February 28, 2013

DSME and DSMS to Assist Diabetes Patients

The subject of diabetes self-management education (DSME) of 2011, and 2012 has taken on a companion in the guidelines for 2013. It is diabetes self-management support (DSMS) and this has been the subject of the last six blogs. This is an interesting change and I suspect that this is a change happening because of the shortage of diabetes educators and the ballooning numbers of patients with diabetes. This discussion is found in section F of the Standards of Medical Care in Diabetes—2013. Go to “Navigate This Article” in the second column and then down to “D” which will take you to Pharmacological and overall approaches to treatment, and then page down to “F. Diabetes self-management education and support”

This could be a two edged sword for the ADA when the physician shortage happens. There will be a shortage of physicians to diagnosis and treat diabetes and a shortage of CDE's. They help a minority of type 2 patients now and there is a greater need for more education now.

It will be interesting now that the National Standards for Diabetes Self-Management Education and Support has been updated, to see if there is actually any increase in the education received by diabetes patients or if the situation continues as is or even decreases. This is just another reason for finding ways of bringing more patients with diabetes into training to assist other patients. Research has proven this works and often with better results than professionals.

Since this should be important for every patient to know and be able to know whether their doctor follows the ADA guidelines, I am quoting the recommendations:
  1. People with diabetes should receive DSME and diabetes self-management support (DSMS) according to National Standards for Diabetes Self-Management Education and Support when their diabetes is diagnosed and as needed thereafter.
Nice of them to say this, but even CDEs don't want to teach people with type 2 diabetes when they can spend all their time with type 1's. Read the first comment to this blog by Bennet at YDMV. Rather revealing.
  1. Effective self-management and quality of life are the key outcomes of DSME and DSMS and should be measured and monitored as part of care.
This is what should happen. Unfortunately, until the rules are changed, it isn't going to happen.
  1. DSME and DSMS should address psychosocial issues, since emotional well-being is associated with positive diabetes outcomes.
At least I must give them credit for trying, but the CDEs are not qualified to deal with depression and emotional well-being.
  1. DSME and DSMS programs are appropriate venues for people with prediabetes to receive education and support to develop and maintain behaviors that can prevent or delay the onset of diabetes.
With the shortage of CDEs, don't expect any help for people with prediabetes. If the Centers for Medicare and Medicaid Services (CMS) continue to promote prevention, maybe another group will be able to move into this void and provide the help and education these people need.
  1. Because DSME and DSMS can result in cost-savings and improved outcomes, DSME and DSMS should be adequately reimbursed by third-party payers.”
We know that many physicians in endocrinology are attempting to follow these guidelines when they have certified diabetes educators (CDEs) available, but some just don't have CDEs available. Most doctors outside the diabetes clinics are not following this and won't because of conflicts with CDEs. Others just don't have them available in many rural areas of the country. Therefore, this points out the need for other measures and methods that are necessary for people to educate themselves about diabetes. And then there may be a place for peer-to-peer workers and peer mentors that have received some training. Somebody needs to fill the holes that the CDEs can't be bothered with.

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