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SELF-MANAGEMENT

DIABETES SELF-MANAGEMENT EDUCATION AND TRAINING

Definition of DSME/T Desired outcomes of DSME/T National Standards Diabetes Educator Practice Levels DSME/T Recognition and Accreditation DSME/T Curricula Underserved Populations

Definition of DSME/T
Diabetes self-management education and training (DSME/T) is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and successfully self-manage the disease and its related conditions. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards.

Desired outcomes of DSME/T
The overall objectives of DSME/T are to support the following in order to improve clinical outcomes, health status, and quality of life:
  • Informed decision-making
  • Self-care behaviors
  • Problem-solving and active collaboration with the health care team

Seven specific self-care behaviors developed by the American Association of Diabetes Educators, known collectively as the AADE7™, have been defined to guide the process of DSME/T and help patients achieve behavior change.

Specific self-care behaviors
  • Healthy eating
  • Being active
  • Monitoring
  • Taking medication
  • Problem solving
  • Healthy coping
  • Reducing risks

National Standards for Diabetes Self-Management Education and Support
National Standards for Diabetes Education and Support were designed to define quality diabetes self-management. The Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community. Organizations seeking Medicare reimbursement for DSME/T must meet the National Standards.

These five guiding principles inform the regular review and revision of the National Standards for Diabetes Self-Management Education and Support:
  1. Diabetes education is effective for improving clinical outcomes and quality of life, at least in the short-term.
  2. DSME/T has evolved from primarily didactic presentations to more theoretically based empowerment models.
  3. There is no one "best" education program or approach; however, programs incorporating behavioral and psychosocial strategies demonstrate improved outcomes. Studies show that culturally and age-appropriate programs improve outcomes and that group education is effective.
  4. Ongoing support is critical to sustain progress made by participants during the DSME/T program.
  5. Behavioral goal-setting is an effective strategy to support self-management behaviors.

Diabetes Educator Practice Levels Overview
The Diabetes Educator Practice Levels support the delivery of DSME/T within the framework of the AADE7™ Self-Care Behaviors and The National Standards for Diabetes Self-Management Education and Support. The purpose of the practice levels is to increase access to DSME and achieve better patient care by:

  1. Delineating the roles and responsibilities of the multiple levels of diabetes educators and associate diabetes educators (for example, community health workers, medical assistants, etc.)
  2. Suggesting a career path for diabetes educators and associate diabetes educators
  3. Clarifying the contribution that can be made by individuals who have the knowledge, capability, diversity, and language skills needed to address diabetes self-management and support in a variety of settings.

A companion to the Diabetes Educator Practice Levels are the AADE's Competencies for Diabetes Educators which are clustered into five main domains. The five domain competencies are specific skills needed across the continuum of care for the various levels of practice, from novice to clinical expert.

  • Domain I: Pathophysiology, Epidemiology, and Clinical Guidelines of Diabetes
  • Domain II: Culturally Competent Supportive Care Across the Lifespan
  • Domain III: Teaching and Learning Skills
  • Domain IV: Self-Management Education
  • Domain V: Program and Business Management

DSME/T Recognition and Accreditation
In 1997, the federal Balanced Budget Act passed, permitting the U.S. Health Care Financing Administration (HCFA) - now called the Centers for Medicare and Medicaid Services (CMS) - to provide expanded coverage for DSME/T.

Three organizations were originally authorized by CMS to determine whether diabetes education programs meet required standards. These 3 organizations were deemed "certifying bodies" and include the American Diabetes Association (ADA) which was authorized in 2001, the Indian Health Service (IHS) authorized in 2002, and the American Association of Diabetes Educators (AADE) authorized in 2009. (The IHS discontinued this work in 2010; more information on this transition is on the IHS website.)

Each certifying body has a formal application process and requires supporting documentation. Both AADE and ADA require a fee with applications. The certifying bodies also require annual reports and renewals and have a process for auditing existing programs to ensure continued compliance with certification criteria. Both organizations have volunteer auditors who are trained reviewers and conduct random program audits. Both also offer multi-site recognition/accreditation. Each certifying body uses a yes-or-no checklist for standards being met or not met. Although their terminology differs, the programs' content and concepts are all based on the National Standards for Diabetes Self-Management Education and Support.

A 2010 article (reference 2 below) in the Diabetes Educator compares the requirements, processes, and costs associated with the ADA Education Recognition Program (ERP) and the AADE Diabetes Education Accreditation Program (DEAP). See the table Overview Comparison of National Accreditation.

DSME/T Curricula
Many curricula exist for diabetes self-management education. However, regardless of the curriculum used, a DSME/T program must meet the National Standards for Diabetes Self-Management Education and Support and successfully obtain ADA recognition or AADE accreditation in order to bill Medicare and many private health plans. This is critical to help ensure program quality and long-term sustainability.

Many curricula are available online; some are available for no cost. Curricula have been developed for specific audiences. Below is not a comprehensive list, but rather a sample of types of curricula that are available. Refer to Standard 6 in the National Standards for Diabetes Self-Management Education and Support for more information on curriculum requirements.

Professional - led training Lay Health Worker-led Training

The Diabetes Empowerment Education Program (DEEP), Stanford Diabetes Self-Management Program (DSMP), and Project Dulce are curricula being used as part of the Everyone with Diabetes Counts initiative supported by the Centers for Medicare and Medicaid Services' (CMS) 11th Scope of Work. The 11th Scope of Work funds the Quality Innovation Networks, former Quality Improvement Organizations, now referred to as Quality Innovation Networks - Quality Improvement Organizations (QIN-QIOs), to increase Medicare beneficiaries' access to ADA-recognized or AADE-accredited DSME/T programs as well as diabetes self-management programs using DEEP, Project Dulce, or the Stanford curriculum that may or may not have recognition/accreditation.

For more information on areas where the work of the QIN-QIOs and 1305 grantees align, please refer to the
1305 alignment document

Underserved Populations
Indian Health Service Division of Diabetes Treatment and Prevention (DDTP), Standards of Care and Clinical Practice Recommendations: Type 2 Diabetes Self-Management Education

The IHS website has comprehensive information for the prevention and treatment of diabetes. The site has best practices, curricula, and clinical guidelines.

Diabetes Self-Management Education (DSME): Establishing a Community-Based DSME Program for Adults with Type 2 Diabetes to Improve Glycemic Control - An Action Guide (updated 2009). Developed by the Partnership for Prevention in Washington, DC, this is a step-by-step guide for a Program Coordinator who wishes to start a community-based DSME program. Roles for public health are outlined in the guide.