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Guidelines for the practice of diabetes education.
Best practices for diabetes education includes families, patients and health care providers. Here is some of the latest research on effective diabetes education solutions.
Following are excerpts from in-depth information about research regarding diabetes education that is provided through The National Guideline Clearinghouse™ (NGC) . Read more at their website
Cost Analysis
The annual direct and indirect costs associated with diabetes and its complications are estimated to be $174 billion.
Large controlled clinical trials have demonstrated that intensive treatment of diabetes can significantly decrease the development and/or progression of the complications of diabetes. Studies differ on intensive management of all risk factors, including lipids, blood pressure, and glycemia, had significant beneficial effects on cardiovascular-related deaths. This intensive therapy also was found to be cost-effective in primary practice settings.
A number of studies have reported findings that strongly support cost reduction as a benefit of diabetes education.
Potential Benefits
Improved patient outcomes through successful diabetes self-management
Addressing Potential Barriers to Implementation of These Guidelines
The AADE recognizes that implementation of the recommendations included in these guidelines may be affected by barriers to the delivery of DSME/T at the patient, practitioner, organizational, or societal level. These barriers may include:
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Lack of public awareness regarding the severity of diabetes and the importance of DSME/T
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Inadequate and/or lack of reimbursement and coverage limitations relevant to DSME/T
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Inadequate and/or lack of staffing and resource allocation within clinical and community settings
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Practice constraints regarding licensure and inconsistencies from state to state
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Institutional resistance to change (e.g., need to adjust staffing, workflow, role delineation, budgets)
A recent claims data analysis supports the use of diabetes education and training as a cost-effective component of quality care for all persons with diabetes. Although it is beyond the scope of this document to address the financial and organizational barriers identified, AADE is actively working with local, state, and federal policy makers to resolve these issues and expand access to DSME/T for all persons with diabetes. Further, AADE has developed education resources and tools to assist DSME/T providers in integrating the AADE7™ framework into their practices. These resources and tools are available on the AADE website (www.diabeteseducator.org/ProfessionalResources  ).
Patient Resources
The following is available:
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Side by side: a partner approach to diabetes self care. Chicago (IL): American Association of Diabetes Educators (AADE); 16 p. Electronic copies: Available in English and Spanish from the American Academy of Diabetes Educators Web site .
Additional patient resources, including handouts, videos, pamphlets, and a patient-focused blog are available from the American Academy of Diabetes Educators Web site .
Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.
Summary of Recommendations
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All patients with diabetes should have access to diabetes self-management education and training. (A)
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Diabetes self-management education and training should focus primarily on supporting behaviors that promote effective self-management as described in the AADE7™ Self-Care Behaviors. (B)
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Diabetes self-management education and training should follow a comprehensive 5-step process that includes: assessment, goal-setting, planning, implementation, and evaluation. (C)
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Diabetes self-management education and training should be delivered by individuals who are prepared and competent. (A)
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People who deliver diabetes education and care services should function within the practice level articulated in these guidelines. (D)
Table. General Scope of Diabetes Educational/Clinical Care Activities
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Level 1
Non-Healthcare Professional |
Level 2
Healthcare Professional Non-Diabetes Educator |
Level 3
Non-Credentialed Diabetes Educator |
Level 4
Credentialed Diabetes Educator* |
Level 5
Advanced Level Diabetes Educator/Clinical Manager**(non-Rx with Protocols or Rx) |
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Assessment |
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Follow office or hospital protocol for patient intake
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Verify basic literacy/numeracy
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Provide support and basic information/guidance for accessing care
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Follow office or hospital protocol for patient intake
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Measure vital signs (VS), anthropometrics
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Verify basic literacy/numeracy
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Provide support and basic information/guidance for accessing care
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Assess family and community support system
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Assess cultural barriers to self care or behavior change
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Assess availability of healthy food choices and community resources for engagement in physical activity
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Assess basic diabetes mellitus (DM) skills/knowledge of diabetes and literacy/numeracy
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Assess for motivation and readiness to learn and make behavior changes
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Assess attitude toward learning and preferred learning style
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Assess impact of social, economic and cultural aspects/circumstances
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Identify potential barriers to behavior change, including: cognitive and physical limitations, literacy, lack of support systems, negative cultural influences
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Screen for acute and long term complications
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Assess basic DM skills/knowledge of diabetes and literacy/numeracy
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Assess impact of social, economic and cultural aspects/circumstances
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Assess for motivation and readiness to learn and make behavior changes
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Assess attitude toward learning and preferred learning style
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Identify potential barriers to behavior change, including: cognitive and physical limitations, literacy, lack of support systems, negative cultural influences
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Perform clinical assessment, including relevant lab values
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Perform physical assessment, including signs of malnutrition and anthropometrics
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Assess for food/drug interactions
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Assess for use of over the counter (OTC) medications and supplements
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Assess for diabetes-specific and related medication use (i.e., insulin-to-carb ratios)
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Assess for psychosocial adjustment, including coping strategies and eating disorders
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Make discipline-specific diagnosis, as appropriate
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Assess basic DM skills/knowledge of diabetes and literacy/numeracy
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Assess impact of social, economic and cultural aspects/circumstances
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Assess for motivation and readiness to learn and make behavior changes
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Assess attitude toward learning and preferred learning style
