Diabetes Training Programs Are Underused

Study leader Rui Li, who is a researcher with the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention in Atlanta told Reuters Health in an email that diabetes training programs are underused.  For me it is easy to understand why they are underused. To begin, there are too few qualified people to teach diabetes self-management education and training (DSME/T) and some of those that could do this are more enamored with using mandates and mantras than actually teaching.

The other problem with the general delivery of the article, because no distinction is made between type 1 and type 2 diabetes. Some reference is made about those on insulin taking the classes, but here again, we are left guessing. A comment is made that those in the North Central region of the U.S. and in metropolitan areas generally have a higher participation rate in DSME/T. This is understandable as there are more certified diabetes educators in metropolitan areas and less in rural areas and often none in many rural areas.

The curriculum of DSMT often includes information about diabetes disease process and treatment options; healthy lifestyle; blood glucose monitoring; preventing, detecting and treating diabetes complications; and developing personalized strategies for decision making

When DSME/T is done correctly, it helps patients improve glycemic management which in turn reduces the risk for diabetes complications, hospitalizations, and health care costs. The study looked at claims data for almost 100,000 adults with private insurance that were diagnosed with diabetes in 2009 to 2012. They found that less than seven percent participated in diabetes self-management education training. Although many people with diabetes know about the classes, a major issue was that individuals with diabetes may not be attending DSME/T once they are referred.

Researchers said better marketing efforts, focusing on education of doctors, patients, and support persons, are needed to publicize the DSME/T programs. Promotion of the message that DSME/T is the foundation of diabetes care might be helpful in promoting the programs. In my own opinion, certified diabetes educators need to improve their method of delivery, actually do education, and stop with the mandates and mantras and then more people might attend the education classes.

The researchers stated that everyone in the study had private insurance, but Medicare and Medicaid programs cover the cost of DSME/T. They said that 40 states mandated private insurance cover DSME/T, but there are private plans that still do not cover it and others that require a co-payment. A person not involved in the study, Kate Lorig, director of the Stanford Patient Education Research Center at Stanford School of Medicine in California, stated that the system for becoming a recognized diabetes program eligible for Medicare reimbursement is difficult and restrictive, plus it is expensive for a program to apply for and receive recognition.

Lorig thinks the way to boost the use of diabetes training programs is to lower the barriers to reimbursement faced by the health care providers who do the training.

Right now reimbursement is usually based on first having a billing code and then have the right content in the education and the right person giving it, she said.