People with diabetes mellitus can often feel alone and overwhelmed by all that is needed to manage diabetes. The reality is that millions of people are available to help provide education and resources and they should be considered part of their own healthcare team.
The traditional approach to patient care was to see the patient as sick and helpless, forced to be compliant with the prescribed medical regimen. A new era has refreshingly changed the paradigm to patient-centered, with all efforts to help increase self-management using the resources and tools provided by the team. The ADA has, in fact, declared the focus of diabetes education to be self-management, not mere compliance with a physician.
Team members include the primary care provider, nurses, diabetes educators, dieticians, podiatrists, optometrists, pharmacists, social workers, and more. The diabetes patient is the day-to-day disease manager on the team. For example, a licensed nurse with special training and education can teach each patient how to check daily BG levels, how to take medications, and how to care for injuries and wounds. A dietician can help the patient learn how to plan a healthy and manageable nutrition plan based on their culture, food preferences, and economic limitations.
In addition, a patient with diabetes should see an ophthalmologist or optometrist for an annual dilated eye exam. The patient should have regular dental exams. Kidney, artery, or foot problems should be monitored by the appropriate specialists. If the patient is having psychological or mood problems, a mental health professional should be involved (ADA 2015). The patient should be referred to a certified diabetes educator, who is a health professional devoted to helping the patient achieve self-care behaviors and positive behavioral change toward health. Each of these professionals is a part of the whole patient team.
Diabetes self management education (DSME) is focused on behavior change. A critical part of caring for people with diabetes is teaching them the overall treatment plan and how to care for themselves (ADA, 2015). People with diabetes have better outcomes when they understand their disease and have the skills and coaching to manage their lives so as to keep their BG levels as close to normal as possible (Strine, 2005). Those people who have not received formal diabetes self-management education have knowledge gaps, don’t receive preventive services, and are more prone to develop chronic complications (Kent, 2013; Strine, 2005).
Certified diabetes educators (CDEs) have additional education and training regarding diabetes mellitus and are generally covered under insurance benefits. A certified diabetes educator (CDE) is a nurse, pharmacist, physician, social worker, or dietician who must take a certifying exam after 1,000 qualifying hours of working in diabetes education. Advanced practice nurses, physicians, those with prescribing abilities, and those who have a master’s degree in diabetes education may choose to take the board certification exam to earn the BC-CDE designation, which focuses on management of diabetes. Public health workers, health coaches, and non-certified diabetes educators, such as dieticians and nurses without the certification, can be a tremendous support in promoting behavior change.
The ADA and the American Association of Diabetes Educators (AADE) have developed similar DSME programs that includes focus on seven topics and self-care behaviors:
- Healthy eating
- Physical activity
- Medication management
- Problem solving
- Reducing risks of acute and chronic complications
- Psychosocial aspects of living with diabetes.
The AADE has coined them the AADE7 self-care behaviors. An ADA-approved diabetes self-management educational program focuses on empowering the person with diabetes to achieve the following:
- Understand the basics of diabetes and its treatment
- How to plan nutritious meals
- How to incorporate physical exercise into daily life
- The importance of smoking cessation
- How to take diabetes medicines properly and safely
- How to prevent, recognize, and cope with acute complications of diabetes
- How to prevent, recognize, and cope with chronic complications of diabetes
- How to prevent, recognize, and cope with social and psychological difficulties caused by diabetes
- Stress management
Click here for an online resource of the National Certification Board for Diabetes Educators.