Diabetes Self-Management Education and Support: Component of Standard Diabetes Care 1, 2 “… Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications …” 1 Using this slide set Use these slides together or either one alone. They can be included when giving most presentations on diabetes and/or education. You can share them widely with other colleagues so they too can easily address the importance of DSMES in their presentations. Encourage providers to include these slides in any presentation on the management of diabetes. Main point of this slide DSMES is a component of standard diabetes care. Referrals to a DSMES program are recommended for quality diabetes care. Talking points Updated annually, the American Diabetes Association’s Standards of Medical Care in Diabetes provides clinicians and others with the components of diabetes care, general treatment goals and tools to evaluate the quality of care. It is published every January as a supplement to Diabetes Care. ADA provides complimentary access. The introduction to the 2017 Standards of Care begins: “Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk-reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications. Significant evidence exists that supports a range or intervention to improve diabetes outcomes…” Four national health organizations collaborated and developed a position statement to define when DSME should be provided for type 2 diabetes and what is included at each of the time points for quality diabetes care. Many of the recommendations are appropriate for other types of diabetes. The four organizations are the American Diabetes Association, the American Association of Diabetes Educators, the Academy of Nutrition and Dietetics, and the National Diabetes Education Program. Additionally, the National Board of Certified Diabetes Educators (NBCDE) supports the position statement and its implementation. This presentation will provide an overarching review of the benefits of DSMES and the 4 critical times to assess, provide, adjust, and refer for DSMES. The goal is to increase the number of persons with diabetes who benefit from DSMES. The Joint Position Statement on DSMES includes an algorithm that describes specifics of when and what DSMES should be provided; thus helping to clarify and guide referral for DMSES. It includes a checklist of when to refer and a checklist of needed education and support for clinical, psychosocial, and behavioral aspects of diabetes care. The algorithm can be reproduced as a stand alone document as an easily available resource. Resources ADA Standards of Medicare Care in Diabetes. Diabetes Care (2017) 1. ADA. Standards of Medical Care. Diabetes Care (2017) 2. Powers MA et al. Joint Position Statement on DSMES. Diabetes Care, TDE, JAND (2015)

Recognizing the many benefits of DSMES If DSMES was a pill, would you prescribe it? 1 Main points of this slide The 5-point rating system used to compare diabetes medications was then applied to DSMES. The ratings scorecard for DSMES is impressive and confirms the benefits and value of DSMES. The scorecard challenges providers to rethink the inclusion of non-pharmacologic therapy in their treatment plans and make referrals to a DSMES program. It can be used as a decision-aid in discussion with patients. Talking points A 2016 paper in Diabetes Care by Maggie Powers, PhD, RD, CDE, raised the question “If DSME was a pill, would you prescribe it?” Diabetes medications have been rated on five criteria – efficacy, hypoglycemia risk, weight changes, side effects, and cost. Dr. Powers applied this rating system to DSMES to provide an objective comparison to metformin. Metformin was selected as it is a commonly used first line, low cost medication therapy. The scorecard challenges providers to rethink the inclusion of non-pharmacologic therapy in their treatment plans and make referrals to DSMES programs. For the DSME ratings, research focusing on medical nutrition therapy (MNT) alone and MNT with DSME was included. Referrals to DSME and MNT are recommended for all patients with diabetes. The scorecard can be used as a decision-aid in discussion with patients. [Presenter – You can review each criteria with the following information or research provided in the paper or briefly compare and go to the last bullet point and summary statement.] Efficacy was rated high for DSME as research shows DSME lowers A1c by 1 or more percentage points. Metformin has the same rating. Hypoglycemia risk was rated low; a rating of low was selected as hypoglycemia may occur as better control is achieved and further adjustments are made. Metformin was rated low hypo risk. Weight: A number of studies show that weight loss is achievable and sustainable through lifestyle intervention, even when insulin is being initiated. Improvement in glycemic control also occur with weight maintenance. Weight change was rated as neutral or loss with DSMES. Metformin had the same rating. Side effects: There have been no reported side effects with DSMES. However, there are potential side effects with metformin, most notably related to GI disturbances. Although rare, lactic acidosis is also noted. Cost: The rating for DSMES is low to cost savings. Medicare reimburses for recognized and accredited DSMES programs and many private insurers follow suit. Research shows that longer term cost savings are realized through decreased hospitalizations, emergency room visits, and better control. Metformin is rated low because of its generic status resulting in low out of pocket cost. Psychosocial benefits: This criteria is added to the scorecard to acknowledge the many benefits realized through DSMES: Increases or improves quality of life, self-efficacy, empowerment, healthy coping, knowledge, self-care behaviors, adherence to a food plan, healthier food choices, increased physical activity, and use of glucose monitoring data. Reduces blood pressure and lipids, problems managing diabetes, the incidence of acute complications, and the risk of long-term complications. In summary, the ratings scorecard for DSMES is impressive and confirms the benefits and value of DSME. The scorecard challenges providers to rethink the inclusion of non-pharmacologic therapy in their treatment plans. It can be used as a decision-aid in discussion with patients.   Resources Powers M. 2016 Health Care & Education Presidential Address: If DSME Were a Pill, Would You Prescribe It? Diabetes Care (2016) Inzucchi S et al. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care (2015) ADA Standards of Medicare Care in Diabetes. Diabetes Care (2017)   1. Powers MA. Diabetes Care (2016)