U.S. Department of Health and Human Services

Principle 3: Provide Self-Management Education & Support

Effective self-management education and ongoing self-management support are essential to enable people with or at risk for diabetes to make informed decisions and to assume responsibility for the day-to-day management of their disease or risk factors. 1–3

Definition and purpose of diabetes self-management education (DSME) and diabetes self-management support (DSMS)

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DSME is an ongoing process to facilitate a person’s knowledge, skill, and ability for self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards. Objectives are to support informed and shared decision making, self-care behaviors, problem solving, and active collaboration with the health care team to improve clinical outcomes, health status, and quality of life.

DSMS involves health care providers in activities that help people with diabetes to implement and sustain ongoing behaviors needed to manage their diabetes. These activities include behavioral, educational, psychosocial, and clinical support.

What is self-management?

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Self-management is an active, ongoing process that changes as the person’s needs, priorities, and situations change. Diabetes educators and others in the health care team (see Resources) can help people with or at risk for diabetes to:

  • Understand the diabetes disease process and the risks and benefits of treatment options.
  • Incorporate healthy eating behaviors into their lifestyles.
  • Incorporate physical activity into their lifestyles.
  • Understand how to use medications safely and for their best effect.
  • Perform self-monitoring of blood pressure when prescribed.
  • Perform self-monitoring of blood glucose when prescribed and demonstrate how to interpret and use the results for self-management decision making.
  • Understand how to prevent, detect, and treat high and low blood glucose.
  • Understand self-management needs during illness or medical procedures.
  • Prevent, detect, and treat chronic diabetes complications.
  • Develop personal strategies to address psychosocial issues and concerns.
  • Develop personal strategies to promote health and behavior change.

(Based on American Diabetes Association/American Association of Diabetes Educators National Standards 4 and Standards of Practice and Standards of Professional Performance for Registered Dietitians [Generalist, Specialty, and Advanced] in Diabetes Care 5)​

How to provide self-management and support

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People with diabetes should receive DSME according to national standards, as well as DSMS. There is no one “best” education program or approach; however, strategies such as self-directed behavioral goal setting and problem solving improve outcomes. Programs that address health literacy and are culturally and age appropriate improve outcomes. Family members can potentially support and reinforce self-management education if they are included in the process.

In addition to one-on-one encounters, approaches such as group visits, scheduled planned visits, telehealth, and other technologies have been used effectively to provide education to people with diabetes.

Amount and frequency of diabetes self-management education and support

Comprehensive self-management education should be provided at the time of diabetes diagnosis and subsequently as needed. The amount of education necessary depends on the needs of each individual and the complexity of the treatment regimen. Medicare and many health insurance companies pay for about 10 hours of initial education, including 3 hours of one-on-one medical nutrition therapy with a registered dietitian/registered dietitian nutritionist (RD/RDN) and annual follow-up education, including 2 hours of medical nutrition therapy with an RD/RDN each subsequent year. To be eligible for Medicare reimbursement, DSME must be provided through an accredited program. The content areas that need to be addressed are defined above.

Ongoing support is critical to implement and sustain the level of self-management needed to care for a person with diabetes over a lifetime. Although there is no definitive evidence to support specific frequencies of follow-up, frequency of reassessment should be based on the patient’s and the health care team’s perceptions of need. Medicare will cover 2 hours of prescribed follow-up education/training each year.

Services for people at risk for type 2 diabetes

Education and counseling to improve nutrition and increase physical activity are recommended for people with prediabetes. Provide access to an evidence-based program such as the Centers for Disease Control and Prevention (CDC)–recognized National Diabetes Prevention Program to support people in making lifestyle changes to improve nutrition, increase physical activity, and lose weight. These services are covered by some state Medicaid programs or commercial payers, and new payment structures via accountable care organizations may increase the provision of this preventive care.

Community-based and other resources

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Providing people with diabetes and prediabetes links to resources such as peers and community health workers, community-based health programs, and support groups can be beneficial. Consider using technology for assessment, instruction, monitoring, feedback, behavior change, coping strategies, and games or simulation experiences. More research is needed to determine the effectiveness of these technologies; however, many people with diabetes currently use them.

Resources

References

1. Heinrich E, Schaper NC, de Vries NK. Self-management interventions for type 2 diabetes: a systematic review. Eur Diabetes Nurs. 2010;7:71–6.

2. Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ. 2008;34:815–23.

3. Marrero DG, Ard J, Delamater AM, Peragallo-Dittko V, Mayer-Davis EJ, Nwankwo R, Fisher EB. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes. A consensus report. Diabetes Care. 2013;36:463–70.

4. Haas L, Maryniuk M, Beck J, et al. National standards for diabetes self-management education and support. Diabetes Care. 2014;37(S1):S144–53.

5. Boucher JL, Evert A, Daly A, et al. American Dietetic Association revised standards of practice and standards of professional performance for registered dietitians (generalist, specialty, and advanced) in diabetes care. J Am Diet Assoc. 2011;111(1):156–66.e1–27.​​