Introduction
I’ve had the privilege to partner with clinical leaders from the diabetes education and support community to revise the 2022 National Standards for Diabetes Self-Management Education and Support (DSMES) recently published in the Journals of Diabetes Care and the Science of Diabetes Self-Management & Care.
Updated every five years, these standards provide invaluable guidelines for operating an effective DSMES program. It is a requirement that accredited programs recognized by the Association of Diabetes Care & Education Specialists (ADCES) meet these guidelines to bill for Medicare. I also recommend that all programs delivering diabetes support should consider and incorporate these standards to ensure that participants are achieving positive health outcomes through high quality, clinically relevant diabetes care.
With more than 122 million, or one-third, of all Americans at risk for developing serious complications from chronic hyperglycemia associated with diabetes, the importance of promoting and enabling greater access to DSMES could not be greater in 2022 and beyond. However, the bleak reality is that less than 5% of Medicare beneficiaries with diabetes and only 6.8% of privately insured people with diabetes have utilized DSMES services, even though these programs are proven to reduce diabetes risk.
The rise and growing adoption of virtual diabetes care models, like those delivered by Cecelia Health, provides me with great optimism for the future health of our nation and for those living with diabetes. However, there is much work to be done if we are to provide the adequate level of education and support needed to help people effectively self-manage their diabetes and live healthy lives.
It is recommended that payers and providers alike utilize these standards as a guide and critical framework to support the development of population health and remote care management programs and when evaluating remote care partners. Here are some things for diabetes care stakeholders to consider in 2022:
People Living with Diabetes Should Not be Limited in Their Ability to Access DSMES Support
The value of participating in DSMES is lifelong and essential to better understanding and managing diabetes. Studies have shown that participation can reduce overall risk of complications and lower one’s A1c. Managing diabetes is a 24/7 job and DSMES helps equip individuals with the knowledge and tools to succeed. The ADCES & ADA have identified four critical times that a person living with diabetes needs to visit a diabetes educator:
- When diabetes is diagnosed
- Annually
- When complicated situations develop
- When transitions in life occur
As the statistics show, far too few are engaging in DSMES at the identified critical times. For anyone living with a chronic condition, personalized education is essential for effective management of the disease given that everyone’s motivations, barriers, and challenges are unique. DSMES programs deliver a personalized and responsive educational framework for individuals. Payers and providers should be proactive in promoting access to programs, so individuals know they are available and where to access them. This process also needs to be simple and seamless.
The Path to Initial and Ongoing DSMES Accreditation Should be Streamlined
To effectively expand access to and adoption of DSMES, people need to have options that meet their preferences. With the rise of digital health technologies and the advent of the COVID-19 pandemic, we are witnessing a dramatic transformation in care right before our eyes that doesn’t appear to show any signs of slowing down anytime soon. In February 2021, use of telehealth was 38x higher than pre-pandemic levels. We need work together to increase the number of accredited programs and make it an easier process for organizations to maintain their accreditation to ensure high quality and recognizable options for individuals.
To address this, a key revision that was made was reducing the number of required standards from ten to six to make accreditation more efficient and better defined. Additionally, clarification and direction related to DSMES documentation structure was improved—reducing the burden related to documentation allows for a greater focus on providing high quality and compassionate education to those with diabetes. It is my hope that this will pave the way in creating more options for people living with diabetes.
Referral for DSMES Should be Seamless and Efficient
By 2025, the shortage of endocrinologists in the United States will expand to 2700 without an increase in the number of fellows trained. This shortage will place increased strain on providers as they will carry a higher provider to patient ratio and will also have negative consequences for patients who will find it difficult to access needed specialty care. As providers are already some of the most time constrained actors in our healthcare system, we need to make it an easy process for providers to refer their patients for DSMES. Moreover, providers should be able to track patient completion of DSMES and work with their teams to conduct appropriate follow up. Additionally, individuals with diabetes having the ability to self-refer for accredited DSMES, if established criteria is met, is something to be explored with payors. With changes to health data access and improved interoperability, I’m optimistic that these changes will facilitate greater visibility and accountability for stakeholders involved in DSMES.
Increased Family & Caregiver Involvement in DSMES is Paramount
Many individuals living with diabetes depends on their caregivers to support their ongoing self-management needs. Caregivers often provide financial support, support the successful adoption and management of diabetes devices, and attend many doctors’ visits with their loved ones. Studies have shown that higher proficiency of caregivers in responding to blood glucose fluctuations is a critical determinant of both medical and psychosocial outcomes for people living with diabetes (DCCT; Diabetes Control & Complications Trial Research Group, 1993). Thus, caregivers have an essential role to play in the care plans of many people living with diabetes.
The updated standards also place greater emphasis on support outside of DSMES through involving family and caregivers. Our key recommendation is that, when possible, these critical stakeholders should participate throughout the DMSES received to gain the knowledge and skills that are essential to promoting positive health outcomes. All diabetes education programs should consider caregivers when developing responsive curriculums and allow for their participation. Moreover, benefit structures should be written to allow for participation and reimbursement for caregiver participation.
In conclusion, it takes a village to move the needle on improving opportunity and access to DSMES for those who carry the heavy load of managing diabetes. I encourage everyone to review and share the 2022 National Standards for DSMES within your networks to increase awareness of the need for DSMES with hope of expanding DSMES opportunities across the entire healthcare community.
About the Author
Teresa McArthur is a Registered Dietitian and Certified Diabetes Care and Education Specialist with a Masters Degree in Clinical Nutrition. Teresa has experience working with diabetes, health and wellness, nutrition support, weight and chronic disease management. She has worked in various capacities including higher education, long-term acute care, critical care, community nutrition, and inpatient and outpatient accredited diabetes management programs.
Teresa has a wealth of experience working with children and adults with type 1 and type 2 diabetes and women with gestational diabetes while serving as a diabetes educator in the inpatient, outpatient and community settings. Teaching patients how to understand their diabetes and providing them with the tools they need to manage their diabetes has been her passion for many years. She believes nothing is more rewarding then to inspire and empower patients with the knowledge and skills they need to reach their goals while in return witness their health and quality of life improve. Teresa understands that diabetes impacts every aspect of a person’s life; therefore, working with patients to identify specific barriers and setting realistic and sustainable goals is the key to lifelong success.