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DEFINITION

• Coordinated set of information and educational experiences which include learning outcomes and effective teaching strategies
• DSME (Diabetes Self Management Education) is a structured and continuous process of learning the knowledge and skills necessary for successful management of diabetes.
• In the U.S., a Certified Diabetes Educator (CDE) is a health care professional who has special training in diabetes education, completed 1000 hours of patient education in diabetes, and passed a standardized examination. Other countries are just beginning to develop their own CD programs.

EPIDEMIOLOGY

• 57% of adults in the US attended DSME (diabetes self management education) provided in outpatient clinical settings in 2007 (CDC).
• Taught by nurses, dieticians, pharmacists, doctors and counselors who have had instruction in diabetes management, preferably a CDE
• Emphasizes practical, problem solving skills, collaborative care, and strategies that sustain self management

CLINICAL TREATMENT

• Survival Skills adapted from Inpatient Management Guidelines for People with Diabetes http://www.healthways.com/WorkArea/DownloadAsset.aspx?id=381 (page 10).
• How and when to take medications: review timing (before or after meals), most common side effects; if taking insulin, review injection technique, storage, needle disposal
• How and when to monitor blood glucose or urine: how to use a glucometer or urine dipstick, write down results for clinician visit (ADA)
• Basics regarding meal planning: "healthy eating", categories of carbohydrate foods (handouts with pictures is very helpful), emphasize regularity and consistency of carbohydrate intake
• How to treat hypoglycemia: review symptoms, management; carry treatment (e.g. orange juice or sugar tablets) at all times (ADA)
• Sick day management: risk of hyperglycemia and need for increased insulin, monitor glucose frequently, urine test for ketones (ADA)
• Date and time of follow-up with clinician
• Information on how to obtain further diabetes education
• When to call for medical advice

• Diabetes: how it is diagnosed, basic disease mechanisms, risk factor management, and treatment options
• Nutrition: describe carbohydrate foods, distribution of carbohydrates using the plate method, reading labels; will need carbohydrate counting if taking insulin with meals
• Physical activity: aerobic versus resistance exercise, frequency recommended, how to adapt to physical limitations
• Medications: mode of action, side effects, how and when to take, proper storage
• Glucose monitoring: how to perform blood or urine testing, record results and use them to adjust food intake and activity; interpretation and use of hemoglobin A1c
• Preventive screening strategies including particular tests recommended and frequency
• Preventing, detecting and treating acute complications (DKA, hypoglycemia, hyperosmolar hyperglycemic syndrome): symptoms, treatment, when to seek medical attention
• Preventing, detecting and treating chronic complications (retinopathy, nephropathy, neuropathy, and cardiovascular disease): symptoms, treatment, when to seek medical attention
• Developing personal strategies to address psychosocial issues and concerns: lack of support and depression can be addressed in support groups including family or church members, social workers, or counselors.
• Developing personal strategies to promote health and behavior change: goal setting to clarify the change, peer support, and support groups can help maintain changes, family support for help with healthy meal planning, transportation to appointments, and maintaining needed medication.

FOLLOW UP

• Evaluate personal goals such as increasing frequency of exercise, or limiting unhealthy snacks. If not achieved, reevaluate; if achieved, set new ones but no more than two goals at a time.
• For learning content, give one page handout on a topic of interest or answer patient questions.

EXPERT COMMENTS

• Understanding diabetes helps patients and their families learn how to manage it successfully.
• Information can be overwhelming; cover topics on a need-to-know basis or in short 1-2 hour segments.
• Use visual aides (pictures, models) to make it interactive and fun or group activities (games, skits).
• Provide individual education if patients have unique needs (physical, learning, or social limitations), otherwise, group education is valuable for support and sharing ideas; support groups can also have an educational component.

Basis for Recommendations

• Sally-Anne S Duke2, Stephen Colagiuri3, Ruth Colagiuri1; Individual patient education for people with type 2 diabetes mellitus; Cochrane Database of Systematic Reviews,; 2009; Vol. Issue 3; pp.
  Rating: Basis for recommendation
  Comments:Review of the value of individual education
  
  
•  Funnell, M; Brown, T.;Childs,B.; Haas,L et al; National Standards for Diabetes Self-Management Education; Diabetes Care; 2008; Vol. S 97 - 104;
  Rating: Basis for recommendation
  Comments:Summary of ADA standards for education
  
  
• CDC; Age-Adjusted Percentage of Ever Attended Diabetes Self -Management Class for Adults >18 Years with Diabetes, United States, 2000 - 2007 ; www.cdc.gov/diabetes/statistics/preventative/fY_class.htm Behavior Risk Factor Surveillance System; 2007; Vol.
  Rating: Basis for recommendation
  Comments:Graph depicting adults attending DSMT
  
  
• Deakin TA, McShane CE, Cade JE, Williams R, ; Group based training for self management strategies in people with Type 2 diabetes mellitus.; Cochrane Database of Systematic Reviews; 2005; Vol. Issue 2; pp.
  Rating: Basis for recommendation
  Comments:Review of the value of group education
  
  
• American Healthways; Inpatient Management Guidelines for People with Diabetes; http://www.healthways.com/WorkArea/showcontent.aspx?id=322; 2004; Vol. p.10;
  Rating: Basis for recommendation
  Comments:List of Survival Skills on p. 10
  
  
• International Diabetes Foundation Consultative Section on Education; International Standards for Diabetes Education; 2003; Vol.
  Rating: Basis for recommendation
  Comments:Summary of International Diabetes Federation standard for diabetes education - very similar to ADA standards
  
  
• International Diabetes Foundation Consultative Section on Education; http://www.idf.org/Diabetes_Education;
  Rating: Basis for recommendation
  Comments:IDA diabetes curriculum - ready to use with power point slides, notes, and curriculum -
  
  

REFERENCES