The standards warn that too few people with diabetes or prediabetes have access to programs that would help them.
Diabetes self-management education and support, also known as DSMES, gained recognition as an ongoing process, one that should evolve with life’s changes, under an updated set of standards released by the American Diabetes Association (ADA) and the American Association of Diabetes Educators (AADE).
The standards were published online in Diabetes Care and will appear in the September issue of Diabetes Educator. They are the result of work by a 22-member task force made up of physicians, nurses, pharmacists, and dietitians. The standards were last revised in 2014.
“The revised Standards reflect a shift in the healthcare landscape toward an outcomes-based model of care that goes beyond in-person education,” AADE Vice President of Science and Practice Leslie Kolb said in a statement. “The quality of education and support the person with diabetes receives is in direct correlation to how well they are able to self-manage the disease outside of time spent with a diabetes educator or other healthcare professional. With so many new technology-enabled models of care entering the practice setting, it is important that we set care guidelines so those affected with diabetes benefit the most.”
In formally changing the name of the education and support elements to DSMES, the 2 organizations are sending a message to payers that reimbursement for this care component cannot be a “one-and-done” enterprise.
The name change, the statement says, signals “the significance of ongoing support for people with diabetes and those at risk for developing the disease, particularly to encourage behavior change, the maintenance of healthy diabetes-related behaviors, and to address psychosocial concerns.”
“Given that self-management does not stop when a patient leaves the educator’s office, self-management support must be an ongoing process,” the statement reads.
AADE, which holds its annual meeting August 4-7, 2017, in Indianapolis, Indiana, joined with Evidence-Based Diabetes Management™ in December 2016 to publish a special issue on the need for payers to support DSMES throughout the lifespan, and especially at at 4 points identified in a 2015 position statement by AADE, ADA, and the Academy of Nutrition and Dietetics. Those points are:
While diabetes educators would like to see payers, and especially Medicare, fund more services than are currently covered, the challenge is that very few patients take advantage of what they could receive under the diabetes self-management training (DSMT) benefit that is now available. Estimates run as low as 5%.
For people with prediabetes, it’s even worse—it has been estimated that only about 100,000 of the 84 million people with prediabetes have taken the National Diabetes Prevention Program (DPP). As it stands, the proposed CMS rule for the Medicare DPP would largely leave digital providers on the sidelines; this group was seen as a solution to scaling the program to a wider audience.
“Currently, the majority of people with diabetes and prediabetes do not receive any structured diabetes education,” the authors of the new standards wrote. “While there are many barriers to DSME, one crucial issue is access.”
The authors say providers can address this issue by:
The document lays out standards in 10 areas, including program coordination, instructional staff, curriculum, individualization, tracking patient program, providing ongoing support, and measuring quality improvement.
“The National Standards for DSMES recognize that the person with diabetes is actually the center of the healthcare team, since it is estimated that a person with diabetes visits his or her primary care provider, on average, only 4 times a year,” said ADA’s Chief Scientific, Medical & Mission Officer William T. Cefalu, MD. “Therefore, it is critical that we support people with diabetes and their caregivers with the appropriate self-management guidance, education, and tools to improve patient outcomes and prevent or delay the many serious complications that can accompany diabetes.”
Haas L, Maryniuk M, Beck J, et al. National standards for diabetes self-management education and support [published online June 28, 2017]. Diabetes Care. https://doi.org/10.2337/dci17-0025.