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Guidelines published by the American Association for Diabetes Educators in 2009 suggested that there should be universal access to diabetes self-management education or “DSME”.
 
•All patients should have access to diabetes self-management education (DSME)
•Focus primarily on supporting behaviors that promote self-management
•Follow a 5-step process
•Delivered by competent, prepared
     personnel
•Barriers:
Lack of awareness, reimbursement,
     staffing, inconsistencies in
     licensure, resistance to change
 
This recommendation has a high grade (grade A) for the evidence that supports it. The AADE guidelines further state that the focus of DSME should be on supporting the types of behaviors that will promote successful self-management and follow a 5-step process, which includes assessment, goal setting, planning, implementation, and evaluation/follow-up. The AADE guidelines offer recommendations for each of the 5-step activities according to the level of personnel who will be handling it, from level 1 (non-healthcare professionals) to level 5 (advanced level diabetes educator or clinical manager).
While education and training on diabetes self-management has been associated with better adherence and outcomes and has been described as a cost-effective component of care, there are several barriers to the implementation of the guidelines, including a lack of public awareness about the severity of diabetes and the importance of self-management, lack of reimbursement and coverage limitations, lack of staffing and resource allocation in both clinical and community settings, practice constraints and inconsistencies in licensure from state to state, and resistance to change because of the complexity to accommodate this guideline through adjusting staff, workflow, role delineation, and budgets.

http://www.guidelines.gov/summary/summary.aspx?doc_id=14696

 

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