Diabetes self-management education and support (DSMES) should not be an optional approach to diabetes management, according to Amy Hess-Fischl, MS, RDN, LDN, BC-ADM, CDCES, recipient of the ADA’s 2022 Outstanding Educator in Diabetes Award.
“DSME must be included in all models of diabetes care. It should be the standard-of-care for every person with diabetes,” said Hess-Fischl, who presented her award lecture, We Are the Champions, My Friends: Adventures in Diabetes Care and Education, on Saturday, June 4. The session was livestreamed and can be viewed on-demand by registered meeting attendees at ADA2022.org. If you haven’t registered for the 82nd Scientific Sessions, register today to access the valuable meeting content.
A career in diabetes care and education is not a job, it’s the adventure of a lifetime, said Hess-Fischl, Advanced Practice Dietitian, Diabetes Educator, and Program Coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicago Kovler Diabetes Center.
“Being a champion for people with diabetes and for their families can increase quality of life and improve outcomes throughout their adventures with diabetes,” she said. “The value of diabetes self-management education is too often understated. We all have a responsibility to say, again and again, ‘DSME for every patient, every time.’”
There’s ample data to support the psychological, social, personal, and clinical value of DSME, Hess-Fischl said, but repeated studies with similarly positive outcomes have not translated to broad utilization. Of individuals newly diagnosed with diabetes who have private health insurance, only 6.8% receive diabetes self-management training services within 12 months of diagnosis, Hess-Fischl reported, and just 5% of Medicare beneficiaries with newly diagnosed diabetes use diabetes self-management training services.
Utilization of medical nutrition therapy (MNT) is even worse. In 2018, 0.5% of Medicare beneficiaries with diabetes received initial MNT. That number fell to 0.4% in 2020 in the wake of COVID-19 restrictions.
“There are anecdotal reports that the approval of telehealth later in 2020 helped increase utilization slightly,” Hess-Fischl said. “Utilization is similar worldwide.”
ADA data published in 2021 indicated that 77.4% of people receiving DSMES experienced a decrease in A1C, with a mean decrease of 2%. DSMES recipients also experienced an 82% reduction in ER visits, an 84.4% decrease in hospital admissions, and 67.9% lost weight, Hess-Fischl said.
“We use DSMES here without the slash (DSME/S) that we’ve used elsewhere in this article. I know we’ve used it in this form in other articles, but maybe we should add the slash to keep it consistent here with the shortened DSME?”
Not every person with diabetes follows the same path, but all can benefit from DSMES, she added. The benefits of knowledgeable support are particularly important for adolescents with diabetes.
“If you take diabetes out of the equation, the teen years are already awkward enough,” Hess-Fischl said. “Adding a condition like diabetes just makes things that much more confusing and difficult.”
One of the important lessons she has learned during her career is to focus on the person, not the diabetes. Every individual has their own adventure with diabetes, with different needs and different strengths. Transitions can be a particularly difficult time, especially the move from adolescent to young adult care. Guidelines call for transition to occur at age 18.
“Focus on age-related responsibilities, starting at diagnosis,” Hess-Fischl advised. “The transition to adult care should come when the individual is ready, not at a specific age.”
Another key lesson: DSME is not a spectator sport. It’s a lifetime of involved learning and improving.
More than half of people with diabetes are not totally confident about their ability to meet DSME goals, she explained. Guidelines call for DSME at four key points: diagnosis, annually or when not meeting targets, when complications develop, and at transitions in life or care. When it comes to education and support, more is better, she said.
“It’s not a one-and-done proposition—it’s a continuous process,” Hess-Fischl said.