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Identify potential barriers to behavior change, including: cognitive and physical limitations, literacy, lack of support systems, negative cultural influences
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Perform clinical assessment, including relevant lab values
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Perform physical assessment, including signs of malnutrition and anthropometrics
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Assess for food/drug interactions
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Assess for use of OTC medications and supplements
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Assess for diabetes-specific and related medication use (i.e., insulin-to-carb ratios)
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Assess for psychosocial adjustment, including coping strategies and eating disorders
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Make discipline-specific diagnosis and/or prescribe, as appropriate
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Goal Setting |
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Increase intake of vegetables and fruit
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Increase leisure time physical activity
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Identify community resources
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Guide patient in setting individualized behavioral goals
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Guide patient to prioritize goals based upon assessment and preference
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Develop success metrics
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Guide patient in setting individualized behavioral and clinical goals to address needs identified in all areas of the assessment
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Guide patient to prioritize goals based upon assessment and preference
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Develop success metrics
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Use behavior change methodology (motivational interviewing [MI], cognitive therapy, etc.) to ensure and influence patient participation in the education process
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Guide patient in setting individualized behavioral and clinical goals to address needs identified in all areas of the assessment
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Guide patient to prioritize goals based upon assessment and preference
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Develop success metrics
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Use behavior change methodology (MI, cognitive therapy, etc.) to ensure and influence patient participation in the education process
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Planning |
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Follow prescriber's orders and diabetes educator's guidance
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Follow prescriber's orders and certified diabetes educator (CDE) guidance for plan
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Develop basic plan related to acquiring necessary DM skills based on needs identified in assessment
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Develop an educational plan to address behavioral goals established in the goal setting process
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Develop a learning plan to address gaps in knowledge
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Plan strategies for addressing barriers identified
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Refer to prescriber as needed
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Develop a detailed intervention plan to address both clinical and behavioral goals established in the goal setting process
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Develop a learning plan to address gaps in knowledge
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Plan strategies for addressing barriers identified
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Follow protocols and/or refer to specialist as needed; prescribe as appropriate
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Implementation |
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Offer guidance on accessing care and financial issues (reimbursement)
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Refer to prescriber or CDE as needed
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Suggest/support/assist with DM skill training; offer guidance on accessing care and financial issues (reimbursement)
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Refer to prescriber or CDE as needed
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Provide culturally appropriate basic health information
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Organize community advocacy activities
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Explain procedures
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Assist with skill development
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Suggest/support DM skill training; offer guidance on accessing care and financial issues (reimbursement)
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Refer to prescriber or CDE as needed
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Recommend and execute plan; insure patient has the knowledge, skills and resources necessary to follow through on the plan
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Identify and address barriers that become evident throughout the process
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Recommend and execute plan; insure patient has the knowledge, skills and resources necessary to follow through on the plan
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Prescribe as appropriate
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Identify and address barriers that become evident throughout the process
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Evaluation/ Follow-Up |
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Monitor adherence
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Report assessment findings to prescriber and diabetes educator (DE)
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Monitor adherence
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Report assessment findings to prescriber and DE
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Healthcare utilization
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Refer for diabetes self care education
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Re-assess cognition of goals and plan
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Monitor adherence
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Refer to prescriber or CDE as needed
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Re-assess cognition of goals and plan
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Re-assess clinical and behavioral goal achievement at each visit
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Re-assess and revise plan and goals
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Re-assess cognition/reevaluate knowledge and skills
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Monitor adherence to plan
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Refer to prescriber or others as needed
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Re-assess cognition of goals and plan
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Re-assess clinical and behavioral goal achievement at each visit
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Re-assess and revise plan and goals
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Re-assess cognition/re-evaluate knowledge and skills
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Monitor adherence to plan
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Follow protocols or prescribe
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Refer to other specialists as appropriate
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*It is recognized that some healthcare professionals who are Level 2 or 3 educators may undertake elements of Diabetes Self-Management Education and Training (DSME/T) that are identified in Level 4, however, these practitioners lack nationally recognized certification in diabetes self-management education.
**Includes but not limited to board certification in advanced management (BC-ADM) and Advanced Practice Nurse
Edited by Carolyn Allen, Managing Editor of Solutions For Green
Publication Date:
5/27/2011
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