential to ensure high quality DSMES is provided to the beneficiary on a continuous basis as they deal with their chronic condition. For proper coordination, providers will need to come up with a program that provides access to the resources that the patient needs and also help to easily navigate the health care system.
Standard 5: Instructional staff
Educators will include registered nurses, registered dietitians, trained pharmacists in offering DSME or CDE/BC-ADM certified professionals. A multidisciplinary team approach to diabetes treatment, care and support is recommended with active involvement of the diabetic patient. Lay health and community workers and peer counselors can also be trained in diabetes management, instructions of self-management skills, group facilitation and emotional support. They will in turn help in disseminating the service to the participants under supervision by a diabetes educator.
Standard 6: Curriculum
The educational program curriculum should be outcome oriented, current and follow practice guidelines. Needs for individual participants will determine which part of the curriculum will be used for specific people. It should be flexible to accommodate the needs of the patients and should include a simple description of diabetes, treatment options, nutrition, physical activity, medication use, blood glucose monitoring, prevention and treatment of acute complications, health and behavioral changes. It should also be patient centered and with delivery methods geared towards more informed decision making and meaningful behavioral change.
Standard 7: Individualization
Instructors should evaluate individual patient needs and form an individualized education and support plan focused on behavior change. Education provided should be evidence based and should be communicated to the participant in a language that they can comprehend.
Standard 8: Ongoing support
To sustain the level of self-management needed to effectively manage prediabetes and diabetes over the long-term, most participants need ongoing DSMS. The participant and the instructor should formulate a personalized follow-up plan for continuing self-management support. There should be collaboration with other members of the care team as this is essential in providing consistent care to the patient.
Standard 9: Patient progress
Providers evaluate effectiveness of educational intervention by checking patient progress and self-management goals at appropriate intervals.
Standard 10: Quality improvement
The DSME should be evaluated to determine its effectiveness in providing the best education and support and see whether there is room for improvement. This will include measuring and monitoring process and outcome data on an ongoing basis.
- DSMES incorporates lifestyle changes designed for individuals with prediabetes to delay and even prevent progression to diabetes status.
- The community and other individuals with vested interest in the DSME program such as health care professionals, and people with diabetes should be involved in order to boost its quality.
- There should be collaboration with other members of the care team as this is essential in providing consistent care to the patient.
Hass, L. Maryniuk, M. Beck, J. et al. National Standards for Diabetes Self-Management Education and Support. Diabetes Care. 2012 Nov; 35(11): 2393-2401. doi.org/10.2337/dc12-1707
Chamberlain JJ, Herman WH, Leal S, Rhinehart AS, Shubrook JH, Skolnik N, et al.
Josephat Macharia, PharmD candidate, Lecom School of Pharmacy class of 2018