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Patient Self-Management

Self-management is a critical component of diabetes care and requires that patients be equipped with the proper skills and knowledge to largely manage their condition on their own. To support self-management skill development and maintenance among their patients with diabetes, primary care teams are encouraged to take advantage of opportunities before, during, and after visits; apply evidence-based strategies that enhance patient-provider communication and foster patient engagement and behavior change; and connect patients with other medical and community resources through a coordinated, planned approach. Care teams are also encouraged to routinely assess a patient’s diabetes self-management needs, skills, and interests, as well as associated factors that may serve as barriers (e.g., distress, depression, financial issues) or support mechanisms (family members, support groups, community resources). Validated assessment tools can help identify and assess changes in these factors, including diabetes-related distress,1 self-efficacy,2 self-care activities,3 and medication-taking behaviors.4

Recently, the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics published a position statement that reiterated the importance of diabetes self-management education. The position statement included an algorithm to guide primary care providers in referring patients for diabetes self-management education.5 Primary care providers are encouraged to rely on diabetes educators as members, or as an extension, of their diabetes care team who provide high-quality, standardized diabetes self-management education to patients. The services of diabetes educators can be integrated directly into the primary care setting, or practices can refer patients to an outpatient, community-based diabetes education program. Beyond the diabetes educator, primary care teams should explore ways to engage medical office staff, non-traditional practitioners, and community partners in reinforcing key messages related to optimal diabetes care and education.

Let the Evidence Guide You

This report provides primary care providers with an algorithm and guidance on when to refer patients to diabetes educators and others for diabetes self-management education and ongoing support.

Powers MA, Bardsley J, Cypress M, et al. Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care. 2015;38(7):1372-82.



The American Association of Diabetes Educators is an organization of professionals, including nurses, registered dietitian nutritionists, and pharmacists, who provide diabetes education to patients with or at risk for diabetes. To locate a Certified Diabetes Educator near you, go to Find a Diabetes Educator.

Tools You Can Use

Institute for Healthcare Improvement’s Partnering in Self-Management Support: A Toolkit for Clinicians provides tested resources and tools to support patients in day-to-day management of chronic conditions.

A variety of resources are available to help practices identify successful ways to integrate chronic disease self-management support techniques into their care.

References

1. Polonsky WH, Anderson BH, Lohrer PA, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754-60.
2. Anderson RM, Fitzgerald JT, Gruppen LD, Funnell MM, Oh MS. The Diabetes Empowerment Scale-Short Form (DES-SF). Diabetes Care. 2003;26(5):1641-2.
3. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-50.
4.Morisky DE, Ang A, Krousel-wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008;10(5):348-54.
5. Powers MA, Bardsley J, Cypress M, et al. Diabetes self-management education and support in type 2 diabetes: A joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care. 2015;38(7):1372-82.

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