Diabetes Care - E. DSME

E. DSME
Recommendations

* People with diabetes should receive DSME according to national standards when their diabetes is diagnosed and as needed thereafter. (B)
* DSME should be provided by health care providers who are qualified to provide that DSME based on their professional training and continuing education. (E)
* DSME should address psychosocial issues, since emotional well-being is strongly associated with positive diabetes outcomes. (C)
* DSME should be reimbursed by third-party payors. (E)

DSME is an essential element of diabetes care, and National Standards for DSME are based on evidence for its benefits. Education helps people with diabetes initiate effective self-care when they are first diagnosed. Ongoing DSME also helps people with diabetes maintain effective self-management as their diabetes presents new challenges and treatment advances become available. DSME helps patients optimize metabolic control, prevent and manage complications, and maximize quality of life, in a cost-effective manner.

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Evidence for the benefits of DSME

Since the 1990s, there has been a shift from a didactic approach with DSME focusing on providing information to a skill-based approach that focuses on helping those with diabetes make informed self-management choices. Several studies have found that DSME is associated with improved diabetes knowledge, improved self-care behavior, improved clinical outcomes such as lower A1C, lower self-reported weight, and improved quality of life. Better outcomes were reported for DSME that were longer and included follow-up support, were tailored to individual needs and preferences , and addressed psychosocial issues.

The national standards for DSME

ADA-recognized DSME programs have staff that includes at least a registered nurse and a registered dietitian; these staff must be certified diabetes educators or have recent experience in diabetes education and management. The curriculum of ADA-recognized DSME programs must cover all areas of diabetes management, with the assessed needs of the individual determining which areas are addressed. All ADA-recognized DSME programs utilize a process of continuous quality improvement to evaluate the effectiveness of the DSME provided and to identify opportunities for improvement.

Reimbursement for DSME

DSME is reimbursed as part of the Medicare program as overseen by the Center for Medicare and Medicaid Services (CMS) (http://www.hcfa.gov/coverage).

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AMERICAN DIABETES ASSOCIATION
DIABETES CARE, VOLUME 27, SUPPLEMENT 1, JANUARY 2004

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May 27, 10 • Diabetes mellitus