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.