Self-management education critical to turn tide against diabetes


Powers reports receiving research funding from Abbott Nutrition, serving as a senior advisor for the American Diabetes Association’s Nutrition Interest Group and being a member of American Diabetes Association/American Heart Association Science Advisory Group for Know Diabetes by Heart. Please see the report for all other authors’ relevant financial disclosures.

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There may be 60.6 million Americans diagnosed with diabetes in 2060, up from 22.3 million in 2014, according to a consensus report issued by several medical societies.

Despite the rise in the prevalence of diabetes, there has been a lack of significant improvements in glycemic, BP, cholesterol level and smoking abstinence targets among patients with diabetes.

Margaret A. Powers

In the report, experts highlighted the importance of diabetes self-management education and support, or DSMES, defined as a “comprehensive blend of clinical, educational, psychosocial and behavioral aspects of care,” in improving patient outcomes. The report was developed by members of the American Diabetes Association, Association of Diabetes Care & Education Specialists, Academy of Nutrition and Dietetics, American Academy of Family Physicians, American Academy of PAs, American Association of Nurse Practitioners and American Pharmacists Association.

“We really need health care providers to prescribe diabetes self-management education,” Margaret A. Powers, PhD, RD, CDCES, lead author of the report and a registered dietitian and certified diabetes care and education specialist with HealthPartners, based in Minnesota, told Healio Primary Care.

Powers discussed clinical situations that warrant DSMES, the impact the program has on patients and more.

Q: When should primary care physicians discuss DSMES with patients?

A: There are four critical times: At diabetes diagnosis, annually or when treatment targets are not being met, when complicating factors develop such as a COVID-19 or cancer diagnosis or an injury that changes physical activity occurs and when transitions in life and care occur.

When someone is diagnosed with type 2 diabetes, they are typically prescribed medication. But diabetes management is more than just giving a pill. It is a whole package of interventions that empower people to make changes that they want to make but do not typically have the guidance or support needed to make them a reality. Therefore, it is better to consider DSMES, medical nutrition therapy and metformin therapy in tandem, rather than separately to address the patient’s individual behavioral, psychological and educational needs and improve their quality of life and health outcomes.

Q: How much of an impact does DSMES have on patient outcomes?


A: The success of any intervention with diabetes is often gauged by reductions in glycemic, BP, cholesterol level and smoking. Research shows that DSMES improves health outcomes and successfully addresses the other outcomes and dimensions of living with diabetes, resulting in improvements in quality of life, self-efficacy, healthy coping, knowledge, self-care behaviors, use of glucose monitoring and reductions in problems in managing diabetes, diabetes distress, the risk of long-term complications and emergency department visits, hospital admissions and hospital readmissions.

Q: What are some of the reasons or barriers that have hindered greater uptake of DSMES?

A: PCPs need to be more aggressive about referring patients to DSMES. Two of the seven recommendations in the report address two significant barriers: the lack of awareness of the many benefits of DSMES and the need for a referral. The recommendations state PCPs should discuss with all persons with diabetes the benefits and value of initial and ongoing DSMES and initiate referral to and facilitate participation in DSMES at the four critical times. If there are other barriers, PCPs, the health care team and health system should determine how to address them. The consensus report offers solutions to four categories of barriers.

Q: What ICD and/or CPT codes should PCPs use to help ensure they are reimbursed for providing DSME and/or medical nutrition therapy?

A: Medicare covers diabetes education and diabetes medical nutrition therapy. Many other health payers follow suit. The consensus report includes a lengthy list of billing codes that can be used by the health team to maximize their return on investment in diabetes care and education. Reimbursement is discussed in the consensus report and the billing codes are in the report’s Supplementary Table 2. The table is available in the journal, and for easy access it is at DiabetesEducator.org/consensusreport.

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