Making the Case for Increasing DSME/S Use

Making the Case for Increasing DSME/S Use

According to recommendations from the American Diabetes Association, all individuals with diabetes should receive diabetes self-management education and support (DSME/S) when they are diagnosed with the disease and as needed thereafter. Recently, the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics released a joint position statement on DSME/S. Published in Diabetes Care and available at, the document aims to enhance patients’ experiences with diabetes care and education, improve overall health, and reduce diabetes-associated healthcare costs. “Currently, there is no consistency with regard to when and how patients with diabetes are referred to DSME/S by their healthcare providers,” says Maggie Powers, PhD, RD, CDE, who was lead author of the joint position statement. “Healthcare providers may also not fully recognize the benefits of DSME/S or how it should be utilized. The joint position statement addresses both of these considerations.” Research shows that DSME/S can improve A1C levels and have a positive effect on other clinical, psychosocial, and behavioral aspects of diabetes, says Jo Ellen Condon, RD, CDE. “Ultimately, DSME/S helps inform, empower, and engage patients to manage the disease on their own and with their healthcare providers,” she says. “Studies show that DSME/S can help lower A1C levels with just one patient visit to these services. Diabetes is a disease that requires patients to be proficient in many self-management skills, and DSME/S is critical to laying the foundation for long-term management. It helps patients become effective self-managers and assists them with important daily decisions about food, exercise, and medications.”   A Helpful Blueprint The joint position statement arms healthcare teams with...

Strategies for Improving Diabetes Care

This Physician’s Weekly feature was completed in cooperation with the experts at the American Diabetes Association. Over the last decade, healthcare providers in primary care settings and endocrinology practices have seen significant and steady improvements in the number of patients with diabetes who are achieving recommended levels of A1C, blood pressure (BP), and cholesterol. National data show that average A1C levels have declined from 7.82% in 1999-2000 to 7.18% in 2004, based on information collected in the National Health and Nutrition Examination Survey. Improvements in lipids and BP control have accompanied improvements in A1C, which in turn have led to substantial reductions in end-stage microvascular complications in individuals with diabetes. While these improvements are significant, data continue to suggest that there are areas for improvement in diabetes care. “Medications, technology, and enhanced insulin pens and pumps have had an important role in improving the management of diabetes,” says Martha M. Funnell, MS, RN, CDE. “However, some studies have shown that a substantial number of people with diabetes still have A1C, BP, and cholesterol levels that need to improve. Complicating the matter is that the quality of diabetes care varies considerably across providers and practice settings.” Examining Diabetes Intervention Over the years, researchers have implemented numerous interventions to improve adherence to recommended diabetes care standards, but care delivery systems are often fragmented and lack clinical information capabilities. In many cases, care delivery systems are poorly designed to manage this chronic disease. “Ideally, patients with chronic conditions like diabetes should be cared for by collaborative, multidisciplinary teams to facilitate self-management and self-care strategies for patients,” says Funnell. In the American Diabetes Association’s Standards of...