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Diabetes Self-management Education and Support in Adults with Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association

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posted on 15.07.2020 by Margaret A. Powers, Joan K. Bardsley, Marjorie Cypress, Martha M. Funnell, Dixie Harms, Amy Hess-Fischl, Beulette Hooks, Diana Isaacs, Ellen D. Mandel, Melinda D. Maryniuk, Anna Norton, Joanne Rinker, Linda M. Siminerio, Sacha Uelmen
Diabetes is a complex and challenging disease that requires daily self-management decisions made by the person with diabetes. Diabetes self-management education and support (DSMES) addresses the comprehensive blend of clinical, educational, psychosocial, and behavioral aspects of care needed for daily self-management and provides the foundation to help all people with diabetes navigate their daily self-care with confidence and improved outcomes (1,2).

The prevalence of diagnosed diabetes is projected to increase in the U.S from 22.3 million (9.1% of total population) in 2014, to 39.7 million (13%) in 2030, and to 60.6 million (17%) in 2060 (3). Approximately 90-95% of those with diabetes have type 2 diabetes (4). Diabetes is an expensive disease, and the medical costs of health care alone for a person with diabetes are 2.3 times more than for a person without diabetes (5). Confounding the diabetes epidemic and high costs, therapeutic targets are not being met (6). There is a lack of improvement in reaching clinical target goals since 2005 despite advancements in medication and technology treatment modalities. Indeed, between 2010 and 2016 improved outcomes stalled or reversed (6).

The goals of the consensus report are to improve clinical care and education services, to improve the health of individuals and populations, and to reduce diabetes-associated per capita health care costs (1,7). This paper is specifically directed towards health care providers (physicians, nurse practitioners, PAs), referred to herein as providers, as it outlines the benefits of DSMES; defines 4 critical times to provide and modify DSMES (see Figure 1); proposes how to locate DSMES related resources; and discusses potential solutions to access and utilization barriers. This report provides guidance to others as well: health systems and organizations can use this report to anticipate and address the needs of persons with diabetes and create access to DSMES services; persons with diabetes can increase their awareness of DSMES services as part of quality care and can advocate for self-management education and support; and payers and policy makers can work to design reimbursement processes that support participation in DSMES. The consensus report’s recommendations are listed in Table 1.

Funding

This activity was funded by the American Diabetes Association and the Association of Diabetes Care and Education Specialists.

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